Please use this identifier to cite or link to this item: https://observatorio.fm.usp.br/handle/OPI/23998
Title: Carbapenem stewardship - positive impact on hospital ecology
Authors: LIMA, Ana Lucia Lei MunhozOLIVEIRA, Priscila Rosalba Domingos dePAULA, Adriana Pereira deDAL-PAZ, KarineALMEIDA JR., Joao Nobrega deFELIX, Cassia da SilvaROSSI, Flavia
Citation: BRAZILIAN JOURNAL OF INFECTIOUS DISEASES, v.15, n.1, p.1-5, 2011
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.
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Artigos e Materiais de Revistas Científicas - HC/ICHC
Instituto Central - HC/ICHC

Artigos e Materiais de Revistas Científicas - HC/IOT
Instituto de Ortopedia e Traumatologia - HC/IOT

Artigos e Materiais de Revistas Científicas - HU
Hospital Universitário - HU

Artigos e Materiais de Revistas Científicas - LIM/03
LIM/03 - Laboratório de Medicina Laboratorial

Artigos e Materiais de Revistas Científicas - LIM/41
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético


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