title: Replacement of broad-spectrum cephalosporins by piperacillin-tazobactam: impact on sustained high rates of bacterial resistance.
abstract: We have previously observed a significant reduction of ceftriaxone resistance in Proteus mirabilis associated with an increase in the use of cefepime, along with a decrease in the consumption of broad-spectrum cephalosporins (CEP). However, we did not observe such a reduction with Klebsiella pneumoniae. Therefore, we sought to determine whether replacement of CEP by piperacillin-tazobactam might be useful in reducing sustained high rates of CEP resistance by this organism. We used a 6-month "before and after model"; during the second (intervention) period, most prescriptions of CEP were changed to piperacillin-tazobactam at the pharmacy. No additional barrier precautions were undertaken. During intervention, consumption of ceftazidime decreased from 17.73 to 1.14 defined daily doses (DDD) per 1,000 patient-days (P < 0.0001), whereas that of piperacillin-tazobactam increased from 0 to 30.57 DDD per 1,000 patient-days (P < 0.0001). The levels of resistance to CEP by K. pneumoniae and P. mirabilis decreased from 68.4 and 57.9% to 37.5 and 29.4%, respectively (P < 0.05). We conclude that replacement of ceftazidime by piperacillin-tazobactam might be a suitable strategy to decrease endemic CEP resistance by K. pneumoniae and P. mirabilis, even where there are high bacterial resistance rates and irrespective of any additional precautions for controlling nosocomial infection.
authors.affiliation: Committee for Prevention and Control of Nosocomial Infection, Hospital San Martín, Paraná, Entre Ríos, Argentina.
authors.forename: Carlos
authors.initials: C
authors.lastname: Bantar
authors.forename: Eduardo
authors.initials: E
authors.lastname: Vesco
authors.forename: Claudia
authors.initials: C
authors.lastname: Heft
authors.forename: Francisco
authors.initials: F
authors.lastname: Salamone
authors.forename: Marcelo
authors.initials: M
authors.lastname: Krayeski
authors.forename: Hernán
authors.initials: H
authors.lastname: Gomez
authors.forename: María Alicia
authors.initials: MA
authors.lastname: Coassolo
authors.forename: Alejandro
authors.initials: A
authors.lastname: Fiorillo
authors.forename: Diego
authors.initials: D
authors.lastname: Franco
authors.forename: Carina
authors.initials: C
authors.lastname: Arango
authors.forename: Fernando
authors.initials: F
authors.lastname: Duret
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Oliva
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001118:Argentina / Q000453:epidemiology; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000627:therapeutic use*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D011307:Drug Prescriptions; D004363:Drug Utilization; D006801:Humans; D017053:Infection Control; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use*; D010878:Piperacillin / Q000627:therapeutic use*; D000077725:Piperacillin, Tazobactam Drug Combination
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin