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1Department of Pharmacy, University of Kentucky, Lexington, Kentucky, USA. rprapp01@pop.uky.edu
Abstract:
Antibiotic resistance in the hospital setting is continuing to increase, particularly in intensive care units (ICUs) and other areas of the hospital such as oncology units, where the use of empiric broad-spectrum antibiotics is common. The problem of antibiotic resistance is also compounded in the immunocompromised patient. Multi-drug resistance is common among both Gram-positive and -negative bacteria, and becoming more prevalent among fungi (yeast). Two major antibiotic-resistant pathogens include extended-spectrum beta-lactamase producing Klebsiella pneumoniae (ESBL-KP) and vancomycin-resistant enterococci (VRE). When infections occur with ESBL-KP, a carbapenem antibiotic is usually the drug of choice. When infection occurs with VRE, specific therapy is bacteriostatic, and the clinician may have to rely on empirically selected antibiotics or combinations of antibiotics to achieve a positive outcome. Two newly-approved agents, linezolid and quinupristin/dalfopristin can be used to treat infections caused by resistant gram-positive cocci, but the latter is approved for use against VR-E. faecium. Risk factors for the development of ESBL-KP include the use of extended-spectrum cephalosporins such as ceftazidime. Risk factors for the development of VRE include inappropriate use of vancomycin, extended-spectrum cephalosporins, and antianaerobic drug therapy such as clindamycin. Several institutions have documented a reduction in one or both of these resistant pathogens following a decrease in the use of extended-spectrum cephalosporins combined with the increased use of extended-spectrum penicillins/beta-lactamase inhibitor combinations, such as piperacillin/tazobactam, for the empiric therapy of infections. For VRE, a reduction in the inappropriate use of vancomycin is also an important interventional strategy along with improved infection control practice.
Insights
Antibiotic resistance is rising in hospitals, especially in ICUs. Reducing broad-spectrum cephalosporin use and optimizing vancomycin can combat resistant pathogens like ESBL-Klebsiella pneumoniae and VRE.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Stewardship
Background:
- Increasing antibiotic resistance in hospitals, particularly in intensive care units (ICUs) and oncology wards, poses a significant threat.
- Multi-drug resistant Gram-positive and -negative bacteria, and increasingly fungi, complicate patient care, especially for immunocompromised individuals.
- Key resistant pathogens include extended-spectrum beta-lactamase producing Klebsiella pneumoniae (ESBL-KP) and vancomycin-resistant enterococci (VRE).
Purpose of the Study:
- To investigate strategies for reducing the incidence of ESBL-KP and VRE in hospital settings.
- To evaluate the impact of antimicrobial stewardship interventions on the prevalence of these resistant pathogens.
- To identify risk factors and effective treatment/prevention strategies for multidrug-resistant organisms.
Main Methods:
- Review of institutional data documenting changes in antibiotic prescribing patterns and pathogen resistance.
- Analysis of the correlation between the use of specific antibiotic classes (e.g., extended-spectrum cephalosporins, piperacillin/tazobactam, vancomycin) and the prevalence of ESBL-KP and VRE.
- Evaluation of infection control practices alongside antimicrobial stewardship initiatives.
Main Results:
- Several institutions reported reductions in ESBL-KP and VRE following decreased use of extended-spectrum cephalosporins and increased use of piperacillin/tazobactam for empiric therapy.
- Reduced inappropriate vancomycin use was identified as a crucial intervention for controlling vancomycin-resistant enterococci (VRE).
- Improved infection control practices complement antimicrobial stewardship in managing resistant pathogens.
Conclusions:
- A decrease in extended-spectrum cephalosporin use, coupled with increased use of beta-lactam/beta-lactamase inhibitor combinations, can effectively reduce ESBL-KP.
- Optimizing vancomycin usage and implementing robust infection control measures are vital for combating VRE.
- Antimicrobial stewardship programs are essential for controlling antibiotic resistance in healthcare settings.
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