Reduced Use of Third‐Generation Cephalosporins Decreases the Acquisition of Extended‐Spectrum Beta‐Lactamase–Producing Klebsiella pneumoniae

• Published in: Infection control and hospital epidemiology 2004-10, Vol.25 (10), p.832-837
• Main Authors: Lee, Sang‐Oh, Lee, Eun Sun, Park, Shin Young, Kim, Sue‐Yun, Seo, Yiel‐Hae, Cho, Yong Kyun
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - pharmacology; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobials; beta-Lactamases - biosynthesis; Biological and medical sciences; Case-Control Studies; Cephalosporins; Cephalosporins - administration & dosage; Cephalosporins - pharmacology; Child; Drug Resistance, Bacterial; Female; Hospital admissions; Hospital units; Humans; Infection control; Infectious diseases; Intensive care units; Intervention; Klebsiella Infections - prevention & control; Klebsiella pneumoniae; Klebsiella pneumoniae - enzymology; Klebsiella pneumoniae - growth & development; Klebsiella pneumoniae - isolation & purification; Male; Medical sciences; Middle Aged; Miscellaneous; Multivariate Analysis; Nursing; Original Articles; Pharmacology. Drug treatments; Predisposing factors; Public health. Hygiene; Public health. Hygiene-occupational medicine; Respiratory System - microbiology; Risk Factors; Teaching hospitals
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/502304

To identify risk factors for the respiratory acquisition of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae among patients admitted to a neurosurgical intensive care unit (NSICU) and to modify them without changing general infection control measures. Nested case-control and intervention study. A 1,200-bed, tertiary-care teaching hospital with a 17-bed NSICU. Sputa of all patients admitted to the NSICU were cultured weekly during the study. From October 2002 through February 2003, 29 case-patients from whose sputum ESBL-producing K. pneumoniae was isolated were detected and 59 controls-patients were randomly selected among patients without any positive isolate of ESBL-producing K. pneumoniae. After analyzing the risk factors, we intervened to modify them and compared the acquisition rate of ESBL-producing K. pneumoniae before (October 2002 to February 2003) and after (April to August 2003) the intervention. Multivariate analysis showed that prior exposure to third-generation cephalosporins (TGCs) (OR, 6.0; CI95, 1.9 to 18.6; P = .002) was an independent risk factor of ESBL-producing K. pneumoniae acquisition. The neurosurgical team was notified of the result, and the infectious diseases specialist visited the NSICU three times a week to regulate TGC use during the intervention period. Patients admitted before the intervention were older than patients admitted after. The respiratory acquisition of ESBL-producing K. pneumoniae per 1,000 patient-days (13.5 [CI95, 8.9 to 18.1] vs 2.7 [CI95, 0.9 to 4.6]) and the antimicrobial use density of TGCs (38.2 +/- 5.0 vs 17.3 +/- 2.6; P < .001) decreased significantly after the intervention. Prior exposure to TGCs was an independent risk factor for the respiratory acquisition of ESBL-producing K. pneumoniae, and less use of TGCs was associated with a decrease in acquisition.