Control of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae using a computer-assisted management program to restrict third-generation cephalosporin use

초록

Objectives: The aim of this study was to evaluate the control of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae and antimicrobial resistance through a computerized antibiotic control program. Methods: An ambidirectional intervention study was conducted at a 750-bed university hospital in Korea from February 2004 to April 2006. In November 2004, hospital-wide restriction of third-generation cephalosporin use was integrated into a pre-existing computerized antibiotic prescription program that included an approval system for 15 antimicrobials. The proportions of ESBL-producing K. pneumoniae and other multidrug-resistant clinical isolates were compared during three phases (9 months per phase): Phase I (pre-intervention), Phase II (intensive-intervention) and Phase III (maintenance). Results: Third-generation cephalosporin use decreased significantly from 103.2 to 84.9 antibiotic use density (AUD, defined daily dose/1000 patient-days) between Phase I and Phase II (P < 0.05), whereas use of carbapenems and beta-lactam/beta-lactamase inhibitors increased from 14.5 to 18.2 AUD and from 53.3 to 62.6 AUD, respectively. The proportion of ESBL-producing K. pneumoniae isolates increased significantly from 8.1% (47/578) in Phase I to 32.0% (188/587) in Phase II, and then decreased significantly to 20.6% (97/470) in Phase III (P < 0.05). In addition, the proportions of imipenem- or piperacillin/tazobactam-resistant Pseudomonas aeruginosa and Acinetobacter baumannii isolates decreased significantly over the same period (P < 0.05). Conclusions: The computerized antibiotic control program appears to be an effective tool for modifying antibiotic consumption, which may in turn prevent the spread of resistant pathogens.

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