title: Control of extended-spectrum {beta}-lactamase-producing Klebsiella pneumoniae using a computer-assisted management program to restrict third-generation cephalosporin use.
abstract: 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.
authors.affiliation: Division of Infectious Diseases, Korea University Medical Center, Seoul, Republic of Korea.
authors.forename: Jeong Yeon
authors.initials: JY
authors.lastname: Kim
authors.forename: Jang Wook
authors.initials: JW
authors.lastname: Sohn
authors.forename: Dae Won
authors.initials: DW
authors.lastname: Park
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Yoon
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Kim
authors.forename: Min Ja
authors.initials: MJ
authors.lastname: Kim
mesh_terms: 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*
chemical_list: D002511:Cephalosporins; D001618:beta-Lactamases