Control of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a children's hospital by changing antimicrobial agent usage policy

Jina Lee, Hyunjoo Pai, Yun Kyung Kim, Nam Hee Kim, Byung Wook Eun, Hyoung Jin Kang, Kyoung Ho Park, Eun Hwa Choi, Hee Young Shin, Eui Chong Kim, Hoan Jong Lee, Hyo Seop Ahn

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objectives: This ambidirectional intervention study was performed to examine the impact of a change in antibiotic policy on extended-spectrum b-lactamase (ESBL) prevalence in a children's hospital with a high prevalence of ESBL production among Escherichia coli and Klebsiella pneumoniae. Methods: The use of extended-spectrum cephalosporins was restricted and use of β-lactam/β-lactamase inhibitor combinations was encouraged from 2002. All strains of E. coli and K. pneumoniae isolated from sterile body fluids from 1999 to 2005 were analysed for β-lactamase production and the prevalences of ESBL production were compared at three periods; pre-intervention (1999-2001), transitional period (2002-03) and post-intervention (2004-05). Results: Comparing the pre- and post-intervention periods, overall piperacillin/tazobactam use increased from 2.2 to 108.0 days on antibiotics/1000 patient admission days/year (AD) (P for trend < 0.001), whereas extended-spectrum cephalosporin use decreased from 175.0 to 96.9 AD (P for trend < 0.001). Among 252 strains of E. coli (n = 128) and K. pneumoniae (n = 124), the overall prevalence of ESBL producers decreased from 39.8% (41/103) to 22.8% (18/79) (P for trend = 0.018). This decreasing trend of ESBL production was more evident for K. pneumoniae (64.1% to 25.6%; P for trend < 0.001) than E. coli (25.0% to 19.4%; P for trend = 0.514). The mortality rates of invasive disease caused by E. coli or K. pneumoniae remained unchanged. Conclusions: The substitution of piperacillin/tazobactam for extended-spectrum cephalosporins successfully decreased the prevalence of ESBL production of K. pneumoniae and E. coli in an institute for children where ESBLs were endemic. The impact of change in antibiotic policy was more evident in K. pneumoniae than E. coli.

Original languageEnglish
Pages (from-to)629-637
Number of pages9
JournalJournal of Antimicrobial Chemotherapy
Volume60
Issue number3
DOIs
Publication statusPublished - 2007 Sep 1

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Klebsiella pneumoniae
Anti-Infective Agents
Escherichia coli
Cephalosporins
Anti-Bacterial Agents
Lactams
Patient Admission
Body Fluids
Mortality

Keywords

  • Cephalosporins
  • Intervention studies
  • Piperacillin/tazobactam

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Control of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a children's hospital by changing antimicrobial agent usage policy. / Lee, Jina; Pai, Hyunjoo; Kim, Yun Kyung; Kim, Nam Hee; Eun, Byung Wook; Kang, Hyoung Jin; Park, Kyoung Ho; Choi, Eun Hwa; Shin, Hee Young; Kim, Eui Chong; Lee, Hoan Jong; Ahn, Hyo Seop.

In: Journal of Antimicrobial Chemotherapy, Vol. 60, No. 3, 01.09.2007, p. 629-637.

Research output: Contribution to journalArticle

Lee, Jina ; Pai, Hyunjoo ; Kim, Yun Kyung ; Kim, Nam Hee ; Eun, Byung Wook ; Kang, Hyoung Jin ; Park, Kyoung Ho ; Choi, Eun Hwa ; Shin, Hee Young ; Kim, Eui Chong ; Lee, Hoan Jong ; Ahn, Hyo Seop. / Control of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a children's hospital by changing antimicrobial agent usage policy. In: Journal of Antimicrobial Chemotherapy. 2007 ; Vol. 60, No. 3. pp. 629-637.
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abstract = "Objectives: This ambidirectional intervention study was performed to examine the impact of a change in antibiotic policy on extended-spectrum b-lactamase (ESBL) prevalence in a children's hospital with a high prevalence of ESBL production among Escherichia coli and Klebsiella pneumoniae. Methods: The use of extended-spectrum cephalosporins was restricted and use of β-lactam/β-lactamase inhibitor combinations was encouraged from 2002. All strains of E. coli and K. pneumoniae isolated from sterile body fluids from 1999 to 2005 were analysed for β-lactamase production and the prevalences of ESBL production were compared at three periods; pre-intervention (1999-2001), transitional period (2002-03) and post-intervention (2004-05). Results: Comparing the pre- and post-intervention periods, overall piperacillin/tazobactam use increased from 2.2 to 108.0 days on antibiotics/1000 patient admission days/year (AD) (P for trend < 0.001), whereas extended-spectrum cephalosporin use decreased from 175.0 to 96.9 AD (P for trend < 0.001). Among 252 strains of E. coli (n = 128) and K. pneumoniae (n = 124), the overall prevalence of ESBL producers decreased from 39.8{\%} (41/103) to 22.8{\%} (18/79) (P for trend = 0.018). This decreasing trend of ESBL production was more evident for K. pneumoniae (64.1{\%} to 25.6{\%}; P for trend < 0.001) than E. coli (25.0{\%} to 19.4{\%}; P for trend = 0.514). The mortality rates of invasive disease caused by E. coli or K. pneumoniae remained unchanged. Conclusions: The substitution of piperacillin/tazobactam for extended-spectrum cephalosporins successfully decreased the prevalence of ESBL production of K. pneumoniae and E. coli in an institute for children where ESBLs were endemic. The impact of change in antibiotic policy was more evident in K. pneumoniae than E. coli.",
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author = "Jina Lee and Hyunjoo Pai and Kim, {Yun Kyung} and Kim, {Nam Hee} and Eun, {Byung Wook} and Kang, {Hyoung Jin} and Park, {Kyoung Ho} and Choi, {Eun Hwa} and Shin, {Hee Young} and Kim, {Eui Chong} and Lee, {Hoan Jong} and Ahn, {Hyo Seop}",
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AU - Lee, Jina

