title: Differences in the changes in resistance patterns to third- and fourth-generation cephalosporins and piperacillin/tazobactam among Klebsiella pneumoniae and Escherichia coli clinical isolates following a restriction policy in a Greek tertiary care hospital.
abstract: The aim of the present study was to investigate whether replacement of broad-spectrum cephalosporins (CEPs) by piperacillin/tazobactam (TZP) as first-line empirical therapy may have an effect on beta-lactam resistance among Klebsiella pneumoniae and Escherichia coli in a tertiary care hospital. Data regarding CEP and TZP consumption and resistance were collected on a bimonthly basis during an open-label 2-year (1 year observational and 1 year interventional) study. Consumption of ceftazidime was reduced by 64.5%. In contrast, consumption of the other third-generation CEPs (cefotaxime and ceftriaxone) remained almost stable, whereas an increase in consumption of TZP by 2.8-fold was observed. A significant decrease in resistance to third-generation cephalosporins among K. pneumoniae isolates was observed, and the incidence of extended-spectrum beta-lactamase-producing isolates was notably reduced. These findings were less evident among E. coli isolates. Despite the significant increase in TZP consumption, the respective resistance rates of both bacterial species examined have remained almost unchanged.
authors.affiliation: First Department of Propaedeutic Medicine, Infectious Diseases Laboratory, G.K. Daikos, Laikon General Hospital, Aghiou Thoma 17, Goudi, Athens 11527, Greece. petrikos@med.uoa.gr
authors.forename: George
authors.initials: G
authors.lastname: Petrikkos
authors.forename: Antonios
authors.initials: A
authors.lastname: Markogiannakis
authors.forename: Joseph
authors.initials: J
authors.lastname: Papaparaskevas
authors.forename: Joseph
authors.initials: J
authors.lastname: Papapareskevas
authors.forename: George L
authors.initials: GL
authors.lastname: Daikos
authors.forename: George
authors.initials: G
authors.lastname: Stefanakos
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Zissis
authors.forename: Athina
authors.initials: A
authors.lastname: Avlamis
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification / Q000378:metabolism; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification / Q000378:metabolism; D008826:Microbial Sensitivity Tests; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D010403:Penicillin Resistance; D010878:Piperacillin / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D011446:Prospective Studies; D000078142:Tazobactam; D013997:Time Factors; D065093:beta-Lactamase Inhibitors; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D004791:Enzyme Inhibitors; D065093:beta-Lactamase Inhibitors; D010397:Penicillanic Acid; D001618:beta-Lactamases; D000078142:Tazobactam; D010878:Piperacillin