Control of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a children's hospital by changing antimicrobial agent usage policy.
OBJECTIVE
This ambidirectional intervention study was performed to examine the impact of a change in antibiotic policy on extended-spectrum beta-lactamase (ESBL) prevalence in a children's hospital with a high prevalence of ESBL production among Escherichia coli and Klebsiella pneumoniae.


METHODS
The use of extended-spectrum cephalosporins was restricted and use of beta-lactam/ beta-lactamase inhibitor combinations was encouraged from 2002. All strains of E. coli and K. pneumoniae isolated from sterile body fluids from 1999 to 2005 were analysed for beta-lactamase production and the prevalences of ESBL production were compared at three periods; pre-intervention (1999-2001), transitional period (2002-03) and post-intervention (2004-05).


RESULTS
Comparing the pre- and post-intervention periods, overall piperacillin/tazobactam use increased from 2.2 to 108.0 days on antibiotics/1000 patient admission days/year (AD) (P for trend < 0.001), whereas extended-spectrum cephalosporin use decreased from 175.0 to 96.9 AD (P for trend < 0.001). Among 252 strains of E. coli (n = 128) and K. pneumoniae (n = 124), the overall prevalence of ESBL producers decreased from 39.8% (41/103) to 22.8% (18/79) (P for trend = 0.018). This decreasing trend of ESBL production was more evident for K. pneumoniae (64.1% to 25.6%; P for trend < 0.001) than E. coli (25.0% to 19.4%; P for trend = 0.514). The mortality rates of invasive disease caused by E. coli or K. pneumoniae remained unchanged.


CONCLUSIONS
The substitution of piperacillin/tazobactam for extended-spectrum cephalosporins successfully decreased the prevalence of ESBL production of K. pneumoniae and E. coli in an institute for children where ESBLs were endemic. The impact of change in antibiotic policy was more evident in K. pneumoniae than E. coli.
Lee
Jina
J
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Pai
Hyunjoo
H
Kim
Yun Kyung
YK
Kim
Nam Hee
NH
Eun
Byung Wook
BW
Kang
Hyoung Jin
HJ
Park
Kyoung Ho
KH
Choi
Eun Hwa
EH
Shin
Hee Young
HY
Kim
Eui Chong
EC
Lee
Hoan Jong
HJ
Ahn
Hyo Seop
HS
D040981:Acinetobacter baumannii / Q000187:drug effects / Q000201:enzymology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D004926:Escherichia coli / Q000187:drug effects* / Q000201:enzymology*; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006776:Hospitals, Pediatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology*; D008297:Male; D008826:Microbial Sensitivity Tests; D016134:Organizational Policy; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism*
D000900:Anti-Bacterial Agents; D001618:beta-Lactamases