The Impact of Ertapenem Use on the Susceptibility of <i>Pseudomonas aeruginosa</i> to Imipenem A Hospital Case Study

Lima, Ana Lúcia Munhoz; Oliveira, Priscila Rosalba Domingos de; Paula, Adriana Pereira de; Dal-Paz, Karine; Rossi, Flávia; Zumiotti, Arnaldo Valdir

doi:10.1086/596781

Cited by 26 publications

(25 citation statements)

References 8 publications

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“…(6,7,11). In these programs, the authors concluded that the improved susceptibilities were related to decreased group 2 carbapenem use.…”

Section: Fig 2 Use Of Antipseudomonal Drugs Over the 10-year Study mentioning

confidence: 99%

“…Previous reports have described no change in or improved susceptibility of Pseudomonas aeruginosa to carbapenems following programs of replacing group 2 carbapenems with ertapenem in the hospital setting (6,7,11). We examined the effect of the addition of ertapenem to our hospital formulary on the susceptibilities of nosocomial isolates of Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii to group 2 carbapenems.…”

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confidence: 99%

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Reduction in Fluoroquinolone Use following Introduction of Ertapenem into a Hospital Formulary Is Associated with Improvement in Susceptibility of Pseudomonas aeruginosa to Group 2 Carbapenems: a 10-Year Study

Cook

Gooch

Rizzo

2011

Antimicrob Agents Chemother

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We examined the effect of the addition of ertapenem to our hospital formulary on the resistance of nosocomial Pseudomonas aeruginosa to group 2 carbapenems (imipenem, meropenem, and doripenem). This was a retrospective, observational study conducted between 1 January 2000 and 31 January 2009 at a large, tertiary-care hospital. Autoregressive integrated moving average (ARIMA) regression models were used to evaluate the effect of ertapenem use on the susceptibility of Pseudomonas aeruginosa to group 2 carbapenems as well as on the use of the group 2 carbapenems, ciprofloxacin, and other antipseudomonal drugs (i.e., tobramycin, cefepime, and piperacillin-tazobactam). Resistance was expressed as a percentage of total isolates as well as the number of carbapenem-resistant bacterial isolates per 10,000 patient days. Pearson correlation was used to assess the relationship between antibiotic use and carbapenem resistance. Following the addition of ertapenem to the formulary, there was a statistically significant decrease in the percentage of Pseudomonas aeruginosa isolates resistant to the group 2 carbapenems (P ‫؍‬ 0.003). Group 2 carbapenem use and the number of carbapenem-resistant Pseudomonas aeruginosa isolates per 10,000 patient days did not change significantly over the time period. There was a large decrease in the use of ciprofloxacin (P ‫؍‬ 0.0033), and there was a correlation of ciprofloxacin use with the percentage of isolates resistant to the group 2 carbapenems ( ‫؍‬ 0.47, P ‫؍‬ 0.002). We suspect that the improvement in susceptibility of Pseudomonas aeruginosa to group 2 carbapenems was related to a decrease in ciprofloxacin use.

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“…(6,7,11). In these programs, the authors concluded that the improved susceptibilities were related to decreased group 2 carbapenem use.…”

Section: Fig 2 Use Of Antipseudomonal Drugs Over the 10-year Study mentioning

confidence: 99%

mentioning

confidence: 99%

Reduction in Fluoroquinolone Use following Introduction of Ertapenem into a Hospital Formulary Is Associated with Improvement in Susceptibility of Pseudomonas aeruginosa to Group 2 Carbapenems: a 10-Year Study

Cook

Gooch

Rizzo

2011

Antimicrob Agents Chemother

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“…Imipenem resistance, for example, has been linked to the use of amikacin, ciprofl oxacin, and ceftazidime, but not to ertapenem. 9,11 Implementation of interventions such as the one we describe here can have a positive impact on antimicrobial resistance, because inappropriate antibiotic use is a main driver of resistance. 15 Goldstein et al reported that adding ertapenem to the formulary in a 344-bed community hospital was an effective antimicrobial management tool.…”

Section: Discussionmentioning

confidence: 99%

“…2,12,16 The premise that ertapenem has minimal activity against P. aeruginosa and is thus less likely to select for resistance has been substantiated in vitro and in clinical settings. 4,6,10,11 Still, the question of the long-term impact of ertapenem on hospital ecology lingers as overall concerns about antibiotic resistance become more pervasive.…”

Section: Introductionmentioning

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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“…Multiple single-centre and multicentre ecological studies have recently been conducted that explore whether ertapenem has an impact on hospital ecology [6][7][8][9][10][11][12][13][14][15][16]. Sufficient long-term data are now available to examine whether ertapenem use has resulted in a change in the proportion of carbapenem-susceptible Pseudomonas or in other associated changes in susceptibility to carbapenems.…”

Section: Introductionmentioning

confidence: 99%

Carbapenem stewardship: does ertapenem affect Pseudomonas susceptibility to other carbapenems? A review of the evidence

Nicolau

Carmeli

Crank

et al. 2012

International Journal of Antimicrobial Agents

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The Impact of Ertapenem Use on the Susceptibility of Pseudomonas aeruginosa to Imipenem A Hospital Case Study

Cited by 26 publications

References 8 publications

Reduction in Fluoroquinolone Use following Introduction of Ertapenem into a Hospital Formulary Is Associated with Improvement in Susceptibility of Pseudomonas aeruginosa to Group 2 Carbapenems: a 10-Year Study

Reduction in Fluoroquinolone Use following Introduction of Ertapenem into a Hospital Formulary Is Associated with Improvement in Susceptibility of Pseudomonas aeruginosa to Group 2 Carbapenems: a 10-Year Study

Carbapenem stewardship: positive impact on hospital ecology

Carbapenem stewardship: does ertapenem affect Pseudomonas susceptibility to other carbapenems? A review of the evidence

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