Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-27T00:22:27.893Z Has data issue: false hasContentIssue false
  • English
  • Français

Decreased Resistance of Pseudomonas aeruginosa with Restriction of Ciprofloxacin in a Large Teaching Hospital's Intensive Care and Intermediate Care Units

Published online by Cambridge University Press:  02 January 2015

G. Jonathan Lewis ,
Xiangming Fang ,
Michael Gooch  and
Paul P. Cook
G. Jonathan Lewis*
Affiliation:
Vidant Medical Center (formerly Pitt County Memorial Hospital), Greenville, North Carolina
Xiangming Fang
Affiliation:
East Carolina University, Greenville, North Carolina
Michael Gooch
Affiliation:
East Carolina University, Greenville, North Carolina
Paul P. Cook
Affiliation:
Vidant Medical Center (formerly Pitt County Memorial Hospital), Greenville, North Carolina
*
Doctors Park 6A, Greenville, NC 27834 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To examine the effect of restricting ciprofloxacin on the resistance of nosocomial gram-negative bacilli, including Pseudomonas aeruginosa, to antipseudomonal carbapenems.

Design.

Interrupted time-series analysis.

Setting.

Tertiary care teaching hospital with 11 intensive care and intermediate care units with a total of 295 beds.

Patients.

All nosocomial isolates of P. aeruginosa.

Intervention.

Restriction of ciprofloxacin.

Results.

There was a significant decreasing trend observed in the percentage (P = .0351) and the rate (P = .0006) of isolates of P. aeruginosa that were resistant to antipseudomonal carbapenems following the restriction of ciprofloxacin. There was also a significant decreasing trend observed in the percentage (P = .0017) and the rate (P = .0001) of isolates of ciprofloxacin-resistant P. aeruginosa. The rate of cefepime-resistant P. aeruginosa isolates declined (P = .004 ) but the percentage of cefepime-resistant P. aeruginosa isolates did not change. There were no significant changes observed in the rate or the percentage of piperacillin-tazobactam-resistant P. aeruginosa isolates. There were no significant changes observed in the susceptibilities of nosocomial Enterobacteriaciae or Acinetobacter baumannii isolates that were resistant to carbapenems. Over the study period there was a significant increase in the use of carbapenems (P = .0134); the use of ciprofloxacin decreased significantly (P = .0027). There were no significant changes in the use of piperacillin-tazobactam or cefepime.

Conclusion.

