title: Restriction of third-generation cephalosporin use decreases infection-related mortality.
abstract: 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.
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Du
authors.forename: Dechang
authors.initials: D
authors.lastname: Chen
authors.forename: Dawei
authors.initials: D
authors.lastname: Liu
authors.forename: Yun
authors.initials: Y
authors.lastname: Long
authors.forename: Yan
authors.initials: Y
authors.lastname: Shi
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Xi
authors.initials: X
authors.lastname: Rui
authors.forename: Na
authors.initials: N
authors.lastname: Cui
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins