{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T02:17:36Z","timestamp":1789352256346,"version":"build-2803163510"},"reference-count":20,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2010,3,1]],"date-time":"2010-03-01T00:00:00Z","timestamp":1267401600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2010,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>A surveillance study was performed in four Singapore public hospitals from 2006 to 2008 to determine the correlation between antibiotic prescription and Gram-negative bacterial antimicrobial resistance. Targeted organisms included ceftriaxone- and ciprofloxacin-resistant<jats:italic>Escherichia coli<\/jats:italic>and<jats:italic>Klebsiella pneumoniae<\/jats:italic>, as well as imipenem-resistant<jats:italic>Pseudomonas aeruginosa<\/jats:italic>and<jats:italic>Acinetobacter<\/jats:italic>spp. Antibiotic prescription data were collated in the WHO anatomical therapeutic chemical (ATC)\/defined daily dose (DDD) format, while antibiotic resistance was expressed as incidence density adjusted for total inpatient-days every quarter. Individual trends were determined by linear regression, while possible associations between antibiotic prescription and resistance were evaluated via cross-correlation analysis. Results over 3 years indicated significantly rising incidence densities of ceftriaxone- and ciprofloxacin-resistant<jats:italic>E. coli<\/jats:italic>and imipenem-resistant<jats:italic>Acinetobacter<\/jats:italic>spp. (blood isolates only). Antimicrobial-resistant<jats:italic>Klebsiella pneumoniae<\/jats:italic>rates declined. The prescription rates of piperacillin-tazobactam, ertapenem, meropenem, ciprofloxacin, and levofloxacin increased significantly, while imipenem and moxifloxacin prescription decreased. Cross-correlation analysis demonstrated possible associations between prescription of fluoroquinolones and ciprofloxacin-resistant<jats:italic>E. coli<\/jats:italic>(<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>= 0.46), fluoroquinolones and ceftriaxone-resistant<jats:italic>E. coli<\/jats:italic>(<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>= 0.47), and carbapenems and imipenem-resistant<jats:italic>Acinetobacter<\/jats:italic>spp. (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>= 0.48), all at zero time lag. Changes in meropenem prescription were associated with a similar trend in imipenem-resistant<jats:italic>Acinetobacter<\/jats:italic>blood isolates after a 3-month time lag. No correlation was found between cephalosporin use and resistance. In conclusion, our data demonstrated correlation between prescription of and Gram-negative bacterial resistance to several, but not all, key antimicrobial agents in Singapore hospitals. In areas where Gram-negative bacterial resistance is endemic and prescription of broad-spectrum antimicrobial agents is high, factors other than antimicrobial usage may be equally important in maintaining high resistance rates.<\/jats:p>","DOI":"10.1128\/aac.01076-09","type":"journal-article","created":{"date-parts":[[2010,1,12]],"date-time":"2010-01-12T02:59:16Z","timestamp":1263265156000},"page":"1173-1178","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":99,"title":["Surveillance and Correlation of Antibiotic Prescription and Resistance of Gram-Negative Bacteria in Singaporean Hospitals"],"prefix":"10.1128","volume":"54","author":[{"given":"Li-Yang","family":"Hsu","sequence":"first","affiliation":[{"name":"Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thean-Yen","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Changi General Hospital, 2 Simei Road 3, Singapore 529889, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent H.","family":"Tam","sequence":"additional","affiliation":[{"name":"Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore"},{"name":"College of Pharmacy, University of Houston, 1441 Moursund, Houston, Texas 77030"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Kwa","sequence":"additional","affiliation":[{"name":"Department of Pharmacy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale Andrew","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tse-Hsien","family":"Koh","sequence":"additional","affiliation":[{"name":"Department of Pathology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1086\/382191"},{"key":"e_1_3_2_3_2","first-page":"913","volume":"53","year":"2009","unstructured":"Bergman, M., S. T. Nyberg, P. Huovinen, P. Paakkari, A. J. Hakanen, and the Finnish Study Group for Antimicrobial Resistance. 2009. Association between antimicrobial consumption and resistance in Escherichia coli. Antimicrob. Agents Chemother.53:913-917.","journal-title":"Antimicrob. 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Gram-negative resistance in Singapore: a historical perspective. Ann. Acad. Med. Singapore37:847-854.","journal-title":"Ann. Acad. Med. Singapore"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkn352"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/5.6.1033"},{"key":"e_1_3_2_15_2","first-page":"253","volume":"63","year":"1987","unstructured":"McGowan, J. E., Jr. 1987. Is antimicrobial resistance in hospital microorganisms related to antibiotic use? Bull. N. Y. Acad. Med.63:253-268.","journal-title":"Bull. N. Y. Acad. Med."},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1592\/phco.28.2.235"},{"key":"e_1_3_2_17_2","unstructured":"Infect. 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