Carbapenem stewardship - positive impact on hospital ecology

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP LIMA, Ana Lucia Lei Munhoz FMUSP-HC
OLIVEIRA, Priscila Rosalba Domingos de FMUSP-HC
PAULA, Adriana Pereira de
ALMEIDA JR., Joao Nobrega de FMUSP-HC
FELIX, Cassia da Silva FMUSP-HC
ROSSI, Flavia FMUSP-HC 2011
dc.identifier.citation BRAZILIAN JOURNAL OF INFECTIOUS DISEASES, v.15, n.1, p.1-5, 2011
dc.identifier.issn 1413-8670
dc.description.abstract Introduction: Excessive group 2 carbapenem use may result in decreased bacterial susceptibility. Objective: We evaluated the impact of a carbapenem stewardship program, restricting imipenem and meropenem use. Methods: Ertapenem was mandated for ESBL-producing Enterobacteriaceae infections in the absence of non-fermenting Gram-negative bacilli (GNB) from April 2006 to March 2008. Group 2 carbapenems were restricted for use against GNB infections susceptible only to carbapenems and suspected GNB infections in unstable patients. Cumulative susceptibility tests were done for nosocomial pathogens before and after restriction using Clinical and Laboratory Standards Institute (CLSI) guidelines. Vitek System or conventional identification methods were performed and susceptibility testing done by disk diffusion according to CLSI. Antibiotic consumption (t-test) and susceptibilities (McNemar's test) were determined. Results: The defined daily doses (DDD) of group 2 carbapenems declined from 61.1 to 48.7 DDD/1,000 patient-days two years after ertapenem introduction (p = 0.027). Mean ertapenem consumption after restriction was 31.5 DDD/1,000 patient-days. Following ertapenem introduction no significant susceptibility changes were noticed among Gram-positive cocci. The most prevalent GNB were P. aeruginosa, Klebsiella pneumoniae, and Acinetobacter spp. There was no change in P. aeruginosa susceptibility to carbapenems. Significantly improved P. aeruginosa and K. pneumoniae ciprofloxacin susceptibilities were observed, perhaps due to decreased group 2 carbapenem use. K. pneumoniae susceptibility to trimethoprim-sulfamethoxazole improved. Conclusion: Preferential use of ertapenem resulted in reduced group 2 carbapenem use, with a positive impact on P. aeruginosa and K. pneumoniae susceptibility.
dc.description.sponsorship · Merck, Sharp Dohme
dc.language.iso eng
dc.publisher CONTEXTO
dc.relation.ispartof Brazilian Journal of Infectious Diseases
dc.rights openAccess
dc.subject carbapenems; drug resistance; bacterial ecology
dc.subject.other pseudomonas-aeruginosa; antimicrobial resistance; klebsiella-pneumoniae; ertapenem; infections; consumption; prevalence; imipenem
dc.title Carbapenem stewardship - positive impact on hospital ecology
dc.type article
dc.rights.holder Copyright CONTEXTO LIM/03 LIM/41
dc.identifier.pmid 21412581
dc.type.category original article
dc.type.version publishedVersion LIMA, Ana Lucia Lei Munhoz:HC:IOT OLIVEIRA, Priscila Rosalba Domingos de:HC:IOT DAL-PAZ, Karine:HU:SVFARMH-62 ALMEIDA JR., Joao Nobrega de:HC:ICHC FELIX, Cassia da Silva:HC:IOT ROSSI, Flavia:HC:ICHC 2-s2.0-79955953878 WOS:000288385100001 SALVADOR BRAZIL
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dc.description.index MEDLINE
hcfmusp.citation.scopus 19
hcfmusp.citation.wos 16

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