Restriction of third-generation cephalosporin use decreases infection-related mortality.
OBJECTIVE
To determine the effect of restriction of third-generation cephalosporin use on antibiotic resistance and the outcome of patients with infection.


METHODS
A prospective, before-after comparative study.


METHODS
A general intensive care unit with 14 beds at a university-affiliated teaching hospital.


METHODS
All patients admitted to the intensive care unit within 2 yrs.


METHODS
A new antibiotic treatment strategy was implemented during phase II. All patients with confirmed or suspected Gram-negative bacterial infections were treated mainly with antibiotics other than third-generation cephalosporins.


RESULTS
Antibiotic resistance among common Gram-negative bacilli and infection-related hospital mortality during phase I were compared with phase II. A 26.6% reduction in third-generation cephalosporin use (from 168.2 +/- 48.0 to 123.5 +/- 39.3 g/month, p =.021), accompanied by a 277.7% increase in cefepime use (from 10.3 +/- 19.2 to 38.9 +/- 31.7 g/month, p =.014) occurred in phase II compared with phase I. This was accompanied by a significant decrease in reduced susceptibility of Gram-negative bacilli to third-generation cephalosporins (p <.05), mainly because of the improved susceptibility of Escherichia coli and Klebsiella species (p <.05). Infection-related hospital mortality was significantly lower in phase II (19.3% vs. 36.3%, p =.014). Multiple logistic regression analysis demonstrated lower respiratory tract infection, the status of immunocompromise, and continuous veno-venous hemofiltration as independent risk factors for infection-related hospital mortality (p <.05), whereas infection with E. coli or Klebsiella species (p =.039) and restriction of third-generation cephalosporin use (p =.025) were associated with a significantly lower mortality rate.


CONCLUSIONS
Restriction of third-generation cephalosporin use may improve the antibiotic susceptibility and reduce infection-related hospital mortality in critically ill patients.
Du
Bin
B
Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, People's Republic of China.
Chen
Dechang
D
Liu
Dawei
D
Long
Yun
Y
Shi
Yan
Y
Wang
Hao
H
Rui
Xi
X
Cui
Na
N
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
D000900:Anti-Bacterial Agents; D002511:Cephalosporins