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Antibiotic utilization: is there an effect on antimicrobial resistance?
1University of Texas Health Science Center, Department of Medicine, 7703 Floyd Curl Dr., Mail Code 7881, San Antonio, TX 78229-3900, USA. pattersonj@uthscsa.edu
Chest
|February 15, 2001
Summary
Antimicrobial resistance is increasing, particularly with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) and vancomycin-resistant enterococci (VRE). Shifting antibiotic use can help control these multidrug-resistant pathogens.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Antimicrobial resistance (AMR) poses a growing threat in healthcare settings.
- Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) and vancomycin-resistant enterococci (VRE) are critical pathogens causing significant patient morbidity and mortality.
- Treatment of infections caused by ESBL-KP and VRE presents considerable therapeutic challenges due to limited effective antibiotic options.
Purpose of the Study:
- To investigate the impact of antibiotic utilization strategies on the prevalence of multidrug-resistant pathogens in hospitals.
- To explore the relationship between broad-spectrum antibiotic use and the selection of ESBL-KP and VRE.
- To assess the effectiveness of antibiotic stewardship in controlling the emergence of resistant bacteria.
Main Methods:
- Review of institutional data on antibiotic prescribing patterns and the prevalence of ESBL-KP and VRE.
- Analysis of the association between the use of third-generation cephalosporins and other broad-spectrum antibiotics with the selection of resistant pathogens.
- Evaluation of the outcomes of shifting antibiotic utilization away from third-generation cephalosporins.
Main Results:
- A decrease in the prevalence of ESBL-KP was observed following a shift in antibiotic utilization from third-generation cephalosporins to other broad-spectrum agents.
- Similar reductions in VRE prevalence were noted when antibiotic use shifted from third-generation cephalosporins to other antibiotic classes.
- Carbapenem use for ESBL-KP infections, while effective, is associated with high costs and potential for further resistance selection.
Conclusions:
- Antibiotic utilization measures, including strategic shifts in prescribing, are effective in controlling the emergence and prevalence of multidrug-resistant pathogens like ESBL-KP and VRE.
- Prudent antibiotic stewardship is crucial for managing hospital-acquired infections caused by challenging resistant organisms.
- Optimizing antibiotic use can mitigate the growing problem of antimicrobial resistance in clinical settings.