Replacement of broad-spectrum cephalosporins by piperacillin-tazobactam: Impact on sustained high rates of bacterial resistance
Replacement of broad-spectrum cephalosporins by piperacillin-tazobactam: Impact on sustained high rates of bacterial resistance
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DOI：
10.1128/aac.48.2.392-395.2004
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发表时间：
2004-02-01
影响因子：
4.9
通讯作者：
Oliva, ME
中科院分区：
文献类型：
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作者：
Bantar, C;Vesco, E;Oliva, ME
我们以前观察到奇异变形杆菌头孢曲松耐药性的显著降低与头孢吡肟使用的增加有关，沿着广谱头孢菌素（CEP）消耗的减少。然而，我们没有观察到肺炎克雷伯氏菌的这种减少。因此，我们试图确定用哌拉西林-他唑巴坦替代CEP是否有助于降低该微生物对CEP的持续高耐药率。我们使用了6个月的“前后模型”;在第二（干预）阶段，大多数CEP处方在药房改为哌拉西林-他唑巴坦。未采取其他屏障预防措施。在干预期间，头孢他啶的消耗量从17.73下降到1.14限定日剂量（DDD）/1,000患者日（P < 0.0001），而哌拉西林-他唑巴坦的消耗量从0增加到30.57 DDD/1,000患者日（P < 0.0001）。K.肺炎克雷伯菌和奇异变形杆菌分别从68.4%和57.9%下降到37.5%和29.4%（P < 0.05）。我们的结论是，用哌拉西林-他唑巴坦替代头孢他啶可能是一种合适的策略，以减少地方性CEP耐药的K。肺炎球菌和奇异变形杆菌，即使在细菌耐药率高的情况下，也不考虑控制医院感染的任何额外预防措施。
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.