Major discrepancy between factual antibiotic resistance and consumption in South of France: analysis of 539,037 bacterial strains

Abstract

AbstractIntroductionThe burden of antibiotic resistance is currently estimated by mathematical modeling, without real count of resistance to key antibiotics. Here we report the real rate of resistance to key antibiotics in bacteria isolated from humans during a 5 years period in a large area in southeast in France.MethodsWe conducted a retrospective study on antibiotic susceptibility of 539,107 clinical strains isolated from hospital and private laboratories in south of France area from January 2014 to January 2019. The resistance rate to key antibiotics as well as the proportion of bacteria classified as Difficult-to-Treat (DTR) were determined and compared with the Mann-Whitney U test, the χ2 test or the Fisher’s exact test.ResultsAmong 539,037 isolates, we did not observe any significant increase or decrease in resistance to key antibiotics for 5 years, (oxacillin resistance inStaphylococcus aureus, carbapenem resistance in enterobacteria andPseudomonas aeruginosaand 3rdgeneration cephalosporin resistance inEscherichia coliandKlebsiella pneumoniae). However, we observed a significant decrease in imipenem resistance forAcinetobacter baumanniifrom 2014 to 2018 (24.19% to 12.27%; p=0.005) and a significant increase of ceftriaxone resistance inKlebsiella pneumoniae(9.9% to 24,03%; p=0.001) andEnterobacter cloacae(24,05% to 42,05%; p=0.004). Of these 539,037 isolates, 1,604 (0.3%) had a DTR phenotype.ConclusionOver a 5-year period, we did not observe a burden of AR in our region despite a high rate of antibiotic consumption in our country. These results highlight the need for implementation of real-time AR surveillance systems which use factual data.