Dossier n. 234/2013 [Abstract] Surveillance of antimicrobial resistance and consumption of systemic antibiotics in Emilia-Romagna. Report 2011

The regional surveillance of antibiotic resistance in Emilia-Romagna provides data from 2003. In recent years there has been an alarming increase in bacterial resistance, particularly among Gram-negative bacteria, which is considered a public health emergency by the World Health Organization (WHO, 2012). The phenomenon of multidrug resistance has increased remarkably in this group of microorganisms due to the diffusion of extended-spectrum beta-lactamase (ESBL) and, more recently, of carbapenemases. These are especially dangerous because infections caused by micro-organisms that produce them (mainly belonging to the species Klebsiella pneumoniae), are difficult to treat. To cope with the worsening trend, the Agenzia sanitaria e sociale regionale dell’Emilia-Romagna (ASSR) has started a project for the control of carbapenemase-producing Enterobacteriaceae (CPE) in hospitals and in the community with the participation of the Regional Department of health and of all local health authorities in the region (Gagliotti et al., 2011, 2012a; Ragni et al., 2011). Among other Gram-negatives with a high prevalence of antibiotic resistance, must be mentioned Pseudomonas aeruginosa and Acinetobacter baumannii. The trend of the resistance of the most common Gram-positive (Staphylococcus aureus, Enterococcus faecalis and Streptococcus pneumoniae), are stable. For Enterococcus faecium has instead observed a reduction of the resistance to vancomycin.

In addition to providing data on antimicrobial resistance, the regional surveillance system has quantified the increase in incidence rates of bacteremia that, during the period 2005-2011, raised from 146 to 228 cases per 100.000 inhabitants/year (+56%). The increase was particularly significant for K. pneumoniae (+188%) and Escherichia coli (+99%).

The consumption of systemic antibiotics, evaluated by regional databases, shows significant increases until 2009; subsequently, the increasing trends are recorded only for hospitals (90.8 DDD/100 in hospital-days in 2011) while there is a decrease in community consumption (18.4 DDD/1.000 inhabitants-day in 2011). The most commonly used antibiotics are penicillins combined with beta-lactamase inhibitors, followed by fluoroquinolones and macrolides in the hospitals and in the community, respectively.

Considering the increasing spread of bacterial resistance and the simultaneous slowdown of pharmaceutical research in this area, the appropriate use of antibiotics has become a priority for health systems. It is the only means, together with the measures to control the spread of resistant microorganisms, for defending the great health benefits that these drugs provide to modern medicine.