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Absence of Association between Use of Ertapenem and Change in Antipseudomonal Carbapenem Susceptibility Rates in 25 Hospitals

Published online by Cambridge University Press:  02 January 2015

Kathryn J. Eagye  and
David P. Nicolau
Kathryn J. Eagye
Affiliation:
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
David P. Nicolau*
Affiliation:
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut Division of Infectious Diseases, Hartford Hospital, Hartford, Connecticut
*
Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour St, Hartford, CT 06102, ([email protected])
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Abstract

Objective.

Ertapenem exposure has been reported to select for cross-resistance to other carbapenems in Pseudomonas aeruginosa in vitro. Single-center investigations report conflicting results. We evaluated ertapenem use and antipseudomonal carbapenem susceptibility for 6 years spanning the time of ertapenem adoption at each of 25 US hospitals.

Design.

Retrospective primary and secondary data analysis.

Methods.

Use density ratios for imipenem and meropenem (collectively, “other carbapenems”) and ertapenem were derived from data in a commercial database on the total number of grams used in the 3 years before and the 3 years after adoption of ertapenem at each hospital. A general linear model using repeated measures analysis of variance was used to explore associations between the 6-year change in antipseudomonal carbapenem susceptibility rates (determined from hospital antibiograms) and ertapenem use in each year, while controlling for other carbapenem use.

Results.

Ertapenem use increased once adopted. With regard to the postadoption period, the median use density ratio for year 4 was 4.1 (interquartile range [IQR], 1.7-5.2), for year 5 was 6.0 (IQR, 2.7-8.5), and for year 6 was 6.5 (IQR, 4.0-11.6). The median use density ratio for other carbapenem use for year 1 was 8.7 (IQR, 5.7-13.5), and by year 6 it had increased to 19.3 (IQR, 9.6-26.2). Change in mean antipseudomonal carbapenem susceptibility across time (85% in year 1 to 82% in year 6) was not significant (P = .22). Change in 6-year antipseudomonal carbapenem susceptibility was not associated with ertapenem use in any year while controlling for other carbapenem use (P > .20 for all years of ertapenem use).

Conclusion.

Although significant change in P. aeruginosa susceptibility to antipseudomonal carbapenems was not detected during this multicenter study, which to our knowledge is the most extensive assessment to date of this important drug use-susceptibility relationship, continued evaluation of the relationship is prudent.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 5 , May 2010 , pp. 485 - 490
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Livermore, DM, Carter, MW, Bagel, S, et al.In vitro activities of ertapenem (MK-0826) against recent clinical bacteria collected in Europe and Australia. Antimicrob Agents Chemother 2001;45(6):1860–1867.CrossRefGoogle ScholarPubMed
2.Fuchs, PC, Barry, AL, Brown, SD. In vitro activities of ertapenem (MK-0826) against clinical bacterial isolates from 11 North American medical centers. Antimicrob Agents Chemother 2001;45(6):1915–1918.CrossRefGoogle ScholarPubMed
3.Livermore, DM, Mushtaq, S, Warner, M. Selectivity of ertapenem for Pseudomonas aeruginosa mutants cross-resistant to other carbapenems. J Antimicrob Chemother 2005;55(3):306–311.CrossRefGoogle ScholarPubMed
4.Mushtaq, S, Ge, Y, Livermore, DM. Doripenem versus Pseudomonas aeruginosa in vitro: activity against characterized isolates, mutants, and trans-conjugants and resistance selection potential. Antimicrob Agents Chemother 2004;48(8):3086–3092.Google Scholar
5.Goff, DA, Mangino, JE. Ertapenem: no effect on aerobic gram-negative susceptibilities to imipenem. J Infect 2008;57(2): 123–127.CrossRefGoogle ScholarPubMed
6.Lima, AL, Oliveira, PR, Paula, AP, Zumiotti, AV. Influence of ertapenem administration on the incidence of carbapenem-resistant Pseudomonas aeruginosa. Braz J Infect Dis 2008;12(2):105–106.Google Scholar
7.Vali, L, Hamouda, A, Schnieders, T, Amyes, SGB. The potential for the emergence of carbapenem resistance when weaker carbapenems are prescribed. In: Program and abstracts of the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/Infectious Diseases Society of America 46th Annual Meeting. 2008. Washington, DC. Abstract Cl-107.Google Scholar
8.Beovic, B, Kreft, S, Seme, K, Cizman, M. Does use of ertapenem influence carbapenem resistance in Pseudomonas aeruginosa? In: Program and abstracts of the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/Infectious Diseases Society of America 46th Annual Meeting. 2008. Washington, DC. Abstract C2-210.Google Scholar
9.Crank, CW, Segreti, J, Hota, B. Effect of ertapenem use on Pseudomonas aeruginosa susceptibility to carbapenems. In: Program and abstracts of the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/Infectious Diseases Society of America 46th Annual Meeting. 2008. Washington, DC. Abstract K-3502.Google Scholar
10.Peterson, LR. Squeezing the antibiotic balloon: the impact of antimicrobial classes on emerging resistance. Clin Microbiol Infect 2005;11(suppl 5):4–16.CrossRefGoogle ScholarPubMed
11.Falagas, ME, Kopterides, P. Risk factors for the isolation of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature. J Hosp Infect 2006;64(1):7–15.Google Scholar
12.Paramythiotou, E, Lucet, JC, Timsit, JF, et al.Acquisition of multidrug-resistant Pseudomonas aeruginosa in patients in intensive care units: role of antibiotics with antipseudomonal activity. Clin Infect Dis 2004;38(5): 670–677.CrossRefGoogle ScholarPubMed
13. WHOCC ATC/DDD Index, http://www.whocc.no/atcddd/. Accessed June 1, 2009.Google Scholar
14.Schwaber, MJ, De-Medina, T, Carmeli, Y. Epidemiological interpretation of antibiotic resistance studies—what are we missing? Nat Rev Microbiol 2004;2(12):979–983.CrossRefGoogle ScholarPubMed
15.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through Juné 2004, issued October 2004. Am J Infect Control 2004;32(8):470–485.CrossRefGoogle Scholar
16.Jones, RN. Global epidemiology of antimicrobial resistance among community-acquired and nosocomial pathogens: a five-year summary from the SENTRY Antimicrobial Surveillance Program (1997-2001). Semin Respir Crit Care Med 2003;24(1):121–134.CrossRefGoogle ScholarPubMed
17.Rosenthal, VD, Maki, DG, Mehta, A, et al.International Nosocomial Infection Control Consortium report, data summary for 2002-2007, issued January 2008. Am J Infect Control 2008;36(9):627–637.Google Scholar
18.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;51(5): 1983–1986.Google Scholar
19.Pakyz, A, Powell, JP, Harpe, SE, Johnson, C, Edmond, M, Polk, RE. Diversity of antimicrobial use and resistance in 42 hospitals in the United States. Pharmacotherapy 2008;28(7):906–912.Google Scholar
20.Eagye, KJ, Kuti, JL, Nicolau, DP. Risk factors and outcomes associated with isolation of meropenem high-level-resistant Pseudomonas aeruginosa. Infect Control Hosp Epidemiol 2009;30(8):746–752.CrossRefGoogle ScholarPubMed