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Antimicrobial Agents and Chemotherapy, February 2004, p. 392-395, Vol. 48, No. 2
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.2.392-395.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Replacement of Broad-Spectrum Cephalosporins by Piperacillin-Tazobactam: Impact on Sustained High Rates of Bacterial Resistance

Carlos Bantar,1* Eduardo Vesco,2 Claudia Heft,3 Francisco Salamone,4 Marcelo Krayeski,2 Hernán Gomez,2 María Alicia Coassolo,3 Alejandro Fiorillo,2 Diego Franco,1 Carina Arango,3 Fernando Duret,5 and María Eugenia Oliva1*

Committee for Prevention and Control of Nosocomial Infection,1 Departments of Internal Medicine,2 Pharmacy,3 Microbiology, Hospital San Martín, Paraná, Entre Ríos,4 Wyeth-Whitehall, Buenos Aires, Argentina5

Received 17 September 2003/ Returned for modification 6 October 2003/ Accepted 8 November 2003

We have previously observed a significant reduction of ceftriaxone resistance in Proteus mirabilis associated with an increase in the use of cefepime, along with a decrease in the consumption of broad-spectrum cephalosporins (CEP). However, we did not observe such a reduction with Klebsiella pneumoniae. Therefore, we sought to determine whether replacement of CEP by piperacillin-tazobactam might be useful in reducing sustained high rates of CEP resistance by this organism. We used a 6-month "before and after model"; during the second (intervention) period, most prescriptions of CEP were changed to piperacillin-tazobactam at the pharmacy. No additional barrier precautions were undertaken. During intervention, consumption of ceftazidime decreased from 17.73 to 1.14 defined daily doses (DDD) per 1,000 patient-days (P < 0.0001), whereas that of piperacillin-tazobactam increased from 0 to 30.57 DDD per 1,000 patient-days (P < 0.0001). The levels of resistance to CEP by K. pneumoniae and P. mirabilis decreased from 68.4 and 57.9% to 37.5 and 29.4%, respectively (P < 0.05). We conclude that replacement of ceftazidime by piperacillin-tazobactam might be a suitable strategy to decrease endemic CEP resistance by K. pneumoniae and P. mirabilis, even where there are high bacterial resistance rates and irrespective of any additional precautions for controlling nosocomial infection.

* Corresponding authors. Mailing address for C. Bantar: Colón 128, 3100 Paraná, Entre Ríos. Phone: (54343)4310783. Fax: (54343) 4310783. E-mail: cbantar{at}arnet.com.ar. Mailing address for M. E. Oliva: Gualeguaychú 882, 3100 Paraná, Entre Ríos. Phone: (54343)4310783. Fax: (54343) 4310714. E-mail: caemi{at}arnet.com.ar.

Antimicrobial Agents and Chemotherapy, February 2004, p. 392-395, Vol. 48, No. 2
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.2.392-395.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.





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