Aim: The aim of this study was to determine quantities of antibiotics used mainly or exclusively for urinary tract infections in Croatia between 2005 and 2014, to describe utilisation trends, and general consequences of antibiotic consumption on antimicrobial resistance.
Methods: Antibiotic utilisation data were obtained from annual reports of both the Croatian Drug Agency and Croatian Academy of Medical Sciences. Antibiotic consumption was expressed in DDD/1000 inhabitants/day (DDD TID). Antimicrobial resistance was analysed for E. coli, E. faecalis, E. faecium, P. aeruginosa, Klebsiella spp., P. mirabilis. Descriptive statistics were used to process data and calculate trends.
Results: Overall, utilisation of antibacterials decreased by 4.8% (from 3,35 to 3,19 DDD TID), while trends of individual agents varied substantially - from 87% decline for ceftibuten to 160% rise for levofloxacin. The consumption of quinolones increased by 32.3%. This was mostly due to increased ciprofloxacin consumption (144% raise). Sulfamethoxazole-trimethoprim declined by 57%, while nitrofurantoin increased by 86%. The use of fosfomycin was marginal. Antimicrobial resistance of E. coli increased against quinolones by 54.5%, and against nitrofurantoin by 2-3%. Quinolone resistance of other pathogens (Klebiella spp, Proteus mirabilis), increased variably - between 17.2% (Klebsiella) and 90% (Proteus), while for P. aeruginosa remained the same at 22%.
Conclusion: High rates of antimicrobial utilisation require prescribing restrictions and educational interventions. The increased use of fluoroquinolones is a potentially serious public health threat due to the rapid development of resistance among uropathogens. This threat can be avoided by greater use of nitrofurantoin and fosfomycin.
Cilj: Cilj te študije je ugotoviti količino antibiotikov, ki so bili porabljeni za okužbe sečil na Hrvaškem med leti 2005 in 2014 in prikazati trende porabe in njene posledice glede odpornosti mikrobov na zdravila.
Metode: Podatki o porabi antibiotikov izhajajo iz letnih poročil hrvaške agencije za zdravila in hrvaške akademije medicinskih znanosti. Poraba antibiotikov je izražena v obliki DDD/1000 prebivalcev/dan (DDD TID). Odpornost mikrobov na zdravila je analizirana za E. coli, E. faecalis, E. faecium, P. aeruginosa, Klebsiella spp., P. mirabilis. Za obdelavo podatkov in izračun trendov je uporabljena opisna statistika.
Rezultati: Splošna poraba antibiotikov se je zmanjšala za 4,8 % (iz 3,35 na 3,19 DDD TID), medtem ko so se trendi porabe posameznih zdravil občutno spreminjali – od upada v višini 87 % za ceftibuten do dviga za 160 % za levofloksacin. Poraba kinolonov se je zvišala za 32,3 % predvsem zaradi povišane porabe ciprofloksacina (dvig za 144 %). Poraba trimetoprim sulfametoksazola (kotrimoksazola) se je zmanjšala za 57 %, medtem ko se je poraba nitrofurantoina povišala za 86 %. Odpornost mikroba E. coli na kinolone se je zvišala za 54,5 %, na nitrofurantoin pa za 2–3 %. Odpornost na kinolone pri drugih patogenih (Klebiella spp, Proteus mirabilis) se zvišuje spremenljivo, in sicer med 17,2 % (Klebsiella) in 90 % (Proteus), vrednost pa je ostala enaka pri patogenu P. aeruginosa, in sicer 22 %.
Zaključek: Visoka poraba antibiotikov zahteva omejitve predpisovanja zdravil in izobraževanje populacije. Zaradi hitrega razvoja odpornosti pri uropatogenih predstavlja povišana poraba fluorokinolonov grožnjo javnemu zdravju. Tej grožnji se lahko izognemo z večjo porabo nitrofurantoina in fosfomicina.
Keywords: antibiotics; bacterial resistance; urinary tract infections; utilisation trends.