title: Control of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a children's hospital by changing antimicrobial agent usage policy.
abstract: 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.
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jina
authors.initials: J
authors.lastname: Lee
authors.forename: Hyunjoo
authors.initials: H
authors.lastname: Pai
authors.forename: Yun Kyung
authors.initials: YK
authors.lastname: Kim
authors.forename: Nam Hee
authors.initials: NH
authors.lastname: Kim
authors.forename: Byung Wook
authors.initials: BW
authors.lastname: Eun
authors.forename: Hyoung Jin
authors.initials: HJ
authors.lastname: Kang
authors.forename: Kyoung Ho
authors.initials: KH
authors.lastname: Park
authors.forename: Eun Hwa
authors.initials: EH
authors.lastname: Choi
authors.forename: Hee Young
authors.initials: HY
authors.lastname: Shin
authors.forename: Eui Chong
authors.initials: EC
authors.lastname: Kim
authors.forename: Hoan Jong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Hyo Seop
authors.initials: HS
authors.lastname: Ahn
mesh_terms: 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*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases