Influence of third-generation cephalosporin utilization on the occurrence of ESBL-positive Klebsiella pneumoniae strains.
BACKGROUND
Klebsiella pneumoniae belongs to important nosocomial pathogens causing mainly hospital-acquired infections. Beta-lactam antibiotics are frequently used in the treatment of infections caused by K. pneumoniae, but by their selection pressure the bacteria become resistant. Excessive use of third-generation cephalosporins is a risk factor for the occurrence and spread of ESBL-producing bacterial strains. The goal of this study was to describe the utilization of third-generation cephalosporins and to analyse their selection pressure on K. pneumoniae in the University Hospital in Olomouc.


METHODS
Data on the utilization of antibiotics in the hospital were obtained for the period 1997-2005 from the computerized database and expressed in defined daily doses per 100 bed-days (DBD). The data were processed according to the ATC/DDD system. Klebsiella pneumoniae strains were isolated from clinical material obtained from hospitalized patients.


RESULTS
Consumption of third-generation cephalosporins, which was 1.79 DBD in 1997, decreased to 0.93 in 1999, remained stable until 2002, and then increased to 2.40 DBD in 2005. During the 9-year period analysed, a total of 9564 strains of K. pneumoniae were isolated. The ESBL-positive K. pneumoniae strains frequency increased from 8% to 18%.


CONCLUSIONS
Increasing utilization of third-generation cephalosporins was associated with a statistically and clinically significant increased incidence of ESBL-positive K. pneumoniae strains.
Urbánek
K
K
Department of Pharmacology, Faculty of Medicine and University Hospital, Olomouc, Czech Republic. urbanek@fnol.cz
Kolár
M
M
Lovecková
Y
Y
Strojil
J
J
Santavá
L
L
D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D003428:Cross Infection / Q000382:microbiology; D018153:Czech Republic; D016208:Databases, Factual; D017723:Drug Utilization Review; D006785:Hospitals, University; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000032:analysis / Q000378:metabolism*
D002511:Cephalosporins; D001618:beta-Lactamases