Related Experiment Videos
Restriction of third-generation cephalosporin use decreases infection-related mortality
Bin Du1, Dechang Chen, Dawei Liu
1Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, People's Republic of China.
Objective:
To determine the effect of restriction of third-generation cephalosporin use on antibiotic resistance and the outcome of patients with infection.
Design:
A prospective, before-after comparative study.
Setting:
A general intensive care unit with 14 beds at a university-affiliated teaching hospital.
Patients:
All patients admitted to the intensive care unit within 2 yrs.
Interventions:
A new antibiotic treatment strategy was implemented during phase II. All patients with confirmed or suspected Gram-negative bacterial infections were treated mainly with antibiotics other than third-generation cephalosporins.
Measurements And Main Results:
Antibiotic resistance among common Gram-negative bacilli and infection-related hospital mortality during phase I were compared with phase II. A 26.6% reduction in third-generation cephalosporin use (from 168.2 +/- 48.0 to 123.5 +/- 39.3 g/month, p =.021), accompanied by a 277.7% increase in cefepime use (from 10.3 +/- 19.2 to 38.9 +/- 31.7 g/month, p =.014) occurred in phase II compared with phase I. This was accompanied by a significant decrease in reduced susceptibility of Gram-negative bacilli to third-generation cephalosporins (p <.05), mainly because of the improved susceptibility of Escherichia coli and Klebsiella species (p <.05). Infection-related hospital mortality was significantly lower in phase II (19.3% vs. 36.3%, p =.014). Multiple logistic regression analysis demonstrated lower respiratory tract infection, the status of immunocompromise, and continuous veno-venous hemofiltration as independent risk factors for infection-related hospital mortality (p <.05), whereas infection with E. coli or Klebsiella species (p =.039) and restriction of third-generation cephalosporin use (p =.025) were associated with a significantly lower mortality rate.
Conclusions:
Restriction of third-generation cephalosporin use may improve the antibiotic susceptibility and reduce infection-related hospital mortality in critically ill patients.
Insights
Restricting third-generation cephalosporins in intensive care units reduced antibiotic resistance and significantly lowered infection-related mortality. This antibiotic stewardship strategy improved patient outcomes in critically ill individuals.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Antimicrobial Stewardship
Background:
- Antibiotic resistance is a growing threat in intensive care units (ICUs).
- Third-generation cephalosporins are frequently used, potentially contributing to resistance.
- Optimizing antibiotic use is crucial for patient outcomes and infection control.
Purpose of the Study:
- To evaluate the impact of restricting third-generation cephalosporin use.
- To assess changes in antibiotic resistance patterns.
- To determine the effect on infection-related hospital mortality in critically ill patients.
Main Methods:
- A prospective, before-after comparative study in a 14-bed general ICU.
- Two phases: Phase I (standard care) and Phase II (restricted third-generation cephalosporin use).
- Monitored antibiotic use, Gram-negative bacilli susceptibility, and infection-related mortality.
Main Results:
- Third-generation cephalosporin use decreased by 26.6%, while cefepime use increased by 277.7%.
- Reduced susceptibility of Gram-negative bacilli to third-generation cephalosporins significantly decreased (p <.05).
- Infection-related hospital mortality was significantly lower in Phase II (19.3% vs. 36.3%, p =.014).
Conclusions:
- Restriction of third-generation cephalosporin use is associated with improved antibiotic susceptibility.
- This strategy significantly reduces infection-related hospital mortality in critically ill patients.
- Antimicrobial stewardship interventions can effectively combat resistance and improve patient outcomes.