Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella.

Abstract

CONTEXT:

Resistance to most or all cephalosporin antibiotics in Klebsiella species has developed in many European and North American hospitals during the past 2 decades.

OBJECTIVE:

To determine if restriction of use of the cephalosporin class of antibiotics would reduce the incidence of patient infection or colonization by cephalosporin-resistant Klebsiella.

DESIGN:

A before-after comparative 2-year trial.

SETTING:

A 500-bed, university-affiliated community hospital in Queens, NY.

PATIENTS:

All adult medical and surgical hospital inpatients.

INTERVENTION:

A new antibiotic guideline excluded the use of cephalosporins except for pediatric infection, single-dose surgical prophylaxis, acute bacterial meningitis, spontaneous bacterial peritonitis, and outpatient gonococcal infection. All other cephalosporin use required prior approval by the infectious disease section.

MAIN OUTCOME MEASURE:

Incidence of patient infection or colonization by ceftazidime-resistant Klebsiella during 1995 (control period) compared with 1996 (intervention period).

RESULTS:

An 80.1% reduction in hospital-wide cephalosporin use occurred in 1996 compared with 1995. This was accompanied by a 44.0% reduction in the incidence of ceftazidime-resistant Klebsiella infection and colonization throughout the medical center (P<.01), a 70.9% reduction within all intensive care units (P<.001), and an 87.5% reduction within the surgical intensive care unit (P<.001). A concomitant 68.7% increase in the incidence of imipenem-resistant Pseudomonas aeruginosa occurred throughout the medical center (P<.01). All such isolates except one were susceptible to other antibiotics.

CONCLUSION:

Extensive cephalosporin class restriction significantly reduced nosocomial, plasmid-mediated, cephalosporin-resistant Klebsiella infection and colonization. This occurred at the price of increased imipenem resistance in P aeruginosa, which remained susceptible to other agents. Thus, an overall reduction in multiply-resistant pathogens was achieved within 1 year.

• Authors: J J Rahal, C Urban, D Horn, K Freeman, S Segal-Maurer, J Maurer, N Mariano, S Marks, J M Burns, D Dominick, M Lim
• Journal: JAMA (JAMA) Vol. 280 Issue 14 Pg. 1233-7 (Oct 14 1998) ISSN: 0098-7484 [Print] United States
• PMID: 9786372 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Cephalosporins
• Thienamycins
• Imipenem

Topics

• Adult
• Cephalosporin Resistance
• Cephalosporins (therapeutic use)
• Cross Infection (epidemiology, prevention & control)
• Drug Resistance, Microbial
• Drug Utilization Review (statistics & numerical data)
• Guideline Adherence
• Hospital Bed Capacity, 500 and over
• Hospitals, Community
• Humans
• Imipenem (pharmacology)
• Incidence
• Infection Control
• Klebsiella (drug effects)
• Klebsiella Infections (epidemiology, prevention & control)
• New York City (epidemiology)
• Pseudomonas Infections (epidemiology)
• Pseudomonas aeruginosa (drug effects)
• Thienamycins (pharmacology)