# Analysis of Antibiotic Consumption Trends and Pathogens’ Epidemiological Profile Within a Multidisciplinary Clinical Hospital from Romania

## TL;DR

This study analyzed antibiotic use and resistant bacteria trends in a Romanian hospital from 2020 to 2024, finding stable patterns and effective antimicrobial practices.

## Contribution

The study provides a five-year analysis of antibiotic consumption and pathogen trends in a Romanian hospital using WHO-recommended tools.

## Key findings

- Antibiotic consumption shifted from Watch to Access class antibiotics, with a notable increase in Access class use from 2022 to 2024.
- Common pathogens included Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae, with ESKAPE bacteria predominantly found in respiratory and digestive tract specimens.
- Resistant strains like MRSA and ESBL Klebsiella spp. were present but did not show alarming increases over the study period.

## Abstract

Background/Objectives: In the broad and current context of antimicrobial resistance, antibiotic management and therapeutic surveillance are essential in hospitals. The present study (five-year retrospective, 2020–2024) aimed to analyze antibiotic consumption in relation to pathogens identified in a multidisciplinary hospital. Results: In terms of antibiotic consumption (overall 2020–2024), although initially Watch antibiotics were predominantly used, a decrease was observed in favor of Access class antibiotics (sharply increase from 2022 to 2023 and maximum in 2024). For Reserve antibiotics, only slight annual fluctuations were observed, but there was an important reduction in colistin consumption. The most used were cephalosporins (cefazolin, cefuroxime and ceftriaxone), carbapenems (meropenem and ertapenem), vancomycin and linezolid. Regarding pathogens, the most notable were: Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Enterococcus spp., Pseudomonas aeruginosa. Among the ESKAPE bacteria, Acinetobacter baumannii was the least frequent in our samples. ESKAPE bacteria predominantly colonized specimens from the respiratory tract, digestive tract, skin and soft tissue. Resistant strains were observed, mainly Methicillin-resistant Staphylococcus aureus (MRSA) and Extended-Spectrum Beta-Lactamase (ESBL) Klebsiella spp., but no alarming increases in number were recorded in the analyzed period. Methods: The analysis was carried out using tools recommended by the World Health Organisation (Access Watch Reserve antibiotics classification (AWaRe); Bacterial Priority Pathogen List (BBPL); Defined Daily Dose (DDD)), Average Annual Percent Change (AAPC) calculation and ESKAPE classification (bacteria group: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.). Conclusions: Relatively stable trends in bacterial isolates and resistant strains over five years (2020–2024) are consistent with effective antimicrobial stewardship practices.