Antibiotic consumption as a driver for resistance in Staphylococcus aureus and Escherichia coli within a developing region

Am J Infect Control. 2010 Apr;38(3):212-6. doi: 10.1016/j.ajic.2009.07.010. Epub 2009 Nov 8.


Background: This study aimed to provide insight into possible antibiotic drivers of methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli resistant to third-generation cephalosporins (3GCREC) in southern and eastern Mediterranean institutions.

Methods: MRSA and 3GCREC susceptibility proportions from 19 regional hospitals, previously published by the ARMed project, were correlated with antibiotic use data from the same institutions.

Results: Hospitals reporting below-median MRSA proportions had significantly lower total antibiotic use. MRSA proportions increased with greater use of carbapenems (P=.04). In multivariate analysis, a positive correlation was identified with the use of carbapenems (P=.002), combination penicillins (P=.018), and aminoglycosides (P=.014). No difference was ascertained between 3GCREC proportions and total antibiotic use. In multivariate linear regression, a correlation was identified only for 3GCREC (P=.005), but a negative association was evident for beta-lactamase-resistant penicillins (P=.010) and first-generation cephalosporins (P=.012).

Conclusions: The results suggest an association between resistance and antibiotic use, especially for carbapenems and third-generation cephalosporins. These data support the urgent implementation of antibiotic stewardship initiatives in hospitals in developing countries that focus on more judicious use of broad-spectrum formulations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Developing Countries
  • Drug Resistance, Bacterial*
  • Drug Utilization / statistics & numerical data*
  • Escherichia coli / drug effects*
  • Escherichia coli / isolation & purification
  • Humans
  • Mediterranean Region
  • Microbial Sensitivity Tests
  • Prevalence
  • Staphylococcus aureus / drug effects*
  • Staphylococcus aureus / isolation & purification


  • Anti-Bacterial Agents