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
dc.contributor.author LIMA, Ana Lucia Lei Munhoz FMUSP-HC
OLIVEIRA, Priscila Rosalba Domingos de FMUSP-HC
PAULA, Adriana Pereira de
DAL-PAZ, Karine FMUSP-HC
ALMEIDA JR., Joao Nobrega de FMUSP-HC
FELIX, Cassia da Silva FMUSP-HC
ROSSI, Flavia FMUSP-HC
dc.date.issued 2011
dc.identifier.citation BRAZILIAN JOURNAL OF INFECTIOUS DISEASES, v.15, n.1, p.1-5, 2011
dc.identifier.issn 1413-8670
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/23998
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
dc.description.group LIM/03
dc.description.group LIM/41
dc.identifier.pmid 21412581
dc.type.category original article
dc.type.version publishedVersion
hcfmusp.author LIMA, Ana Lucia Lei Munhoz:HC:IOT
hcfmusp.author OLIVEIRA, Priscila Rosalba Domingos de:HC:IOT
hcfmusp.author DAL-PAZ, Karine:HU:SVFARMH-62
hcfmusp.author ALMEIDA JR., Joao Nobrega de:HC:ICHC
hcfmusp.author FELIX, Cassia da Silva:HC:IOT
hcfmusp.author ROSSI, Flavia:HC:ICHC
hcfmusp.origem.id 2-s2.0-79955953878
hcfmusp.origem.id WOS:000288385100001
hcfmusp.publisher.city SALVADOR
hcfmusp.publisher.country BRAZIL
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dc.description.index MEDLINE
hcfmusp.citation.scopus 19
hcfmusp.citation.wos 16


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