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Association of Antibiotic Utilization Measures and Control of Multiple-Drug Resistance in Klebsiella pneumoniae

Published online by Cambridge University Press:  02 January 2015

Jan E. Patterson ,
Thomas C. Hardin ,
Cindy A. Kelly ,
Rosa C. Garcia  and
James H. Jorgensen
Jan E. Patterson*
Affiliation:
Departments of Medicine and Pathology, University of Texas Health Science Center at San Antonio, University Health System, and South Texas Veterans' Health Care System, San Antonio, Texas
Thomas C. Hardin
Affiliation:
Departments of Medicine and Pathology, University of Texas Health Science Center at San Antonio, University Health System, and South Texas Veterans' Health Care System, San Antonio, Texas
Cindy A. Kelly
Affiliation:
Departments of Medicine and Pathology, University of Texas Health Science Center at San Antonio, University Health System, and South Texas Veterans' Health Care System, San Antonio, Texas
Rosa C. Garcia
Affiliation:
Departments of Medicine and Pathology, University of Texas Health Science Center at San Antonio, University Health System, and South Texas Veterans' Health Care System, San Antonio, Texas
James H. Jorgensen
Affiliation:
Departments of Medicine and Pathology, University of Texas Health Science Center at San Antonio, University Health System, and South Texas Veterans' Health Care System, San Antonio, Texas
*
Dept of Medicine (Infectious Diseases), 7703 Floyd Curl Dr, Mail Code 7881, San Antonio, TX, 78229-3900
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Abstract

Objective:

To study the association of antibiotic-utilization measures and control of multidrug-resistant (MDR) Klebsiella pneumoniae after emergence in two hospitals in our medical center.

Design and Setting:

Rates of MDR K pneumoniae at two hospitals were compared before and after acute interventions, including emphasis on Contact Precautions and education in antibiotic utilization. Antipseudomonal β-lactam antibiotic use was measured before and after the interventions at both hospitals. Pulsed-field gel electrophoresis of whole cell DNA was used as a marker of strain identity.

Results:

Clonal strain dissemination was the major mechanism of emergence at hospital A; emergence was polyclonal at hospital B. Antibiotic-utilization interventions at both institutions included physician education regarding the association of ceftazidime use and MDR K pneumoniae. At hospital A, ceftazidime use decreased from 4,301 g in the preintervention period, to 1,248 g in the postintervention period. Piperacillin-tazobactam use increased from 12,455 g to 17,464 g. Ceftazidime resistance in Kpneumoniae decreased from 110 (22%) of 503 isolates to 61 (15%) of 407 isolates (P<.05); piperacillin-tazobactam resistance decreased from 181 (36%) of 503 to 77 (19%) of 407 isolates (P<.05). At hospital B, ceftazidime use decreased from 6,533 g in the preintervention period to 4,792 g in the postintervention period. Piperacillin-tazobactam use increased from 58,691 g to 67,027 g. Ceftazidime resistance in K pneumoniae decreased from 42 (10%) of 415 isolates to 19 (5%) of 383 isolates (P<.05). Piperacillin-tazobactam resistance decreased from 91 (22%) of 415 isolates to 54 (14%) of 383 isolates (P<.05). Follow-up data showed continued decrease in piperacillin-tazobactam resistance despite increased use at both hospitals.

Conclusions:

Antibiotic-use measures may be particularly important for control of MDR K pneumoniae, whether emergence is clonal or polyclonal.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 7 , July 2000 , pp. 455 - 458
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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