The effect of 3rd generation cephalosporin use restriction on antimicrobial resistance and clinical outcomes among intensive care unit patients

Abstract number: P828

Seo Y.B., Cheong H.J., Choi W.S., Lee J., Song J.Y., Kim W.J.

Objectives: The primary goal of this study was to evaluate the effect of 3rd-generation cephalosporin restriction policy on the changes of the antimicrobial usage among patients admitted to ICU. The secondary goal was to investigate the changes of meticillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) colonisation rate. The third aim was to analyse the differences of the isolation rate of MRSA, VRE, 3rd-generation cephalosporin resistant Acinetobacter baumannii, extended spectrum b-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae from clinical specimens between pre- and post-restriction period. The fourth aim was to estimate the impact on clinical outcomes of patients, including hospital day, infection-related mortality and medical expenses.

Methods: This study was conducted between February 2006 and January 2007: a cross-sectional study with intervention measures. All patients admitted to the intensive care unit were eligible for investigation. Third-generation cephalosporin use restriction program was implemented at March 20, 2006. We compared the differences of antibiotic usage, bacterial resistance and clinical outcomes of patients between 1 month before restriction and after 8 months.

Results: Seventy-four percent reduction in cephalosporin use was observed after 3rd-generation cephalosporin restriction. This was accompanied with increments of piperacillin-tazobactam (781.3%) and 4th-generation cephalosporin (417.1%) use. There was no significant difference in colonisation rate of MRSA and VRE. The isolation rates of MRSA, VRE, 3rd-generation cephalosporin resistant A. baumannii, ESBL-producing E. coli and K. pneumoniae from clinical specimens of sputum and urine did not show significant differenc, while those from blood and CSF were positively correlated with the usage of 3rd-generation cephalosporin. In clinical outcomes, the infection-related mortality and the length of hospotal stay were not different. However, medical expense was decreased significantly.

Conclusion: Despite the significant decrease of 3rd-generation cephalosporin consumption after restriction policy, the bacterial resistance patterns remained unchanged. In clinical outcomes, medical expense was decreased significantly. Restriction of 3rd-generation cephalosporin was demonstrated to be efficient in the view of decreased invasive infections and economics among patients of ICU.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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