Cross-resistance to antibiotics of Escherichia coli in the inpatient installation of general regional hospital “X” Bali, Indonesia

Abstract

Escherichia coli (E. coli) is a critical-priority group of Multidrug-resistant (MDR) bacteria and its spread can occur in hospital inpatient settings. Several studies showed that antibiotics consumption for inpatients can cause E. coli resistance to other antibiotics called cross-resistance. The aim of this study to determine the cross-resistance in E. coli to antibiotics in the inpatient installation of the regional general hospital "X" in Bali, Indonesia.This study was a non-experimental ecological study that utilized retrospective data from the inpatient installation databases at general hospital "X" in Bali, Indonesia. The independent variable is the antibiotics consumption defined as defined daily doses/100 bed-days and the dependent variable is the percentage of E. coli resistance during 2017-2020. To examine the presence of cross-resistance in E. coli, an analysis of the correlation between antibiotic usage and the percentage of E. coli resistance to different antibiotics will be performed. The Pearson correlation tests were used to analyze the correlation between the level of antibiotic consumption and the percentage of E. coli resistance to antibiotics. The results indicated a significant correlation between tetracycline consumption and increased resistance of E. coli to both meropenem and piperacillin-tazobactam (r=0.8-1.0; p<0.05). This showed that there is cross-resistance in E. coli. Tetracycline significantly correlates with increased E. coli resistance to meropenem and piperacillin-tazobactam. This suggests that the level of use of one antibiotic can influence E. coli's resistance to other antibiotics. Keywords: Defined Daily Dose (DDD), Escherichia coli (E. coli), gene transfer, selection pressure