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Carbapenem stewardship: positive impact on hospital ecology
Lima, Ana Lucia Lei Munhoz; Oliveira, Priscila Rosalba Domingos de; Paula, Adriana Pereira de; Dal-Paz, Karine; Almeida Júnior, João Nóbrega de; Félix, Cássia da Silva; Rossi, Flávia.
Afiliação
  • Lima, Ana Lucia Lei Munhoz; Universidade de São Paulo. School of Medicine. Hospital das Clínicas. Institute of Orthopedics and Traumatology Infection Control Service. BR
  • Oliveira, Priscila Rosalba Domingos de; LIM. Microbiology Laboratory. Infection Control Service.
  • Paula, Adriana Pereira de; USP. School of Medicine. Hospital das Clínicas. Infection Control Service. BR
  • Dal-Paz, Karine; USP. School of Medicine. Institute of Orthopedics and Traumatology. Infection Service. BR
  • Almeida Júnior, João Nóbrega de; USP. School of Medicine. Hospital das Clínicas. LIM 03 Divisão de Laboratório Central Microbiology Laboratory. BR
  • Félix, Cássia da Silva; USP. School of Medicine. Hospital das Clínicas. Institute of Orthopedics and Traumatology Infection Service. BR
  • Rossi, Flávia; USP. School of Medicine. Hospital das Clínicas. LIM 03 Divisão de Laboratório Central Microbiology Laboratory. BR
Braz. j. infect. dis ; 15(1): 1-5, Jan.-Feb. 2011. tab
Artigo em Inglês | LILACS | ID: lil-576777
Biblioteca responsável: BR1.1
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) guide-lines.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.
Assuntos


Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: Doenças Negligenciadas Problema de saúde: Doenças Negligenciadas / Zoonoses Base de dados: LILACS Assunto principal: Pseudomonas aeruginosa / Acinetobacter / Carbapenêmicos / Infecção Hospitalar / Enterobacteriaceae / Antibacterianos Tipo de estudo: Guia de prática clínica Limite: Humanos Idioma: Inglês Revista: Braz. j. infect. dis Assunto da revista: Doenças Transmissíveis Ano de publicação: 2011 Tipo de documento: Artigo País de afiliação: Brasil Instituição/País de afiliação: USP/BR / Universidade de São Paulo/BR

Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: Doenças Negligenciadas Problema de saúde: Doenças Negligenciadas / Zoonoses Base de dados: LILACS Assunto principal: Pseudomonas aeruginosa / Acinetobacter / Carbapenêmicos / Infecção Hospitalar / Enterobacteriaceae / Antibacterianos Tipo de estudo: Guia de prática clínica Limite: Humanos Idioma: Inglês Revista: Braz. j. infect. dis Assunto da revista: Doenças Transmissíveis Ano de publicação: 2011 Tipo de documento: Artigo País de afiliação: Brasil Instituição/País de afiliação: USP/BR / Universidade de São Paulo/BR
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