Association between antimicrobial resistance among Enterobacteriaceaeand burden of environmental bacteria in hospital acquired infections:analysis of clinical studies and national reports

Abstract

Background:WHO has named three groups of gram-negative bacteria“our critical antimicrobial resistance-relatedproblems globally”. It is thus a priority to unveil any important covariation of variables behind this three-headedepidemic, which has gained alarming proportions in Low Income Countries, and spreads rapidly. Environmentalbacteria including Acinetobacter spp. are common nosocomial pathogens in institutions that have high rates ofantimicrobial resistance among other groups of gram-negative bacteria.Methods:Based on two different data sources, we calculated the correlation coefficient (Pearson'sr) betweenpathogenic burden of Acinetobacter spp. and antimicrobial resistance among Enterobacteriaceae in European andAfrican nosocomial cohorts.Clinical reports:Database search for studies on nosocomial sepsis in Europe and Africa was followed by a PRISMA-guided selection process.National reports:Data from Point prevalence survey of healthcare-associated infections published by EuropeanCentre for Disease Prevention and Control were used to study the correlation between prevalence of Acinetobacterspp. and antimicrobial resistance amongK. pneumoniaein blood culture isolates.Findings:The two approaches both revealed a strong association between prevalence of Acinetobacter spp. andrates of resistance against 3. generation cephalosporins among Enterobacteriaceae. In the study of clinical reports(13 selected studies included),rwas 0.96 (0.80–0.99) when calculated by proportions on log scale. Based onnational reports,rwas 0.80 (0.56–0.92) for the correlation between resistance rates ofK. pneumoniaeand pro-portion of Acinetobacter spp.Interpretation:The critical antimicrobial resistance-related epidemics that concern enteric and environmentalgram-negative bacteria are not independent epidemics; they have a common promoting factor, or they aremutually supportive. Further, accumulation of antimicrobial resistance in nosocomial settings depends on thetherapeutic environment. Burden of Acinetobacter spp. as defined here is a candidate measure for this dependence