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Effect of the Increasing Use of Piperacillin/Tazobactam on the Incidence of Vancomycin-Resistant Enterococci in Four Academic Medical Centers

Published online by Cambridge University Press:  02 January 2015

Usha Stiefel ,
David L. Paterson ,
Nicole J. Pultz ,
Steven M. Gordon ,
David C. Aron  and
Curtis J. Donskey
Usha Stiefel
Affiliation:
Infectious Diseases Division, University Hospitals of Cleveland, Cleveland, Ohio
David L. Paterson
Affiliation:
Infectious Diseases Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Nicole J. Pultz
Affiliation:
Infectious Diseases Section, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Steven M. Gordon
Affiliation:
Infectious Diseases Division, Cleveland Clinic Foundation, Cleveland, Ohio
David C. Aron
Affiliation:
Health Services Research and Development, Department of Veterans Affairs, and Center for Quality Improvement Research, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Curtis J. Donskey*
Affiliation:
Infectious Diseases Section, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
*
Infectious Diseases Section, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106
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Abstract

Background:

The substitution of piperacillin/tazobactam, ampicillin/sulbactam, or both for third-generation cephalosporins has been associated with reduced vancomycin-resistant enterococci (VRE). However, piperacillin/tazobactam came into widespread use during a period in which the prevalence of VRE increased. We hypothesized that the increasing use of piperacillin/tazobactam and other agents with relatively enhanced anti-enterococcal activity (ie, piperacillin, ampicillin/sulbactam, and ampicillin) has been associated with increased or unchanged rates of VRE in some hospitals.

Design:

We retrospectively evaluated the correlation between hospital antibiotic use (defined daily doses per 10,000 patient-days of care) and incidence of stool or non-stool VRE isolation. We assessed whether a high or increasing proportion of use of beta-lactam agents with relatively enhanced versus minimal (ie, third-generation cephalosporins and ticarcillin/clavulanate) anti-enterococcal activity would prevent increased VRE.

Setting:

Four academic medical centers.

Results:

With the increasing use of piperacillin/tazobactam, the use of beta-lactam agents with enhanced activity against enterococci surpassed the combined use of third-generation cephalosporins and ticarcillin/clavulanate in each hospital. In one hospital, the incidence of VRE was positively correlated with the use of piperacillin/tazobactam or beta-lactam agents with enhanced anti-enterococcal activity (P< .0001). The incidence of VRE rose steadily in another hospital despite relatively high use of beta-lactam agents with enhanced versus minimal anti-enterococcal activity. A negative correlation between VRE and piperacillin/tazobactam or beta-lactam agents with enhanced anti-enterococcal activity was observed in one hospital, but this correlation was not statistically significant.

Conclusion:

Increasing the hospital use of piperacillin/tazobactam and other beta-lactams with relatively enhanced anti-enterococcal activity may not be an effective control measure for VRE.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 5 , May 2004 , pp. 380 - 383
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Quale, J, Landman, D, Saurina, G, Atwood, E, DiTore, V, Patel, K. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis 1996;23:1020–1025.Google Scholar
2.Bradley, SJ, Wilson, ALT, Allen, MC, Sher, HA, Goldstone, AH, Scott, GM. The control of hyperendemic glycopeptide-resistant Enterococcus species on a haematology unit by changing antibiotic usage. J Antimicrob Chemother 1999;43:261–266.Google Scholar
3.May, AK, Melton, SM, McGwin, G, Cross, JM, Moser, SA, Rue, LW. Reduction of vancomycin-resistant enterococcal infections by limitation of broad-spectrum cephalosporin use in a trauma and burn intensive care unit. Shock 2000;14:259–264.Google Scholar
4.Smith, DW. Decreased antimicrobial resistance following changes in antibiotic use. Surgical Infections 2000;1:73–78.Google Scholar
5.Harbarth, S, Cosgrove, S, Carmeli, Y. Effects of antibiotics on nosocomial epidemiology of vancomycin-resistant enterococci. Antimicrob Agents Chemother 2002;46:1619–1628.CrossRefGoogle ScholarPubMed
6.Donskey, CJ, Hanrahan, JA, Hutton, RA, Rice, LB. Effect of parenteral antibiotic administration on the establishment of colonization with vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. J Infect Dis 2000;181:1830–1833.Google Scholar
7.Donskey, CJ, Hanrahan, JA, Hutton, RA, Rice, LB. Effect of parenteral antibiotic administration on persistence of vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. J Infect Dis 1999;180:384–390.Google Scholar
8.Donskey, CJ, Chowdhry, TK, Hecker, MT, et al.Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med 2000;343:1925–1932.Google Scholar
9.Paterson, DL, Ndirangu, M, Clarke, L, Bandlamuri, S, Donskey, CJ. Relative “collateral damage” caused by piperacillin/tazobactam and cefepime in patients treated in the intensive care unit. Presented at the 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy; September 14-17, 2003; Washington, DC. Abstract K-1418.Google Scholar
10.Harbarth, S, Harris, AD, Carmelli, Y, Samore, MH. Parallel analysis of individual and aggregated data on antibiotic exposure and resistance in gram-negative bacilli. Clin Infect Dis 2001;33:1462–1468.Google Scholar
11.Montecalvo, MA, Jarvis, WR, Uman, J, et al.Infection control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting. Ann Intern Med 1999;131:269–272.CrossRefGoogle Scholar