Replacement of Broad-Spectrum Cephalosporins by Piperacillin-Tazobactam: Impact on Sustained High Rates of Bacterial Resistance

Antimicrobial Agents and Chemotherapy - Tập 48 Số 2 - Trang 392-395 - 2004
Carlos Bantar1, Eduardo Vesco2, Claudia Heft3, Francisco Salamone4, Marcelo Krayeski2, Hernán F. Gómez2, M Coassolo3, Alejandro Fiorillo2, Diego Franco1, Carina Arango3, Fernando Duret5, María Eugenia Oliva1
1Committee for Prevention and Control of Nosocomial Infection
2Departments of Internal Medicine,
3Pharmacy,
4Microbiology, Hospital San Martín, Paraná, Entre Ríos
5Wyeth-Whitehall, Buenos Aires, Argentina

Tóm tắt

ABSTRACT We have previously observed a significant reduction of ceftriaxone resistance in Proteus mirabilis associated with an increase in the use of cefepime, along with a decrease in the consumption of broad-spectrum cephalosporins (CEP). However, we did not observe such a reduction with Klebsiella pneumoniae . Therefore, we sought to determine whether replacement of CEP by piperacillin-tazobactam might be useful in reducing sustained high rates of CEP resistance by this organism. We used a 6-month “before and after model”; during the second (intervention) period, most prescriptions of CEP were changed to piperacillin-tazobactam at the pharmacy. No additional barrier precautions were undertaken. During intervention, consumption of ceftazidime decreased from 17.73 to 1.14 defined daily doses (DDD) per 1,000 patient-days ( P < 0.0001), whereas that of piperacillin-tazobactam increased from 0 to 30.57 DDD per 1,000 patient-days ( P < 0.0001). The levels of resistance to CEP by K. pneumoniae and P. mirabilis decreased from 68.4 and 57.9% to 37.5 and 29.4%, respectively ( P < 0.05). We conclude that replacement of ceftazidime by piperacillin-tazobactam might be a suitable strategy to decrease endemic CEP resistance by K. pneumoniae and P. mirabilis , even where there are high bacterial resistance rates and irrespective of any additional precautions for controlling nosocomial infection.

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Thông tin xuất bản

Antimicrobial Agents and Chemotherapy

Tập 48 Số 2

392-395

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