Intervention study of the association of antibiotic utilization measures with control of extended-spectrum β-lactamase (ESBL)-producing bacteria

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• 作者：Zhongguang Wen ; Xiaoyang Wei ; Yonghong Xiao ; Feng Xue ; Fenglan Hao ; Yan Zhu ; Nan Ma ; Yan Xiao ; Haiyan Wang
• 关键词：Cephalosporins ; Extended spectrum β ; -lactamases ; Piperacillin– ; tazobactam ; Acquisition rate ; Infection rate
• 刊名：Microbes and Infection
• 出版年：2010
• 出版时间：September 2010
• 年：2010
• 卷：12
• 期：10
• 页码：710-715
• 全文大小：147 K

文摘

We investigated the effects of replacing third-/fourth-generation cephalosporins with piperacillin–tazobactam on the rate of acquisition of extended spectrum β-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 β-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 β-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 β-lactamases-producing K. pneumoniae, and no substantial decrease in the rate of its acquisition was observed.