Relationships between antimicrobial use and antimicrobial resistance in Gram-negative bacteria causing nosocomial infections from 1991–2003 at a university hospital in Taiwan

Hsueh, Po-Ren; Chen, Wen-Hwei; Luh, Kwen‐Tay

doi:10.1016/j.ijantimicag.2005.08.016

Cited by 221 publications

(166 citation statements)

References 36 publications

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“…Signifi cant correlations between the consumption of specifi c antibiotics and resistance have been reported for Gram-negative bacteria including P. aeruginosa and Acinetobacter. 8,9,13 The rate of consumption of specifi c antibiotics is also related to the prevalence of resistance among nosocomial pathogens. 9 Examining correlations between consumption of specifi c antimicrobials and antibiotic resistance can assist in putting effective antimicrobial use policies in place in hospitals.…”

Section: Discussionmentioning

confidence: 99%

Carbapenem stewardship: positive impact on hospital ecology

Lima¹,

Oliveira²,

Paula³

et al. 2011

Braz J Infect Dis

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INTRODUCTION: Excessive group 2 carbapenem use may result in decreased bacterial susceptibility. OBJECTIVE: We evaluated the impact of a carbapenem stewardship program, restricting imipenem and meropenem use. METHODS: Ertapenem was mandated for ESBL-producing Enterobacteriaceae infections in the absence of non-fermenting Gram-negative bacilli (GNB) from April 2006 to March 2008. Group 2 carbapenems were restricted for use against GNB infections susceptible only to carbapenems and suspected GNB infections in unstable patients. Cumulative susceptibility tests were done for nosocomial pathogens before and after restriction using Clinical and Laboratory Standards Institute (CLSI) guide-lines.Vitek System or conventional identification methods were performed and susceptibility testing done by disk diffusion according to CLSI.Antibiotic consumption (t-test) and susceptibilities (McNemar's test) were determined. RESULTS: The defined daily doses (DDD) of group 2 carbapenems declined from 61.1 to 48.7 DDD/1,000 patient-days two years after ertapenem introduction (p = 0.027). Mean ertapenem consumption after restriction was 31.5 DDD/1,000 patient-days. Following ertapenem introduction no significant susceptibility changes were noticed among Gram-positive cocci. The most prevalent GNB were P. aeruginosa, Klebsiella pneumoniae, and Acinetobacter spp. There was no change in P. aeruginosa susceptibility to carbapenems. Significantly improved P. aeruginosa and K. pneumoniae ciprofloxacin susceptibilities were observed, perhaps due to decreased group 2 carbapenem use. K. pneumoniae susceptibility to trimethoprim-sulfamethoxazole improved. CONCLUSION: Preferential use of ertapenem resulted in reduced group 2 carbapenem use, with a positive impact on P. aeruginosa and K. pneumoniae susceptibility

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Section: Discussionmentioning

confidence: 99%

Carbapenem stewardship: positive impact on hospital ecology

Lima¹,

Oliveira²,

Paula³

et al. 2011

Braz J Infect Dis

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“…En el caso de cefazolina, su penetración obedece en parte a su utilización profilác-tica en varias condiciones. El mercado de las cefalosporinas tiene un alcance mundial y se ha asociado a la emergencia de complejas resistencias hacia estos mismos compuestos en bacilos gramnegativos productores de BLEE (β-lactamasas de espectro extendido), a la aparición de Enterococcus sp resistente a vancomicina o a un mayor riesgo de candiduria para citar algunos ejemplos 3,5,19,20 . En tercer lugar, se logró identificar algunos factores que se asociaron significativamente a las variaciones observadas en el consumo de diferentes compuestos.…”

Section: Discussionunclassified

“…Una de ellas, la evaluación del consumo en Dosis Diaria Definida (DDD) por 100 días camas, que refleja cuántos pacientes cada 100 están recibiendo diariamente un tratamiento específico, ha sido ampliamente utilizada y ha permitido comparar diferentes escenarios, tendencias, asociación con resistencia y en forma más importante, el efecto de diferentes medidas de intervención [1][2][3][4][5] .…”

Section: Introductionunclassified

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Consumo de antimicrobianos parenterales en diferentes hospitales de Chile durante el año 2005

et al. 2008

Rev. chil. infectol.

