CORRECTION article
Front. Cell. Infect. Microbiol.
Sec. Antibiotic Resistance and New Antimicrobial drugs
Volume 15 - 2025 | doi: 10.3389/fcimb.2025.1678273
The correlation between antibiotic usage and antibiotic resistance: a 3-year retrospective study.
Provisionally accepted
Ann Lisa Arulappen1*
Amer Hayat Khan2
Shahzad Syed3
Sabariah Noor Harun2Ting Soo Chow1Basil A Al-Rawi4
Wajid Syed4- 1Ministry of Health (Malaysia), Putrajaya, Malaysia
- 2Universiti Sains Malaysia, Minden Heights, Malaysia
- 3University of Huddersfield, Huddersfield, United Kingdom
- 4King Saud University, Riyadh, Saudi Arabia
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Introduction: Multidrug-resistant (MDR) microorganisms have increased all over the world, which 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. Method: This was a retrospective cross-sectional study reviewing the positive bacterial culture results and the total antibiotic usage in six hospitals in Penang for 3 years from January 2021 to December 2023 through a convenient sampling method. Results: 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, methicillin-resistant Staphylococcus aureus (MRSA), K. pneumoniae, and Pseudomonas aeruginosa showed significant changes in the number of total isolates from blood cultures only in the 3 years. In terms of prevalence, statistically significant differences were observed for most microorganisms from all samples except for S. pneumoniae, CRE E. coli, and CRE K. pneumoniae across the years. P. aeruginosa showed significant prevalence in blood culture over time. Cefoperazone/sulbactam, amoxicillin/clavulanic acid, ceftriaxone, and ceftazidime showed significant changes in susceptibility for K. pneumoniae over time. A statistically significant difference in total antibiotic usage across the 3 years was observed. Regarding the correlation between antibiotic usage and antibiotic resistance, Pearson’s correlation was 0.777 (p = 0.433), which is suggestive of a strong positive correlation between thirdgeneration cephalosporin usage and extended-spectrum beta-lactamase (ESBL), whereas Pearson’s correlation was 0.762 (p = 0.448), which also suggests strong positive correlation between carbapenem usage and CREs. Conclusion: The correlation between the use of third-generation cephalosporins and ESBL rate, as well as the use of carbapenems and CRE rate, further suggests that controlling certain antibiotic usage could help mitigate the rise in MDR microorganisms.
Keywords: antimicrobial resistance, Antibiogram, Gram positive, Gram negative, Prevalence, Antibiotic usage
Received: 07 Aug 2025; Accepted: 07 Aug 2025.
Copyright: © 2025 Arulappen, Khan, Syed, Harun, Chow, Al-Rawi and Syed. 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, Ministry of Health (Malaysia), Putrajaya, Malaysia
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