Restriction of ciprofloxacin was associated with a decreased resistance of P. aeruginosa isolates to antipseudomonal carbapenems and ciprofloxacin in our hospital's intermediate care and intensive care units. There were no changes observed in the susceptibilities of nosocomial Enterobacteriaciae or A. baumannii to carbapenems, despite increased carbapenem use. Reducing ciprofloxacin use may be a means of controlling multidrug-resistant P. aeruginosa.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 4: Special Topic Issue: Antimicrobial Stewardship , April 2012 , pp. 368 - 373
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Neuhauser, MM, Weinstein, RA, Rydman, R, Danziger, LH, Karam, G, Quinn, JR Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use. JAMA 2003;289:885–888.Google ScholarPubMed
2. Dellit, TH, Owens, RC, McGowan, JE Jr., et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159–177.CrossRefGoogle Scholar
3. Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163:972–978.CrossRefGoogle ScholarPubMed
4. John, JF Jr, Fishman, NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997;24:471–485.CrossRefGoogle ScholarPubMed
5. Erlandsson, M, Burman, LG, Cars, O, et al. Prescription of antibiotic agents in Swedish intensive care units is empiric and precise. Scand J Infect Dis 2007;39:63–69.CrossRefGoogle ScholarPubMed
6. Warren, MM, Gibb, AP, Walsh, TS. Antibiotic prescription practice in an intensive care unit using twice-weekly collection of screening specimens: a prospective audit in a large UK teaching hospital. J Hosp Infect 2005;59:90–95.CrossRefGoogle Scholar
7. Kaki, R, Elligsen, M, Walker, S, Simor, A, Palmay, L, Daneman, N. Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother 2011;66:1223–1230.CrossRefGoogle ScholarPubMed
8. Weber, DJ, Raasch, R, Rutala, WA. Nosocomial infections in the ICU: the growing importance of antibiotic-resistant pathogens. Chest 1999;115(Suppl 3):S34–S41.CrossRefGoogle ScholarPubMed
9. Eggimann, P, Pittet, D. Infection control in the ICU. Chest 2001; 120:2059–2093.CrossRefGoogle ScholarPubMed
10. Kallen, AJ, Hidron, AI, Patel, J, Srinivasan, A. Multidrug resistance among gram-negative pathogens that caused healthcare-associated infections reported to the National Healthcare Safety Network, 2006-2008. Infect Control Hosp Epidemiol 2010;31:528–531.CrossRefGoogle Scholar
11. Njoku, JC, Hermsen, ED. Antimicrobial stewardship in the intensive care unit: a focus on potential pitfalls. J Pharm Pract 2010;23:50–60.CrossRefGoogle ScholarPubMed
12. Cook, PP, Das, TD, Gooch, M, Catrou, PG. Effect of a program to reduce hospital ciprofloxacin use on nosocomial Pseudomonas aeruginosa susceptibility to quinolones and other antimicrobial agents. Infect Control Hosp Epidemiol 2008;29:716–722.CrossRefGoogle ScholarPubMed
13. Pfaller, MA, Jones, RN, Doern, GV, Kugler, K. Bacterial pathogens isolated from patients with bloodstream infection: frequencies of occurrence and antimicrobial susceptibility patterns from the SENTRY antimicrobial surveillance program (United States and Canada, 1997). Antimicrob Agents Chemother 1998;42:1762–1770.CrossRefGoogle Scholar
14. Jones, RN. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis 2010;51(Suppl 1):S81–S87.CrossRefGoogle ScholarPubMed
15. Lautenbach, E, Weiner, MG, Nachamkin, I, Bilker, WB, Sheridan, A, Fishman, NO. Imipenem resistance among Pseudomonas aeruginosa isolates: risk factors for infection and impact of resistance on clinical and economic outcomes. Infect Control Hosp Epidemiol 2006;27:893–900.CrossRefGoogle ScholarPubMed
16. King, A, Shannon, K, Phillips, I. Resistance to imipenem in Pseudomonas aeruginosa . J Antimicrob Chemother 1995;36:1037–1041.CrossRefGoogle ScholarPubMed
17. Lautenbach, E, Synnestvedt, M, Weiner, MG, et al. Imipenem resistance in Pseudomonas aeruginosa: emergence, epidemiology, and impact on clinical and economic outcomes. Infect Control Hosp Epidemiol 2010;31:47–53.CrossRefGoogle ScholarPubMed
