Effect of the increasing use of piperacillin/tazobactam on the incidence of vancomycin-resistant enterococci in four academic medical centers

Stiefel, Usha, Paterson, David L., Pultz, Nicole J., Gordon, Steven M., Aron, David C. and Donskey, Curtis J. (2004) Effect of the increasing use of piperacillin/tazobactam on the incidence of vancomycin-resistant enterococci in four academic medical centers. Infection Control and Hospital Epidemiology, 25 5: 380-383. doi:10.1086/502409

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Author Stiefel, Usha
Paterson, David L.
Pultz, Nicole J.
Gordon, Steven M.
Aron, David C.
Donskey, Curtis J.
Title Effect of the increasing use of piperacillin/tazobactam on the incidence of vancomycin-resistant enterococci in four academic medical centers
Journal name Infection Control and Hospital Epidemiology   Check publisher's open access policy
ISSN 0899-823X
1559-6834
Publication date 2004-05
Sub-type Article (original research)
DOI 10.1086/502409
Open Access Status File (Publisher version)
Volume 25
Issue 5
Start page 380
End page 383
Total pages 4
Place of publication New York, NY, United States
Publisher Cambridge University Press
Language eng
Formatted 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.
Keyword Mouse Gastrointestinal-Tract
Faecium
Unit
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collection: UQ Centre for Clinical Research Publications
 
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Created: Tue, 07 Sep 2010, 17:12:35 EST