title: The effect of an antibiotic policy on the control of vancomycin-resistant enterococci outbreak and on the resistance patterns of bacteria isolated from the blood of patients in a hematology unit.
abstract: BACKGROUND
  Antibiotic resistance has become one of the main medical problems worldwide. This is mainly due to an overuse and misuse of antibiotics.
  
  
  OBJECTIVE
  The aim of the study was to assess the effect of an antibiotic policy and enhanced infection control on the occurrence of epidemic strains of vancomycin-resistant enterococci (VRE) and resistance patterns of bacteria isolated from the blood of patients hospitalized in two departments of a hematology center in Poland.
  
  
  METHODS
  Antibiotic use was calculated in daily defined doses (DDD) per 100 patient-days during the two 5-month periods, before and after the introduction of the policy. Infection control measures included a 1-week screening for VRE rectal carriage and contact isolation.
  
  
  RESULTS
  Antibiotic consumption decreased from 82.1 to 57.3 DDD per 100 patient-days, mainly because of a decrease in the use of co-trimoxazole, other antimicrobials active against anaerobes, and cephalosporins. A significant change in antibiotic resistance patterns was observed and in vitro efficacy of antibiotics against bacteria isolated from the blood increased remarkably. We managed to eradicate the outbreak of VRE.
  
  
  CONCLUSIONS
  The introduction of antibiotic policy and enhanced infection control measures may prove efficacious in VRE control.
authors.affiliation: Poradnia Endokrynologiczna HERMED, Wschowa. wherman@wschowa.com.pl
authors.forename: Tomasz
authors.initials: T
authors.lastname: Ozorowski
authors.forename: Magdalena
authors.initials: M
authors.lastname: Kawalec
authors.forename: Maria
authors.initials: M
authors.lastname: Zaleska
authors.forename: Lech
authors.initials: L
authors.lastname: Konopka
authors.forename: Waleria
authors.initials: W
authors.lastname: Hryniewicz
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003428:Cross Infection / Q000175:diagnosis / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control*; D016984:Enterococcus faecium / Q000302:isolation & purification*; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology*; D019983:Guideline Adherence; D006402:Hematologic Diseases / Q000188:drug therapy; D006801:Humans; D017053:Infection Control / Q000458:organization & administration*; D007297:Inpatients / Q000706:statistics & numerical data; D011044:Poland / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D014640:Vancomycin / Q000008:administration & dosage; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin