title: Control of multi-resistant bacteria and ventilator-associated pneumonia: is it possible with changes in antibiotics?
abstract: Potent antimicrobial agents have been developed as a response to the development of antibiotic-resistant bacteria, which especially affect patients with prolonged hospitalization in Intensive Care Units (ICU) and who had been previously treated with antimicrobials, especially third-generation cephalosporins. This study was to determine how changes in the empirical treatment of infections in ICU patients affect the incidence of Gram-negative bacteria species and their susceptibility to antimicrobials, and examine the impact of these changes on nosocomial infections. A prospective interventional study was performed in a university hospital during two periods: 1) First period (September 1999 to February 2000); and 2) Second period (August 2000 to December 2000); empirical treatment was changed from ceftriaxone and/or ceftazidime in the first period to piperacillin/tazobactam in the second. ICU epidemiological and infection control rates, as well as bacterial isolates from upper airways were analyzed. Ceftazidime consumption dropped from 34.83 to 0.85 DDD/1000 patients per day (p=0.004). Piperacillin/tazobactam was originally not available; its consumption reached 157.07 DDD/1000 patients per day in the second period (p=0.0002). Eighty-seven patients and 66 patients were evaluated for upper airway colonization in the first and second periods, respectively. There was a significant decrease in the incidence of K. pneumoniae (p=0.004) and P. mirabilis (p=0.036), restoration of K. pneumoniae susceptibility to cephalosporins (p<0.0001) and reduction of ventilator-associated pneumonia rates (p<0.0001). However, there was an increase in P. aeruginosa incidence (p=0.005) and increases in ceftazidime (p=0.003) and meropenem (p<0.0001) susceptibilities. Changing antimicrobial selective pressure on multi-resistant Gram-negative bacteria helps control ventilator-associated pneumonia and decreases antimicrobial resistance.
authors.affiliation: Infectious Diseases Division, Internal Medicine Department, School of Medicine, Federal University of São Paulo, Brazil. elisricardo@hotmail.com
authors.forename: Elisa M
authors.initials: EM
authors.lastname: Jukemura
authors.forename: Marcelo N
authors.initials: MN
authors.lastname: Burattini
authors.forename: Carlos A P
authors.initials: CA
authors.lastname: Pereira
authors.forename: Alfésio L F
authors.initials: AL
authors.lastname: Braga
authors.forename: Eduardo A S
authors.initials: EA
authors.lastname: Medeiros
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002511:Cephalosporins / Q000494:pharmacology; D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000494:pharmacology; D010878:Piperacillin / Q000494:pharmacology; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000517:prevention & control; D011446:Prospective Studies; D000078142:Tazobactam
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin