title: Reduced use of third-generation cephalosporins decreases the acquisition of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae.
abstract: OBJECTIVE
  To identify risk factors for the respiratory acquisition of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae among patients admitted to a neurosurgical intensive care unit (NSICU) and to modify them without changing general infection control measures.
  
  
  METHODS
  Nested case-control and intervention study.
  
  
  METHODS
  A 1,200-bed, tertiary-care teaching hospital with a 17-bed NSICU.
  
  
  METHODS
  Sputa of all patients admitted to the NSICU were cultured weekly during the study. From October 2002 through February 2003, 29 case-patients from whose sputum ESBL-producing K. pneumoniae was isolated were detected and 59 controls-patients were randomly selected among patients without any positive isolate of ESBL-producing K. pneumoniae. After analyzing the risk factors, we intervened to modify them and compared the acquisition rate of ESBL-producing K. pneumoniae before (October 2002 to February 2003) and after (April to August 2003) the intervention.
  
  
  RESULTS
  Multivariate analysis showed that prior exposure to third-generation cephalosporins (TGCs) (OR, 6.0; CI95, 1.9 to 18.6; P = .002) was an independent risk factor of ESBL-producing K. pneumoniae acquisition. The neurosurgical team was notified of the result, and the infectious diseases specialist visited the NSICU three times a week to regulate TGC use during the intervention period. Patients admitted before the intervention were older than patients admitted after. The respiratory acquisition of ESBL-producing K. pneumoniae per 1,000 patient-days (13.5 [CI95, 8.9 to 18.1] vs 2.7 [CI95, 0.9 to 4.6]) and the antimicrobial use density of TGCs (38.2 +/- 5.0 vs 17.3 +/- 2.6; P < .001) decreased significantly after the intervention.
  
  
  CONCLUSIONS
  Prior exposure to TGCs was an independent risk factor for the respiratory acquisition of ESBL-producing K. pneumoniae, and less use of TGCs was associated with a decrease in acquisition.
authors.affiliation: Division of Infectious Diseases, Gil Medical Center, Gachon Medical School, 1198 Guwoldong, Namdong-gu, Incheon 405-760, Korea.
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Lee
authors.forename: Shin Young
authors.initials: SY
authors.lastname: Park
authors.forename: Sue-Yun
authors.initials: SY
authors.lastname: Kim
authors.forename: Yiel-Hae
authors.initials: YH
authors.lastname: Seo
authors.forename: Yong Kyun
authors.initials: YK
authors.lastname: Cho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D016022:Case-Control Studies; D002511:Cephalosporins / Q000008:administration & dosage* / Q000494:pharmacology; D002648:Child; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000517:prevention & control*; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000254:growth & development* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012137:Respiratory System / Q000382:microbiology; D012307:Risk Factors; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D001618:beta-Lactamases