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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)
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 ?-lactam/?-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.
Keywords : Piperacillin/tazobactam, Extended-spectrum ?-lactamase, Antimicrobial drug resistance, Klebsiella pneumoniae, Escherichia coli