Control of multi-resistant bacteria and ventilator-associated pneumonia: is it possible with changes in antibiotics?

Control of multi-resistant bacteria and ventilator-associated pneumonia: is it possible with changes in antibiotics?

Autor Jukemura, Elisa Maria Autor UNIFESP Google Scholar
Burattini, Marcelo Nascimento Autor UNIFESP Google Scholar
Pereira, Carlos Alberto Pires Autor UNIFESP Google Scholar
Braga, Alfésio L.f. Google Scholar
Medeiros, Eduardo Alexandrino Servolo de Autor UNIFESP Google Scholar
Instituição Universidade Federal de São Paulo (UNIFESP)
Catholic University of Santos Collective Health Pos-graduation Program
Resumo Potent antimicrobial agents have been developed as a response to the development of antibiotic-resistant bacteria, which especially affect patients with prolonged hospitalization in Intensive Care Units (ICU) and who had been previously treated with antimicrobials, especially third-generation cephalosporins.This study was to determine how changes in the empirical treatment of infections in ICU patients affect the incidence of Gram-negative bacteria species and their susceptibility to antimicrobials, and examine the impact of these changes on nosocomial infections. A prospective interventional study was performed in a university hospital during two periods: 1) First period (September 1999 to February 2000); and 2) Second period (August 2000 to December 2000); empirical treatment was changed from ceftriaxone and/or ceftazidime in the first period to piperacillin/tazobactam in the second. ICU epidemiological and infection control rates, as well as bacterial isolates from upper airways were analyzed. Ceftazidime consumption dropped from 34.83 to 0.85 DDD/1000 patients per day (p=0.004). Piperacillin/tazobactam was originally not available; its consumption reached 157.07 DDD/1000 patients per day in the second period (p=0.0002). Eighty-seven patients and 66 patients were evaluated for upper airway colonization in the first and second periods, respectively. There was a significant decrease in the incidence of K. pneumoniae (p=0.004) and P. mirabilis (p=0.036), restoration of K. pneumoniae susceptibility to cephalosporins (p<0.0001) and reduction of ventilator-associated pneumonia rates (p<0.0001). However, there was an increase in P. aeruginosa incidence (p=0.005) and increases in ceftazidime (p=0.003) and meropenem (p<0.0001) susceptibilities. Changing antimicrobial selective pressure on multi-resistant Gram-negative bacteria helps control ventilator-associated pneumonia and decreases antimicrobial resistance.
Palavra-chave Ventilator associated pneumonia
multi-resistant bacteria
infection control
Idioma Inglês
Data de publicação 2007-08-01
Publicado em Brazilian Journal of Infectious Diseases. Brazilian Society of Infectious Diseases, v. 11, n. 4, p. 418-422, 2007.
ISSN 1413-8670 (Sherpa/Romeo, fator de impacto)
Publicador Brazilian Society of Infectious Diseases
Extensão 418-422
Fonte http://dx.doi.org/10.1590/S1413-86702007000400010
Direito de acesso Acesso aberto Open Access
Tipo Artigo
Web of Science WOS:000254388600010
SciELO S1413-86702007000400010 (estatísticas na SciELO)
Endereço permanente http://repositorio.unifesp.br/handle/11600/3833

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