JAC Advance Access published online on April 14, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn164
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Original research |
Control of extended-spectrum β-lactamase-producing Klebsiella pneumoniae using a computer-assisted management program to restrict third-generation cephalosporin use
1 Division of Infectious Diseases, Korea University Medical Center, Seoul, Republic of Korea 2 Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea 3 Department of Pharmacy, Korea University Medical Center, Seoul, Republic of Korea
Received 13 November 2007; returned 11 March 2008; revised 9 January 2008; accepted 19 March 2008
* Correspondence address. Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1 5-ga, Anam-dong, Sungbuk-gu, Seoul 136-705, Korea. Tel: +82-2-920-5685; Fax: +82-2-920-5616; E-mail: macropha{at}korea.ac.kr
Objectives: The aim of this study was to evaluate the control of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae and antimicrobial resistance through a computerized antibiotic control program.
Methods: An ambidirectional intervention study was conducted at a 750-bed university hospital in Korea from February 2004 to April 2006. In November 2004, hospital-wide restriction of third-generation cephalosporin use was integrated into a pre-existing computerized antibiotic prescription program that included an approval system for 15 antimicrobials. The proportions of ESBL-producing K. pneumoniae and other multidrug-resistant clinical isolates were compared during three phases (9 months per phase): Phase I (pre-intervention), Phase II (intensive-intervention) and Phase III (maintenance).
Results: Third-generation cephalosporin use decreased significantly from 103.2 to 84.9 antibiotic use density (AUD, defined daily dose/1000 patient-days) between Phase I and Phase II (P< 0.05), whereas use of carbapenems and β-lactam/β-lactamase inhibitors increased from 14.5 to 18.2 AUD and from 53.3 to 62.6 AUD, respectively. The proportion of ESBL-producing K. pneumoniae isolates increased significantly from 8.1% (47/578) in Phase I to 32.0% (188/587) in Phase II, and then decreased significantly to 20.6% (97/470) in Phase III (P < 0.05). In addition, the proportions of imipenem- or piperacillin/tazobactam-resistant Pseudomonas aeruginosa and Acinetobacter baumannii isolates decreased significantly over the same period (P < 0.05).
Conclusions: The computerized antibiotic control program appears to be an effective tool for modifying antibiotic consumption, which may in turn prevent the spread of resistant pathogens.
Key Words: antibacterial agents , bacterial drug resistance , cephalosporins , β-lactamases
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  J. Y. Kim and M. J. Kim Control of extended-spectrum {beta}-lactamase-producing Klebsiella pneumoniae by utilizing a computer-assisted management program to restrict third-generation cephalosporin use--authors' response J. Antimicrob. Chemother., July 31, 2008; (2008) dkn324v1. [Full Text] [PDF]
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B. Huttner, D. Pittet, and S. Harbarth Comment on: Control of extended-spectrum {beta}-lactamase-producing Klebsiella pneumoniae using a computer-assisted management program to restrict third-generation cephalosporin use J. Antimicrob. Chemother., July 25, 2008; (2008) dkn310v1. [Full Text] [PDF]
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