Impact of Piperacillin/Tazobactam Use to Intestinal Colonization of Extended- spectrum-lactamase Producing Escherichia coli and Klebsiella pneumoniae.
- Author:
Hyun Jong SHIN
1
;
Yoon Suk JANG
;
Mi Ran SEO
;
Hyun Joo PAI
;
Myung Ju AHN
;
Yung Yiul LEE
;
Tae Yeol CHOI
Author Information
1. Division of Infectious Disease, Department of Internal Medicine, Hanyang University Hospital, Seoul, Korea. paihj@hanyang.ac.kr
- Publication Type:Original Article
- Keywords:
Piperacillin/tazobactam;
Extended-spectrum beta-lactamase;
Antimicrobial drug resistance;
Klebsiella pneumoniae;
Escherichia coli
- MeSH:
Anti-Bacterial Agents;
Carbapenems;
Cephalosporins;
Colon*;
Communicable Diseases;
Drug Resistance, Microbial;
Escherichia coli*;
Escherichia*;
Humans;
Klebsiella pneumoniae*;
Klebsiella*;
Mortality;
Pneumonia;
Prospective Studies
- From:
Infection and Chemotherapy
2007;39(2):65-70
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Being able to hydrolyze the majority of b-lactam antibiotics that are currently in use, extended-spectrum b-lactamases (ESBLs) pose a serious clinical problem. In order to solve this problem, it is recommended to use beta-lactam/beta-lactamase inhibitor instead of extended-spectrum cephalosporins. This study investigated the relationship between piperacillin/tazobactam use and ESBL-producing Klebsiella pneumoniae and Escherichia coli in stool colony. MATERIALS AND METHODS: A prospective study was performed in hemato-oncology department patients of Hanyang University Hospital. During the pre-intervention period of 3 months (Feb. 2005 to Apr. 2005), antibiotics were prescribed liberally. During the intervention period of 6 months (May. 2005 to Oct. 2005), use of the 3rd (4th) generation cephalosporins and carbapenems were restricted and piperacillin/tazobactam was recommended. All enrolled patients performed stool culture or rectal swab culture. ESBL confirmed by Double disk synergy test and commercial identification kit. Between the pre-intervention and intervention groups, acquisition rates of ESBL producing organisms were compared. RESULTS: 50 cases were enrolled in pre-intervention period and 112 cases were enrolled in intervention period. In intervention period, use of 3rd (4th) generation cephalosporins and carbapenems decreased from 27 daily define dose/1,000patient/days to 6.82 DDD/1,000patient/days, but use of piperacillin/tazobactam increased from 1.98 DDD/1,000patient/days to 5.66 DDD/1,000patient/days. The intestinal acquisition rate of ESBL producing organism decreased from 30% to 12%. There was no difference in overall mortality of infectious disease between two phase. CONCLUSION: Use of piperacillin/tazobactam instead of extended-spectrum cephalosporins reduces intestinal acquisition rate of ESBL producing K. pneumoniae and E. coli. Therefore, in order to decrease the number of ESBL producing organism, we recommend using piperacillin/tazobactam instead of using extended-spectrum cephalosporins.