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Intravenous antimicrobial use among different hospital in Chile during 2005Intravenous antimicrobial consumption has not been evaluated previously in Chile. In order to know this consumption (in DDD per 100 bed days), associated factors and antimicrobial control systems across the country, a questionnaire was sent to evaluate these features during 2005. A total of 29 public hospitals and private clinics answered this poll, 20 belonging to the public health system (69%). Only 48.1% declared to have an independent antimicrobial committee and 17.2% allowed unrestricted antimicrobial use. Glycopeptides and carbapenems were the most regulated compounds (75.9 and 82.8%, respectively). Antimicrobial controls systems were more frequently declared among public hospitals and only non-public hospitals permitted free use of antimicrobials. Global consumption reached 59.98 DDD per 100 bed-days, with beta-lactams representing 74.3% of this consume (44.57 DDD per 100), and cephalosporins 43% (25.78 DDD per 100). Chloramphenicol, penicillin G and cloxacillin use was significantly higher among public hospitals. The opposite was observed for imipenem-cilastatin, linezolid, cefuroxime and caspofungin with higher consumes observed among nonpublic hospitals. In a multivariate analysis, increased cefazolin use was independently associated with sites allowing unrestricted use, and ciprofloxacin consumption with non-public hospitals. Institutions with decreased susceptibility to imipenem-cilastatin among non-fermentative gram negative bacilli showed a higher use of this compound and linezolid consumption paralleled vancomycin-resistant enterococci prevalence. It is necessary to reinforce governmental regulations about antimicrobial use issued during 1999.

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“…The elevation in the consumption of cephalosporines and carbapenems demonstrated a significant association with the increase in the resistance of Acinetobacter spp. to meropenem [4]. Another study carried out between 1997 and 2000 reported the association between periods of elevation of the consumption of imipenem and the increase in the resistance of Pseudomonas aeruginosa not only to this antibiotic but also to other beta-lactams such as ceftazidime and piperacilintazobactam [5].…”

mentioning

confidence: 99%

Analysis of the use of imipenem at a University Hospital following the restructuring of an antimicrobial audit system

Souza¹,

Noblat²,

Noblat³

2008

Braz J Infect Dis

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This study analyzed the use pattern of imipenem following the restructuring of the antimicrobial audit system at a University Hospital. It was an observational study before and after the restructuring of the antimicrobial audit system in a University Hospital from May to August and then from September to December 2006. The criteria of the rational use of imipenem were obtained from a non-systematic revision of the literature. The collection of data on the general characteristics and clinical state of the patient, the infection and the established therapy was carried out in a previously tested instrument. Data was recorded, revised and analyzed in a database built with the software SPSS® for Windows® PC, version 10.0. The statistical analysis had a descriptive character: frequencies, mean, median and standard deviation. No differences were encountered in relation to the appropriate indication, consumption and clinical outcomes of patients. However, there was a reduction of 4 to 1 (75.0%) in the number of associations with spectrum superposition and an increase of 4 to 8 (50.0%) in the change of therapy. The restructuring of the antimicrobial audit system in the studied hospital did not reflect significantly the increase of the appropriate indication of imipenem. It contributed, however, to the reduction of the inappropriate associations of this antibiotic and to changes of therapy, without, however, compromising the quality of services rendered to patients.

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Relationships between antimicrobial use and antimicrobial resistance in Gram-negative bacteria causing nosocomial infections from 1991–2003 at a university hospital in Taiwan

Cited by 221 publications

References 36 publications

Carbapenem stewardship: positive impact on hospital ecology

Carbapenem stewardship: positive impact on hospital ecology

Consumo de antimicrobianos parenterales en diferentes hospitales de Chile durante el año 2005

Analysis of the use of imipenem at a University Hospital following the restructuring of an antimicrobial audit system

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