Association of antibiotic utilization measures and reduced incidence of infections with extended-spectrum beta-lactamase-producing organisms.
With the overuse of expanded-spectrum cephalosporins, especially ceftazidime, outbreaks of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli infections have been reported. In this prospective observational study, we demonstrated that the addition of piperacillin/tazobactam to the formulary and the restriction of ceftazidime were associated with a decrease in the percentage of ceftazidime-resistant isolates. When the use of ceftazidime decreased by 96.43%, and the use of piperacillin/tazobactam increased by over 50% during the 9-month study period, a concomitant decrease was found in the percentage of colonization and infection by ESBL-producing E. coli or K. pneumoniae in patients admitted to the intensive care unit. Results from this 9-month intervention study support the concept that levels of local and institutional use of ceftazidime are of substantial importance to the emergence and persistence of endemic ceftazidime-resistant K. pneumoniae.
Lan
Chi-Kin
CK
Division of Infectious Diseases, Department of Internal Medicine, Ping-Tung Christian Hospital, Ping-Tong, Taiwan, ROC. 00543@ptch.org.tw
Hsueh
Po-Ren
PR
Wong
Wing-Wai
WW
Fung
Chang-Phone
CP
Lau
Ya-Tin
YT
Yeung
Jimmy Y K
JY
Young
Grace T
GT
Su
Ching-Chyuan
CC
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002442:Ceftazidime / Q000494:pharmacology; D018550:Cephalosporin Resistance; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification; D008297:Male; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011446:Prospective Studies; D013624:Taiwan; D001618:beta-Lactamases / Q000096:biosynthesis
D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D002442:Ceftazidime; D001618:beta-Lactamases; D010878:Piperacillin