18. Kang, CI, Kim, SH, Kim, HB, et al. Pseudomonas aeruginosa bacteremia: risk factors for mortality and influence of delayed receipt of effective antimicrobial therapy on clinical outcome. Clin Infect Dis 2003;37:745–751.CrossRefGoogle Scholar
19. Obritsch, MD, Fish, DN, MacLaren, R, Jung, R. National surveillance of antimicrobial resistance in Pseudomonas aeruginosa isolates obtained from intensive care unit patients from 1993 to 2002. Antimicrob Agents Chemother 2004;48:4606–4610.CrossRefGoogle ScholarPubMed
20. Joo, EJ, Kang, CI, Ha, YE, et al. Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia: clinical impact of antimicrobial resistance on outcome. Microb Drug Resist 2011;17:305–312.CrossRefGoogle ScholarPubMed
21. Mohr, JF, Jones, A, Ostrosky-Zeichner, L, Wanger, A, Tillotson, G. Associations between antibiotic use and changes in susceptibility patterns of Pseudomonas aeruginosa in a private, university-affiliated teaching hospital: an 8-year-experience: 1995-2002. Int J Antimicrob Agents 2004;24:346–351.CrossRefGoogle Scholar
22. Messadi, AA, Lamia, T, Kamei, B, Salima, O, Monia, M, Saida, BR. Association between antibiotic use and changes in susceptibility patterns of Pseudomonas aeruginosa in an intensive care burn unit: a 5-year study, 2000-2004. Burns 2008;34:1098–1102.CrossRefGoogle Scholar
23. Carmeli, Y, Troillet, N, Eliopoulos, GM, Samore, MH. Emergence of antibiotic-resistant Pseudomonas aeruginosa: comparison of risks associated with different antipseudomonal agents. Antimicrob Agents Chemother 1999;43:1379–1382.CrossRefGoogle ScholarPubMed
24. Harris, AD, Smith, D, Johnson, JA, Bradham, DD, Roghmann, MC. Risk factors for imipenem-resistant Pseudomonas aeruginosa among hospitalized patients. Clin Infect Dis 2002;34:340–345.CrossRefGoogle ScholarPubMed
25. Lepper, PM, Grusa, E, Reichl, H, Högel, J, Trautmann, M. Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa . Antimicrob Agents Chemother 2002;46:2920–2925.CrossRefGoogle ScholarPubMed
26. Cook, PP, Catrou, PG, Christie, JD, Young, PD, Polk, RE. Reduction in broad-spectrum antimicrobial use associated with no improvement in hospital antibiogram. J Antimicrob Chemother 2004;53:853–859.CrossRefGoogle ScholarPubMed
27. Aubert, G, Carricajo, A, Vautrin, AC, et al. Impact of restricting fluoroquinolone prescription on bacterial resistance in an intensive care unit. J Hosp Infect 2005;59:83–89.Google Scholar
28. Pakyz, AL, Oinonen, M, Polk, RE. Relationship of carbapenem restriction in 22 university teaching hospitals to carbapenem use and carbapenem-resistant Pseudomonas aeruginosa . Antimicrob Agents Chemother 2009;53:1983–1986.CrossRefGoogle ScholarPubMed
29. Pai, H, Kim, J, Kim, J, Lee, JH, Choe, KW, Gotoh, N. Carbapenem resistance mechanisms in Pseudomonas aeruginosa clinical isolates. Antimicrob Agents Chemother 2001;45:480–484.CrossRefGoogle ScholarPubMed
30. Köhler, T, Michea-Hamzehpour, M, Epp, SF, Pechere, JC. Carbapenem activities against Pseudomonas aeruginosa: respective contributions of OprD and efflux systems. Antimicrob Agents Chemother 1999;43:424–427.CrossRefGoogle ScholarPubMed
31. Livermore, DM. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Clin Infect Dis 2002;34:634–640.CrossRefGoogle ScholarPubMed
32. Ochs, MM, McCusker, MP, Bains, M, Hancock, RE. Negative regulation of the Pseudomonas aeruginosa outer membrane porin OprD selective for imipenem and basic amino acids. Antimicrob Agents Chemother 1999;43:1085–1090.CrossRefGoogle ScholarPubMed
33. Rhomberg, PR, Jones, RN. Summary trends for the meropenem yearly susceptibility test information collection program: a 10-year experience in the United States (1999-2008). Diagn Microbiol Infect Dis 2009;65:414–426.CrossRefGoogle Scholar
34. Cook, PP, Gooch, M, Rizzo, S. Reduction in fluoroquinolone use following introduction of ertapenem into a hospital formulary is associated with improvement in susceptibility of Pseudomonas aeruginosa to group 2 carbapenems: a 10-year study. Antimicrob Agents Chemother 2011;55:5597–5601.CrossRefGoogle Scholar