Evaluating the Role of Antimicrobial Resistance Surveillance: A Successful Intervention: Evidence from Hamad Medical Corporation–Qatar | Chapter 6 | Microbiology and Biotechnology Research: An Overview Vol. 4

 

Antibiotic resistance is an increasing global problem. Excessive and inappropriate antimicrobial use results in strong selective pressure that facilitates the emergence of antimicrobial-resistant pathogens. The intensive care units are epicentres for the emergence of antibiotic-resistant gram-negative bacteria because of the high use of antibiotics, prolonged hospital stay, reduced patient immunity, use of medical devices, and the frequent contact between healthcare workers and patients. Surveillance of bacterial resistance is the key element to understand the size of the problem, drive interventions, and measure the effect of these measures. Several reports have linked the use of third-generation cephalosporins with β-lactam resistance in gram-negative bacteria. Several strategies were introduced by the Antibiotic Stewardship Programs to reduce antibiotic resistance, but the efficacy of these interventions is not well studied. The Microbiology Laboratory of Hamad Medical Corporation (HMC) monitors antimicrobial resistance by continuous surveillance using the National Committee for Clinical Laboratory Standards (NCCLS) - currently Clinical Laboratory Standards Institute Interpretive Criteria (CLSI). Surveillance data were released annually and shared with clinicians and policymakers for review of the antibiotic policy and the antibiotic formulary. Several measures were taken, including antibiotic cycling, antibiotic rotation and restriction.

 

Surveillance data in 2001 showed high-level β-lactam antibiotic resistance and high-level production of extended-spectrum β-lactamases (ESBL) among gram-negative bacteria. As a result, the Hospital Antibiotic Policy Committee decided to withdraw ceftazidime, a third–generation cephalosporin known to be a strong inducer of ESBL, from the hospital formulary. Subsequent resistance surveillance over the following three years in the Medical Intensive Care unit (MICU) demonstrated a gradual drop in the resistance of Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli; the commonest isolated gram-negative bacteria from MICU, not only to third and fourth generation cephalosporins, but also to Piperacillin–Tazobactam in spite of the increased use of the latter drug in the MICU.

 

The study concludes that the selection of resistance is an inevitable consequence of antibiotic usage. Regular surveillance of antimicrobial resistance is essential not only for detecting and monitoring resistance development but also for ensuring that the information gathered is effectively used to guide empirical therapy and inform strategic interventions to prevent the emergence and spread of resistance.

 

Author(s) Details

Elshafie Sittana Shamseldin
Aspetar, Qatar Orthopedic and Sports Medicine Hospital, Doha, Qatar.

Al-Khal A/Latif
Hamad Medical Corporation, Doha, Qatar.

 

A Maslamani Muna
Hamad Medical Corporation, Doha, Qatar.

Al Janahi Mohammed
Hamad Medical Corporation, Doha, Qatar.

 

Alamri Zainab
Medical Military Specialized Center, Qatar.

 

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