203. Are Cultural Determinants related with the Use of Antibiotics and Emergence of Multidrug Resistant Microorganisms?
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
  • IDSA2015_Cultura_Poster.pdf (960.4 kB)
  • Background: There is a great variation in the use of antibiotics and the emergence of resistant pathogens between different countries. In that sense, some cultural patterns have been associated with MRSA prevalence in European countries. The aim of this study was to validate the relationship between cultural dimensions and the use of antibiotics and the prevalence of antimicrobial resistance in different countries and scenarios

    Methods: Countries were classified according two particular dimensions (Hofstede et al. Cultures and organizations: software of the mind. New York: McGraw-Hill; 2010): Power Distance Index (PDI), related to the extent to which the less powerful members of organizations accept that power is distributed unequally, and Uncertainty Avoidance Index (UAI) related to what extent a society tolerates uncertainty and ambiguity. While a high PDI has been associated with failures in the effective implementation of infection prevention and control (IPC) and empowerment initiatives, a high UAI has been related with higher use of antibiotics. These dimensions were stratified as high, medium and low index. These data were compared with the Defined Daily Doses (DDD) per 1,000 inhabitants of penicillin and fluoroquinolone in 17 European countries (Emerging Infectious Diseases. 2008; 14(11): 1722-1730). A second comparison was performed with the prevalence of third-generation cephalosporins-resistant and carbapenems-resistant K. pneumoniae (3GCr-Kp; Cr-Kp) in 65 countries around the world by using the Antimicrobial Resistance Global Report on Surveillance, WHO 2014 

    Results: European countries with high UAI have higher rate of penicillin and fluoroquinolone use than those countries with medium-low UAI (median 10.94 and 1.88 vs 6.56 and 1.00 DDD per 1,000 inhabitants, p<0.001; respectively). By other hand, while the prevalence of 3GCr-Kp around the world was statistically associated with UAI and PDI (high: median 49.0% and 50.0% vs medium-low: median 18.0% and 33.0%, p<0.001; respectively), the prevalence of Cr-Kp was only associated with PDI (high: median 3.0% vs medium-low: median 0.3%, p<0.03; respectively)

    Conclusion: While UAI was associated with the use of antibiotics and the prevalence of 3GCr-Kp, Cr-Kp was only related to PDI reflecting in this case the relevance of IPC strategies to contain its emergence

    Rodolfo Quiros, MD, Prevention and Control Infection Department, Hospital Universitario Austral, Buenos Aires, Argentina and Mariana Valerio, PH, Pharmacy, HOSPITAL UNIVERSITARIO AUSTRAL, PILAR, Anguilla


    R. Quiros, None

    M. Valerio, None

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