Carbapenem stewardship: positive impact on hospital ecology
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 abs...
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| Format: | Article |
| Language: | English |
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Elsevier
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| Series: | Brazilian Journal of Infectious Diseases |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702011000100001&lng=en&tlng=en |
| _version_ | 1818494772463009792 |
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| author | Ana Lucia Lei Munhoz Lima Priscila Rosalba Domingos de Oliveira Adriana Pereira de Paula Karine Dal-Paz João Nóbrega de Almeida Jr Cássia da Silva Félix Flávia Rossi |
| author_facet | Ana Lucia Lei Munhoz Lima Priscila Rosalba Domingos de Oliveira Adriana Pereira de Paula Karine Dal-Paz João Nóbrega de Almeida Jr Cássia da Silva Félix Flávia Rossi |
| author_sort | Ana Lucia Lei Munhoz Lima |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-10T18:11:00Z |
| format | Article |
| id | doaj.art-af0938a4a8304f009fb9d053af4c0489 |
| institution | Directory Open Access Journal |
| issn | 1678-4391 |
| language | English |
| last_indexed | 2024-12-10T18:11:00Z |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Infectious Diseases |
| spelling | doaj.art-af0938a4a8304f009fb9d053af4c04892022-12-22T01:38:26ZengElsevierBrazilian Journal of Infectious Diseases1678-43911511510.1590/S1413-86702011000100001S1413-86702011000100001Carbapenem stewardship: positive impact on hospital ecologyAna Lucia Lei Munhoz Lima0Priscila Rosalba Domingos de Oliveira1Adriana Pereira de Paula2Karine Dal-Paz3João Nóbrega de Almeida Jr4Cássia da Silva Félix5Flávia Rossi6Universidade de São PauloLIMUniversidade de São PauloUniversidade de São PauloUniversidade de São PauloUniversidade de São PauloUniversidade de São PauloINTRODUCTION: 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.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702011000100001&lng=en&tlng=encarbapenemsdrug resistancebacterial ecology |
| spellingShingle | Ana Lucia Lei Munhoz Lima Priscila Rosalba Domingos de Oliveira Adriana Pereira de Paula Karine Dal-Paz João Nóbrega de Almeida Jr Cássia da Silva Félix Flávia Rossi Carbapenem stewardship: positive impact on hospital ecology Brazilian Journal of Infectious Diseases carbapenems drug resistance bacterial ecology |
| title | Carbapenem stewardship: positive impact on hospital ecology |
| title_full | Carbapenem stewardship: positive impact on hospital ecology |
| title_fullStr | Carbapenem stewardship: positive impact on hospital ecology |
| title_full_unstemmed | Carbapenem stewardship: positive impact on hospital ecology |
| title_short | Carbapenem stewardship: positive impact on hospital ecology |
| title_sort | carbapenem stewardship positive impact on hospital ecology |
| topic | carbapenems drug resistance bacterial ecology |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702011000100001&lng=en&tlng=en |
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