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The Effect of an Antimicrobial Restriction Program on Pseudomonas aeruginosa Resistance to β‐Lactams in a Large Teaching Hospital
Author(s) -
Regal Randolph E.,
DePestel Daryl D.,
VandenBussche Heather L.
Publication year - 2003
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.23.5.618.32197
Subject(s) - piperacillin , ceftazidime , aztreonam , medicine , tazobactam , tobramycin , imipenem , ciprofloxacin , pseudomonas aeruginosa , antibiotic resistance , antimicrobial , piperacillin/tazobactam , microbiology and biotechnology , antibiotics , biology , bacteria , gentamicin , genetics
Study Objectives . To compare the use of β‐lactams and subsequent Pseudomonas aeruginosa sensitivity patterns before and after implementation of a clinical pharmacist‐facilitated antimicrobial restriction program in August 1997. Design . Retrospective consecutive data collection. Setting . Large university‐affiliated medical center. Intervention . The study results are the accumulation of the daily intervention activities of the antimicrobial restriction program. Data on antimicrobial grams purchased/1000 patient‐days and susceptibility patterns were collected and analyzed retrospectively. Measures and Main Results . Annual grams of ceftazidime, piperacillin, piperacillin‐tazobactam, and other antipseudomonal β‐lactams purchased/1000 patient‐days were compared during the 2 full calendar years before the antimicrobial restriction program (1995–1996) with the 4 full calendar years after the program was implemented (1998–2001). Pseudomonas aeruginosa resistance trends for the antipseudomonal β‐lactams, ciprofloxacin, and tobramycin also were compared for the 2 years before the program (1995–1996) with the last 2 years of the program (2000–2001). A 44% reduction in ceftazidime use was documented; ostensibly, minimal changes occurred in the overall use of piperacillin and piperacillin‐tazobactam. During the same time period, ceftazidime resistance fell from 24% to 11.8% (p<0.001), whereas piperacillin resistance fell from 32.5% to 18.5% (p<0.001). Imipenem resistance declined from 20.5% to 12.3% (p<0.001) with an 18% reduction in use. Aztreonam resistance declined from 29.5% to 16.5% (p<0.001) despite a 57% increase in use. No changes in resistance to either ciprofloxacin or tobramycin were found. Conclusion . Through an antimicrobial restriction program, a dramatic reduction in ceftazidime use was achieved with judicious use of other antipseudomonal antimicrobials, which resulted in reduced resistance of P. aeruginosa to other β‐lactams.