title: Fighting the spread of AmpC-hyperproducing Enterobacteriaceae: beneficial effect of replacing ceftriaxone with cefotaxime.
abstract: OBJECTIVE
  Considering the hypothesis that the high biliary elimination of ceftriaxone could be responsible for the selection of Enterobacteriaceae harbouring high-level AmpC β-lactamase (HL-CASE), the use of ceftriaxone was discontinued in our hospital in 2006 and replaced with cefotaxime.
  
  
  METHODS
  Antibiotic consumption, expressed as defined daily dose (DDD)/1000 patient-days (PD), and HL-CASE incidence, expressed as the number of patients carrying HL-CASE/1000 PD, were compared between the pre-intervention period (Period 1, 2001-05) and the post-intervention period (Period 2, 2006-12) using an interrupted time series analysis.
  
  
  RESULTS
  The incidence of HL-CASE increased significantly from 0.32 to 0.69/1000 PD during Period 1 (coefficient = 0.082, P < 0.01). A significant inflection of the slope in the incidence curve occurred in Period 2 (coefficient = -0.061, P = 0.05), mainly owing to the stabilization of the HL-CASE incidence of Enterobacteriaceae harbouring chromosomally inducible cephalosporinase (Period 1, 0.27 to 0.64/1000 PD; Period 2, 0.58 to 0.61/1000 PD) and especially for Enterobacter cloacae (Period 1, 0.09 to 0.30/1000 PD; Period 2, 0.26 to 0.27/1000 PD). This deceleration was observed despite a significant increase in the slope of cefotaxime consumption over Period 2 (coefficient = 2.97, P < 0.01).
  
  
  CONCLUSIONS
  Despite the disadvantages of using cefotaxime compared with ceftriaxone (administration three times daily versus once a day), the ecological benefits of this substitution seem sufficiently convincing to preferentially use cefotaxime. Control of HL-CASE incidence is crucial to limiting carbapenem use and preventing the selection of carbapenemase-producing Enterobacteriaceae.
authors.affiliation: Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris F-75015, France.
authors.forename: P
authors.initials: P
authors.lastname: Grohs
authors.forename: S
authors.initials: S
authors.lastname: Kernéis
authors.forename: B
authors.initials: B
authors.lastname: Sabatier
authors.forename: M
authors.initials: M
authors.lastname: Lavollay
authors.forename: E
authors.initials: E
authors.lastname: Carbonnelle
authors.forename: H
authors.initials: H
authors.lastname: Rostane
authors.forename: C
authors.initials: C
authors.lastname: Souty
authors.forename: G
authors.initials: G
authors.lastname: Meyer
authors.forename: L
authors.initials: L
authors.lastname: Gutmann
authors.forename: J L
authors.initials: JL
authors.lastname: Mainardi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000378:metabolism*; D002439:Cefotaxime / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use*; D004363:Drug Utilization; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D012189:Retrospective Studies; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D002443:Ceftriaxone; C048795:AmpC beta-lactamases; D001618:beta-Lactamases; D002439:Cefotaxime
keywords: antibiotics; bacterial resistance; cephalosporins