Control of extended-spectrum {beta}-lactamase-producing Klebsiella pneumoniae using a computer-assisted management program to restrict third-generation cephalosporin use.
OBJECTIVE
The aim of this study was to evaluate the control of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae and antimicrobial resistance through a computerized antibiotic control program.


METHODS
An ambidirectional intervention study was conducted at a 750-bed university hospital in Korea from February 2004 to April 2006. In November 2004, hospital-wide restriction of third-generation cephalosporin use was integrated into a pre-existing computerized antibiotic prescription program that included an approval system for 15 antimicrobials. The proportions of ESBL-producing K. pneumoniae and other multidrug-resistant clinical isolates were compared during three phases (9 months per phase): Phase I (pre-intervention), Phase II (intensive-intervention) and Phase III (maintenance).


RESULTS
Third-generation cephalosporin use decreased significantly from 103.2 to 84.9 antibiotic use density (AUD, defined daily dose/1000 patient-days) between Phase I and Phase II (P< 0.05), whereas use of carbapenems and beta-lactam/beta-lactamase inhibitors increased from 14.5 to 18.2 AUD and from 53.3 to 62.6 AUD, respectively. The proportion of ESBL-producing K. pneumoniae isolates increased significantly from 8.1% (47/578) in Phase I to 32.0% (188/587) in Phase II, and then decreased significantly to 20.6% (97/470) in Phase III (P < 0.05). In addition, the proportions of imipenem- or piperacillin/tazobactam-resistant Pseudomonas aeruginosa and Acinetobacter baumannii isolates decreased significantly over the same period (P < 0.05).


CONCLUSIONS
The computerized antibiotic control program appears to be an effective tool for modifying antibiotic consumption, which may in turn prevent the spread of resistant pathogens.
Kim
Jeong Yeon
JY
Division of Infectious Diseases, Korea University Medical Center, Seoul, Republic of Korea.
Sohn
Jang Wook
JW
Park
Dae Won
DW
Yoon
Young Kyung
YK
Kim
Young Mi
YM
Kim
Min Ja
MJ
D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification; D002511:Cephalosporins / Q000627:therapeutic use*; D003201:Computers; D004363:Drug Utilization; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification; D007723:Korea; D054539:Medication Therapy Management; D008826:Microbial Sensitivity Tests; D016134:Organizational Policy; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis*
D002511:Cephalosporins; D001618:beta-Lactamases