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 Original Articles |
| Impact of Piperacillin/Tazobactam Use to Intestinal Colonization of Extended- spectrum-lactamase Producing Escherichia coli and Klebsiella pneumoniae |
| Hyun Jong Shin, M.D.1, Yoon Suk Jang, M.D.4, Mi Ran Seo, M.D.1, Hyun Joo Pai, M.D.1, Myung Ju Ahn, M.D.2, Yung Yiul Lee, M.D.2 and Tae Yeol Choi, M.D.3 |
| Division of Infectious Disease1, Division of Hemato-oncology2, Department of Internal MedicineDepartment of Clinical Pathology3, Infection control observatory4, Hanyang University Hospital, Seoul, Korea. |
Vol.39 Num.2 (p65~70)
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Background:Being able to hydrolyze the majority of b-lactam antibiotics that are currently in use, extended-spectrum b-lactamases (ESBLs) pose a serious clinical problem. In order to solve this problem, it is recommended to use β-lactam/β-lactamase inhibitor instead of extended-spectrum cephalosporins. This study investigated the relationship between piperacillin/tazobactam use and ESBL-producing Klebsiella pneumoniae and Escherichia coli in stool colony.
Materials and Methods:A prospective study was performed in hemato-oncology department patients of Hanyang University Hospital. During the pre-intervention period of 3 months (Feb. 2005 to Apr. 2005), antibiotics were prescribed liberally. During the intervention period of 6 months (May. 2005 to Oct. 2005), use of the 3rd (4th) generation cephalosporins and carbapenems were restricted and piperacillin/tazobactam was recommended. All enrolled patients performed stool culture or rectal swab culture. ESBL confirmed by Double disk synergy test and commercial identification kit. Between the pre-intervention and intervention groups, acquisition rates of ESBL producing organisms were compared.
Results:50 cases were enrolled in pre-intervention period and 112 cases were enrolled in intervention period. In intervention period, use of 3rd (4th) generation cephalosporins and carbapenems decreased from 27 daily define dose/1,000patient/days to 6.82 DDD/1,000patient/days, but use of piperacillin/tazobactam increased from 1.98 DDD/1,000patient/days to 5.66 DDD/1,000patient/days. The intestinal acquisition rate of ESBL producing organism decreased from 30% to 12%. There was no difference in overall mortality of infectious disease between two phase.
Conclusion:Use of piperacillin/tazobactam instead of extended-spectrum cephalosporins reduces intestinal acquisition rate of ESBL producing K. pneumoniae and E. coli. Therefore, in order to decrease the number of ESBL producing organism, we recommend using piperacillin/tazobactam instead of using extended-spectrum cephalosporins.
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Keywords : Piperacillin/tazobactam, Extended-spectrum β-lactamase, Antimicrobial drug resistance, Klebsiella pneumoniae, Escherichia coli |
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