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Surveillance of carbapenem-resistant Klebsiella pneumoniae in Chinese hospitals - A five-year retrospective study.

INTRODUCTION
Antibiotic consumption is associated with the development of antibiotic resistance. Our aim was to study the relationship between antibiotic consumption and carbapenem-resistant Klebsiella pneumoniae (CRKP) in three public general tertiary hospitals from 2011-2015 in the eastern, western and central regions of China.


METHODOLOGY
Valid data were collected quarterly, and the antibiotic consumption data were expressed as the defined daily dose (DDD) per 100 inpatient days (ID). Bacterial resistance was reported as the percentage of resistant isolates among all tested isolates. Individual trends were calculated by linear regression, while possible correlations between antibiotic consumption and CRKP were evaluated by distributed lags time series analysis.


RESULTS
Over the 5-year period, an overall significant increasing trend (P < 0.1, R2 > 0.3) of carbapenems consumption and the prevalence of CRKP was observed in all three hospitals. This correlated with the use of ceftazidime, cefoperazone/sulbactam, cefminox and meropenem at a hospital in eastern China, with the increased use of meropenem at a hospital in eentral China and with the increased use of doxycycline, ceftriaxone, ceftazidime, meropenem and biapenem at a hospital in western China.


CONCLUSIONS
We report a high incidence of CRKP in all three hospitals and that an increase in carbapenem usage is associated with this. Further research is needed to elucidate which factors influence the increased consumption of carbapenems.