Impact of ceftazidime restriction on gram-negative bacterial resistance in an intensive care unit

Brahmi, Nozha; Blel, Youssef; Kouraichi, Nadia; Lahdhiri, Salma; Thabet, H.; Hédhili, Abderrazek; Amamou, M.

doi:10.1007/s10156-006-0452-0

Cited by 34 publications

(14 citation statements)

References 21 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In November 2003, the clinicians of Hanyu General Hospital also agreed with the Infection Control Committee to restrict the use of ceftazidime, meropenem, ciprofloxacin, pazufloxacin, vancomycin and teicoplanin. Some reports show that the restriction of antibiotic use is efficient in reducing antimicrobial resistance [25,26]. Our data also suggest that restriction of carbapenem use was effective in decreasing the selection of carbapenem-resistant bacteria.…”

Section: Discussionsupporting

confidence: 59%

Nosocomial outbreak of genetically related IMP-1 β-lactamase-producing Klebsiella pneumoniae in a general hospital in Japan

Fukigai¹,

Alba

Kimura

et al. 2007

International Journal of Antimicrobial Agents

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 59%

Nosocomial outbreak of genetically related IMP-1 β-lactamase-producing Klebsiella pneumoniae in a general hospital in Japan

Fukigai¹,

Alba

Kimura

et al. 2007

International Journal of Antimicrobial Agents

View full text Add to dashboard Cite

“…this setting, implementation of barrier measures for all infected or colonized patients and reinforcement of hand hygiene with alcoholic gel were the keystone control measures. Although it has been considered controversial (5), restriction of wide-spectrum cephalosporins has been successfully applied in several outbreaks caused by ESBL-producing K. pneumoniae (2,28). In our case, the circumstance of concomitant increased cefepime use and the emergence of ESBL-producing E. cloacae allowed us to introduce this measure with an effective result.…”

Section: Discussionmentioning

confidence: 99%

Nosocomial Outbreak Due to Extended-Spectrum-Beta-Lactamase- Producing Enterobacter cloacae in a Cardiothoracic Intensive Care Unit

et al. 2007

View full text Add to dashboard Cite

Enterobacter cloacae has been associated with several outbreaks, usually involving strains that overproduce chromosomal ␤-lactamase or, uncommonly, strains expressing extended-spectrum ␤-lactamases (ESBL). Only sporadic cases of ESBL-producing E. cloacae have been identified in our hospital in recent years. We describe the epidemiology and clinical and microbiological characteristics of an outbreak caused by ESBL-producing E. cloacae in a cardiothoracic intensive care unit (CT-ICU). Prospective surveillance of patients with infection or colonization by ESBL-producing E. cloacae among patients admitted to the CT-ICU was performed during the outbreak. Production of ESBL was determined by decreased susceptibility to expanded-spectrum cephalosporins and a positive double-disk test result. Clone relatedness was determined by pulsed-field gel electrophoresis (PFGE). From July to September 2005, seven patients in the CT-ICU with ESBL-producing E. cloacae were identified (four males; median age, 73 years; range, 45 to 76 years); six patients had cardiac surgery. Four patients developed infections; three had primary bacteremia, one had ventilator-associated pneumonia, and one had tracheobronchitis. ESBLproducing E. cloacae showed resistance to quinolones and aminoglycosides. PFGE revealed two patterns.

show abstract

“…These components include audits [57] , infectious disease specialist or senior clinician input [58][59][60][61][62][63][64] , or planned discontinuation/deescalation of treatment in response to clinical and microbiological outcome data [65] . Other components include rotating antibiotic schedules [57,[66][67][68][69][70] changes in prescribing policies involving antibiotic restriction, different dosing regimens or prophylaxis protocols [57,62,65,67,[71][72][73][74][75][76][77][78][79][80][81][82][83][84] and a multi-disciplinary team (MDT) approach in treatment initiation and discontinuation, often emphasising feedback and non-punitive atmosphere among staff members [83,85] . Some programmes also encompassed staff education [57,74,76] and computerised decision support platforms [86][87][88][89][90][91] .…”

Section: Discussionmentioning

confidence: 99%

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Zhang

Singh

2015

WJCCM

View full text Add to dashboard Cite

Antibiotic usage and increasing antimicrobial resistance (AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units (ICU). Antibiotic stewardship programmes (ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include "standard" control of antibiotic prescribing such as "de-escalation strategies" through to interventional approaches utilising biomarkerguided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 nonprotocolised studies, [1 randomised control trial (RCT), 22 observational and 11 case series], 29 (85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin (PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop (de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core aspects of successful ASPs that are transferable, and further well-conducted trials will be necessary if ASPs are to be an effective platform for delivering desired patient outcomes and safety through best antibiotic policy.

show abstract

Impact of ceftazidime restriction on gram-negative bacterial resistance in an intensive care unit

Cited by 34 publications

References 21 publications

Nosocomial outbreak of genetically related IMP-1 β-lactamase-producing Klebsiella pneumoniae in a general hospital in Japan

Nosocomial outbreak of genetically related IMP-1 β-lactamase-producing Klebsiella pneumoniae in a general hospital in Japan

Nosocomial Outbreak Due to Extended-Spectrum-Beta-Lactamase- Producing Enterobacter cloacae in a Cardiothoracic Intensive Care Unit

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Contact Info

Product

Resources

About