title: Impact of ceftriaxone de-restriction on the occurrence of ESBL-positive bacterial strains and antibiotic consumption.
abstract: As a cost-saving measure, the Drug and Therapeutics Committee (DTC) removed ceftriaxone from the list of restricted antibiotics in May, 2008, which permitted its use as a first-line antibiotic. To evaluate the impact of this change, the occurrence of extended-spectrum beta-lactamase (ESBL)-positive bacterial strains and antibiotic consumption were monitored for 2 years before and after the intervention. In the post-intervention period, ceftriaxone utilization increased, while total antibiotic utilization did not change significantly. The utilization of all restricted antibiotics decreased (p <0.05) in the post-intervention period. Utilization of carbapenems increased (p <0.05), while utilization of quinolones increased nonsignificantly. The density of resistant ESBLs increased (p = 0.001) from 0.99 to 1.34 per 1000 bed-days from the pre- to the postintervention period. Ceftriaxone use was significantly correlated with ESBL occurrence (p <0.005). It can be concluded that ceftriaxone de-restriction increased the occurrence of ESBLs and the utilization of carbapemens.
authors.affiliation: Department of Clinical Microbiology and Hospital Infections, University Hospital Dubrava, Zagreb, Croatia.
authors.forename: J
authors.initials: J
authors.lastname: Skrlin
authors.forename: V
authors.initials: V
authors.lastname: Bacic Vrca
authors.forename: S
authors.initials: S
authors.lastname: Marusic
authors.forename: M
authors.initials: M
authors.lastname: Ciric-Crncec
authors.forename: L
authors.initials: L
authors.lastname: Mayer
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects* / Q000201:enzymology*; D002443:Ceftriaxone / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D006801:Humans; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D001618:beta-Lactamases