Antimicrobial utilization and resistance in Pseudomonas aeruginosa using segmented regression analysis: a comparative study between Serbia and eight European Countries

Abstract

Background In Europe, Serbia occupies a high position in antibiotic utilization and antimicrobial resistance (AMR). Aim The aim was to analyse utilization trends of meropenem, ceftazidime, aminoglycosides, piperacillin/tazobactam and fluoroquinolones (2006–2020), and the reported AMR in Pseudomonas aeruginosa (2013–2020) in Serbia and to compare with data from eight European countries (2015–2020). Method Joinpoint regression was used to analyse antibiotic utilization data (2006–2020) and the reported AMR in Pseu- domonas aeruginosa (2013–2020). Data sources were relevant national and international institutions. Antibiotic utilization and AMR in Pseudomonas aeruginosa data in Serbia were compared with eight European countries. Results There was a significantly increased trend for ceftazidime utilization and reported resistance in Pseudomonas aer- uginosa, Serbia (p < 0.05) (2018–2020). For ceftazidime, piperacillin/tazobactam, and fluoroquinolones resistances in Pseu- domonas aeruginosa an increased trend was observed, Serbia (2013–2020). A decrease in both the utilization of aminogly- cosides, Serbia (p < 0.05) (2006–2018) and contemporaneous Pseudomonas aeruginosa resistance (p > 0.05) was detected. Fluoroquinolone utilization (2015–2020) was highest in Serbia compared to Netherlands and Finland, 310 and 305% higher, similar compared to Romania, and 2% less compared to Montenegro. Aminoglycosides (2015–2020) were 2550 and 783% more used in Serbia compared to Finland and Netherlands, and 38% less regarding Montenegro. The highest percentage of Pseudomonas aeruginosa resistance was in Romania and Serbia (2015–2020). Conclusion The use of piperacillin/tazobactam, ceftazidime and fluoroquinolones should be carefully monitored in clinical practice due to increased Pseudomonas aeruginosa resistance. The level of utilization and AMR in Pseudomonas aeruginosa is still high in Serbia compared to other European countries.