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

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

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