AU - Pai, Hyunjoo

AU - Kim, Yun Kyung

AU - Kim, Nam Hee

AU - Eun, Byung Wook

AU - Kang, Hyoung Jin

AU - Park, Kyoung Ho

AU - Choi, Eun Hwa

AU - Shin, Hee Young

AU - Kim, Eui Chong

AU - Lee, Hoan Jong

AU - Ahn, Hyo Seop

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N2 - Objectives: This ambidirectional intervention study was performed to examine the impact of a change in antibiotic policy on extended-spectrum b-lactamase (ESBL) prevalence in a children's hospital with a high prevalence of ESBL production among Escherichia coli and Klebsiella pneumoniae. Methods: The use of extended-spectrum cephalosporins was restricted and use of β-lactam/β-lactamase inhibitor combinations was encouraged from 2002. All strains of E. coli and K. pneumoniae isolated from sterile body fluids from 1999 to 2005 were analysed for β-lactamase production and the prevalences of ESBL production were compared at three periods; pre-intervention (1999-2001), transitional period (2002-03) and post-intervention (2004-05). Results: Comparing the pre- and post-intervention periods, overall piperacillin/tazobactam use increased from 2.2 to 108.0 days on antibiotics/1000 patient admission days/year (AD) (P for trend < 0.001), whereas extended-spectrum cephalosporin use decreased from 175.0 to 96.9 AD (P for trend < 0.001). Among 252 strains of E. coli (n = 128) and K. pneumoniae (n = 124), the overall prevalence of ESBL producers decreased from 39.8% (41/103) to 22.8% (18/79) (P for trend = 0.018). This decreasing trend of ESBL production was more evident for K. pneumoniae (64.1% to 25.6%; P for trend < 0.001) than E. coli (25.0% to 19.4%; P for trend = 0.514). The mortality rates of invasive disease caused by E. coli or K. pneumoniae remained unchanged. Conclusions: The substitution of piperacillin/tazobactam for extended-spectrum cephalosporins successfully decreased the prevalence of ESBL production of K. pneumoniae and E. coli in an institute for children where ESBLs were endemic. The impact of change in antibiotic policy was more evident in K. pneumoniae than E. coli.

AB - Objectives: This ambidirectional intervention study was performed to examine the impact of a change in antibiotic policy on extended-spectrum b-lactamase (ESBL) prevalence in a children's hospital with a high prevalence of ESBL production among Escherichia coli and Klebsiella pneumoniae. Methods: The use of extended-spectrum cephalosporins was restricted and use of β-lactam/β-lactamase inhibitor combinations was encouraged from 2002. All strains of E. coli and K. pneumoniae isolated from sterile body fluids from 1999 to 2005 were analysed for β-lactamase production and the prevalences of ESBL production were compared at three periods; pre-intervention (1999-2001), transitional period (2002-03) and post-intervention (2004-05). Results: Comparing the pre- and post-intervention periods, overall piperacillin/tazobactam use increased from 2.2 to 108.0 days on antibiotics/1000 patient admission days/year (AD) (P for trend < 0.001), whereas extended-spectrum cephalosporin use decreased from 175.0 to 96.9 AD (P for trend < 0.001). Among 252 strains of E. coli (n = 128) and K. pneumoniae (n = 124), the overall prevalence of ESBL producers decreased from 39.8% (41/103) to 22.8% (18/79) (P for trend = 0.018). This decreasing trend of ESBL production was more evident for K. pneumoniae (64.1% to 25.6%; P for trend < 0.001) than E. coli (25.0% to 19.4%; P for trend = 0.514). The mortality rates of invasive disease caused by E. coli or K. pneumoniae remained unchanged. Conclusions: The substitution of piperacillin/tazobactam for extended-spectrum cephalosporins successfully decreased the prevalence of ESBL production of K. pneumoniae and E. coli in an institute for children where ESBLs were endemic. The impact of change in antibiotic policy was more evident in K. pneumoniae than E. coli.

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