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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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