ORIGINAL RESEARCH article
Front. Cell. Infect. Microbiol.
Sec. Antibiotic Resistance and New Antimicrobial drugs
Volume 15 - 2025 | doi: 10.3389/fcimb.2025.1608921
The Correlation between Antibiotic Usage and Antibiotic Resistance: A Three Year Retrospective Study
Provisionally accepted
Ann Lisa Arulappen1,2*
Amer Hayat Khan1*
Syed Shahzad Hasan3
Sabariah Noor Harun1Ting Soo Chow2Mahmood Basil4- 1University of Science Malaysia (USM), Penang, Malaysia
- 2Penang General Hospital, Georgetown, Penang, Malaysia
- 3University of Huddersfield, Huddersfield, West Yorkshire, United Kingdom
- 4King Saud University, Riyadh, Riyadh, Saudi Arabia
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Multidrug-resistance (MDR) microorganisms have been increased all over the world that is considered a public health threat. The emergence of MDR bacterial pathogens correlates with the increased antibiotic usage. This study aimed to determine the correlation between antibiotic usage and antibiotic resistance within 3 years.This was a retrospective cross-sectional study reviewing the positive bacterial culture results and the total antibiotic usage in six hospitals within Penang for 3 years from January 2021 to December 2023 through convenient sampling method.Every sample type has experienced a significant shift over the years. Most microorganisms from all samples significantly changed in distribution over time except for Streptococcus pneumoniae, carbapenem-resistant enterobacterales (CRE) Escherichia coli and CRE Klebsiella pneumoniae. However, MRSA, Klebsiella pneumoniae and Pseudomonas aeruginosa have shown to have significant changes in the number of total isolates from blood cultures only past three years. In terms of prevalence, statistically significant differences were observed for most microorganisms from all samples except for Streptococcus pneumoniae, CRE Escherichia coli and CRE Klebsiella pneumoniae across the years. Pseudomonas aeruginosa shown to be significantly prevalent from blood culture only over the time. Cefoperazone/ sulbactam, amoxicillin/ clavulanic acid, ceftriaxone and ceftazidime showed significant changes in susceptibility for Klebsiella pneumoniae over time. A statistically significant difference in total antibiotic usage across the three years. Regarding the correlation between antibiotic usage and antibiotic resistance, Pearson correlation showed 0.777 (p=0.433), which is suggestive of strong positive correlation between third generation cephalosporins usage and extended spectrum beta lactamase (ESBL) whereas Pearson correlation showed 0.762 (p=0.448) which also suggests for strong positive correlation between carbapenem usage and CRE.The correlation between the use of third generation of cephalosporins and ESBL rate, also the use of carbapenems and CRE rate, further suggest that controlling certain antibiotic usage could help mitigate the rising of MDR microorganisms.
Keywords: antimicrobial resistance, Antibiogram, Gram positive, Gram negative, Prevalence, Antibiotic usage
Received: 15 Apr 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Arulappen, Khan, Hasan, Harun, Chow and Basil. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ann Lisa Arulappen, University of Science Malaysia (USM), Penang, Malaysia
Amer Hayat Khan, University of Science Malaysia (USM), Penang, Malaysia
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