engleski

Control of an outbreak of ESBL Klebsiella pneumoniae in a university hospital

Background: Formulary restriction and preauthorisation requirements can lead to decrease of antimicrobial use, and may be beneficial in combating nosocomial outbreak of multidrug resistant bacteria. The aim of this intervention study was to investigate wheather the restriction of fluoroquinolone and cephalosporin use may impact the prevalence of ESBL Klebsiella pneumoniae and ESBL Klebsiella pneumoniae ertapenem resistant in a university hospital. Methods: An interrupted time series analysis method was used to determine the prevalence rate changes of ESBL Klebsiella pneumoniae and ESBL Klebsiella pneumoniae ertapenem resistant in relation to the hospital antibiotic consumption measured in defined daily doses/100 patient days during a period of six months before, throughout the intervention and six months after the implementation of hospital antibiotic control policy at the Clinical Hospital Centre Rijeka. Restrictive policy consisted of limitation of fluoroquinolone and third generation cephalosporins use during a nine-month period. Disc diffusion technique, and E-test were used to determine susceptibility of Klebsiella pneumoniae and isolates were categorized as: susceptible, intermediate susceptible and resistant. A Double-Disk Synergy Test was used for phenotype determination of ESBL production. ESBL Klebsiella pneumoniae isolates are presented as the ratio of all Klebsiella strains isolated in the period of 21 months. Results: A correlation between cephalosporins and fluoroquinolones consumption and bacterial resistance was observed. A significant decrease in the third generation cephalosporins use was found (p<0.01) after the intervention and was followed by a significant decrease of ESBL Klebsiella pneumoniae ertapenem resistant (p<0.01). There was no statistical difference in prevalence of ESBL Klebsiella pneumoniae among all Klebsiella isolates before and after restrictive intervention, although there was fewer isolates after intervention. Conclusion: The restriction and preauthorisation of antimicrobials is shown to be a successful and not expensive stewardship measure in controlling bacterial resistance in the Hospital.

Klebsiella pneumoniae; ESBL; antibiotics; stewardship

grant No. 13.06.1.1.07., and 13.06.1.2.23. from the University of Rijeka, Croatia