Does Identification of an Extended-Spectrum β-Lactamase-producing Organism by the Microbiology Laboratory Influence Patient Management?

Gavin, Patrick J.; Bolden, John R.; Peterson, Lance R.; Thomson, Richard B.

doi:10.1097/01.idc.0000195907.84587.c0

Cited by 3 publications

(2 citation statements)

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“…[ 23 24 25 ] Hence, reliable and accurate detection of ESBL in a microbiology laboratory is a must. In a recent study conducted by Gavin et al .,[ 26 ] it was found that the majority of physicians changed therapy after a report of an ESBL-producing pathogen from microbiology laboratory highlighting the importance of ESBL detection. Since no data on ESBL prevalence in our area were available, a study was conducted in our institute to look for prevalence of ESBL among members of the family Enterobacteriaceae and antimicrobial susceptibility pattern of such isolates.…”

Section: Discussionmentioning

confidence: 99%

Study of extended spectrum β-lactamase producing Enterobacteriaceae and antibiotic coresistance in a tertiary care teaching hospital

Shashwati¹,

Kiran²,

Dhanvijay³

2014

J Nat Sc Biol Med

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Aims:To study the prevalence of extended spectrum β-lactamase (ESBL) producing Enterobacteriaceae and coresistance to other commonly used antibiotics from the Bhopal region of Central India.Settings and Design:A prospective study was conducted from September 2011 to August 2012 in Microbiology Department of our tertiary health care center.Materials and Methods:A total of 1044 Enterobacteriaceae isolates were recovered from various specimens. ESBL production was detected by using Clinical Laboratory Standard Institute (CLSI) that described the phenotypic confirmatory test along with routine antibiotic susceptibility testing.Statistical Analysis:Two-tailed Z-test.Results:Escherichia coli was the most common isolate (65.32%). ESBL production was confirmed in 504 (48.27%) isolates. The isolates of E. coli (50.14%) were the most common ESBL producers. Maximum ESBL isolates were obtained from urine samples (52.28%) and male patients (52.54%). Sensitivity to imipenem was 100% followed by piperacillin–tazobactam (89.28%), meropenem (87.5%), and amikacin (83.92%). Significant resistance was detected against trimethoprim–sulfomethoxazole, fluoroquinolones, and gentamicin.Conclusion:This is the only study conducted from Central India and shows high prevalence of ESBL production among Enterobacteriaceae. Imipenem seems to be more sensitive than meropenem. Piperacillin–tazobactam combination was found to be the best among the β-lactam–β-lactamase inhibitor combinations. Prevalence of ESBL producers were more in males than females.

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Section: Discussionmentioning

confidence: 99%

Study of extended spectrum β-lactamase producing Enterobacteriaceae and antibiotic coresistance in a tertiary care teaching hospital

Shashwati¹,

Kiran²,

Dhanvijay³

2014

J Nat Sc Biol Med

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“…Laboratories must critically look for ESBL‐producing pathogens, as indicated by a recent study by Gavin et al. [26], who found that the majority of physicians changed therapy after a report of an ESBL‐producing pathogen from the laboratory; 40% altered the regimen to appropriate monotherapy; and another 23% substituted an active for the initially used inactive antibiotic. After the microbiology report was generated, 54% of the patients were treated with piperacillin–tazobactam, 20% with a carbapenem, and 11% with a fluoroquinolone.…”

Section: Implications For Patient Carementioning

confidence: 99%

Antibiotic policy and prescribing strategies for therapy of extended-spectrum β-lactamase-producing Enterobacteriaceae: the role of piperacillin–tazobactam

Peterson

2008

Clinical Microbiology and Infection

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Therapy of infections caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria with an antimicrobial to which they are resistant results in treatment failure, higher cost and increased mortality. The CLSI recommends reporting ESBL-producing strains of Escherichia coli, Klebsiella spp. and Proteus spp. as resistant to all penicillin, true cephalosporin and monobactam antimicrobials, but as susceptible to beta-lactam-beta-lactamase inhibitor combinations, including piperacillin-tazobactam, when they test as such. Current literature supports the action of piperacillin-tazobactam against susceptible strains of ESBL-producing bacteria based on the structure-activity relationship between inhibitors and the ESBLs, as well as on recent clinical outcome studies.

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Influence of automated screening and confirmation of extended-spectrum β-lactamase-producing members of the Enterobacteriaceae on prescribing of antibiotics

Nicasio

Kuti

Aslanzadeh

et al. 2008

Journal of Medical Microbiology

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This study investigated the clinician response to the extended-spectrum b-lactamase (ESBL) confirmation report generated by an automated detection system, MicroScan Walkaway. The study compared two cohorts (pre-and post-automated detection) of patients with an ESBLproducing Escherichia coli or Klebsiella species non-urinary infection over the period October 2001-December 2006. Acceptance of the report, as defined by the initiation of carbapenem therapy, was observed in 69.2 % of the post-automated detection cohort (n578) versus 20 % in the pre-automated detection period (n515) (P ¡0.001). The utilization of a carbapenem increased progressively over the course of the study. Moreover, the time to initiation of carbapenem therapy was reduced from 15.7±4.9 to 0.1±2.0 days (P ¡0.001) after implementation of this automated detection system. Overall, clinicians responded positively to the ESBL automated detection report, as gauged by the increased utilization of a carbapenem and the earlier initiation of appropriate therapy; however, reductions in length of stay and mortality were not observed in this infected population.

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Does Identification of an Extended-Spectrum β-Lactamase-producing Organism by the Microbiology Laboratory Influence Patient Management?

Cited by 3 publications

References 10 publications

Study of extended spectrum β-lactamase producing Enterobacteriaceae and antibiotic coresistance in a tertiary care teaching hospital

Study of extended spectrum β-lactamase producing Enterobacteriaceae and antibiotic coresistance in a tertiary care teaching hospital

Antibiotic policy and prescribing strategies for therapy of extended-spectrum β-lactamase-producing Enterobacteriaceae: the role of piperacillin–tazobactam

Influence of automated screening and confirmation of extended-spectrum β-lactamase-producing members of the Enterobacteriaceae on prescribing of antibiotics

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