Intervention study of the association of antibiotic utilization measures with control of extended-spectrum beta-lactamase (ESBL)-producing bacteria.
We investigated the effects of replacing third-/fourth-generation cephalosporins with piperacillin-tazobactam on the rate of acquisition of extended spectrum beta-lactamase-producing Klebsiella pneumoniae and Escherichia coli by patients hospitalized in a Department of Respiratory Medicine. This 9-month, prospective, non-controlled, intervention study comprised two phases: a 3-month pre-intervention phase (Phase I) and a 6-month intervention phase (Phase II), during which the use of third-/forth-generation cephalosporins was restricted and replaced by piperacillin-tazobactam. Rectal swabs were obtained within 24 h after admission (baseline screening), weekly, and 48 h before discharge during Phase I and the last 3 months of Phase II (Phase IIb). Swabs were tested for E. coli and K. pneumoniae, and extended spectrum beta-lactamase production was detected with the double disc test. Use of third/fourth-generation cephalosporins decreased by 63.0% and 100%, respectively; while the use of piperacillin-tazobactam increased by 28-fold. The rate of acquisition of extended spectrum beta-lactamase-producing E. coli and K. pneumoniae together in rectal swab specimens decreased in Phase IIb as compared with Phase I (19.5% vs 29.5%). Few rectal swab specimens were positive for extended spectrum beta-lactamases-producing K. pneumoniae, and no substantial decrease in the rate of its acquisition was observed.
Wen
Zhongguang
Z
Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital, PLA General Hospital, #51 Fucheng Road, Haidian District, Beijing 100048, PR China. wen323@263.net
Wei
Xiaoyang
X
Xiao
Yonghong
Y
Xue
Feng
F
Hao
Fenglan
F
Zhu
Yan
Y
Ma
Nan
N
Xiao
Yan
Y
Wang
Haiyan
H
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology; D001618:beta-Lactamases / Q000096:biosynthesis*; D047090:beta-Lactams / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D001618:beta-Lactamases