Replacement of Broad-Spectrum Cephalosporins by Piperacillin-Tazobactam: Impact on Sustained High Rates of Bacterial Resistance
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Published:2004-02
Issue:2
Volume:48
Page:392-395
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ISSN:0066-4804
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Container-title:Antimicrobial Agents and Chemotherapy
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language:en
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Short-container-title:Antimicrob Agents Chemother
Author:
Bantar Carlos1, Vesco Eduardo2, Heft Claudia3, Salamone Francisco4, Krayeski Marcelo2, Gomez Hernán2, Coassolo María Alicia3, Fiorillo Alejandro2, Franco Diego1, Arango Carina3, Duret Fernando5, Oliva María Eugenia1
Affiliation:
1. Committee for Prevention and Control of Nosocomial Infection 2. Departments of Internal Medicine 3. Pharmacy 4. Microbiology, Hospital San Martín, Paraná, Entre Ríos 5. Wyeth-Whitehall, Buenos Aires, Argentina
Abstract
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.
Publisher
American Society for Microbiology
Subject
Infectious Diseases,Pharmacology (medical),Pharmacology
Reference18 articles.
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