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Limiting the Emergence of Extended-Spectrum β–Lactamase-Producing Enterobacteriaceae: Influence of Patient Population Characteristics on the Response to Antimicrobial Formulary Interventions

Published online by Cambridge University Press:  21 June 2016

Adam D. Lipworth ,
Emily P. Hyle ,
Neil O. Fishman ,
Irving Nachamkin ,
Warren B. Bilker ,
Ann Marie Marr ,
Lori A. Larosa ,
Nishaminy Kasbekar  and
Ebbing Lautenbach
Adam D. Lipworth
Affiliation:
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia
Emily P. Hyle
Affiliation:
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia
Neil O. Fishman
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia
Warren B. Bilker
Affiliation:
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia
Ann Marie Marr
Affiliation:
Department of Pharmacy, University of Pennsylvania School of Medicine, Philadelphia
Lori A. Larosa
Affiliation:
Department of Pharmacy, University of Pennsylvania School of Medicine, Philadelphia
Nishaminy Kasbekar
Affiliation:
Department of Pharmacy, University of Pennsylvania School of Medicine, Philadelphia
Ebbing Lautenbach*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia
*
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021 (elautenb@cceb.med.upenn.edu)
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Abstract

Background.

Effective methods to control the emergence of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species (ESBL-EK) remain unclear. Variations in the patient populations at different hospitals may influence the effect of antimicrobial formulary interventions.

Methods.

To examine variations across hospitals in the response to antimicrobial interventions (ie, restriction of ceftazidime and ceftriaxone) designed to curb the spread of ESBL-EK, we conducted a 5-year quasi-experimental study. This study was conducted at 2 hospitals within the same health system: Hospital A is a 625-bed academic medical center, and Hospital B is a 344-bed urban community hospital. All adult patients with a healthcare-acquired clinical culture of ESBL-EK from July 1, 1997 through December 31, 2002 were included.

Results.

After the interventions, the use of ceftriaxone decreased by 86% at Hospital A and by 95% at Hospital B, whereas the use of ceftazidime decreased by 95% at Hospital A and by 97% at Hospital B. The prevalence of ESBL-EK at Hospital A decreased by 45% (P< .001), compared with a 22% decrease at Hospital B (P = .36). The following variables were significantly more common among ESBL-EK-infected patients at Hospital B: residence in a long-term care facility (adjusted odds ratio, 3.77 [95% confidence interval, 1.70-8.37]), advanced age (adjusted odds ratio, 1.04 [95% confidence interval, 1.01-1.06]), and presence of a decubitus ulcer (adjusted odds ratio, 4.13 [95% confidence interval, 1.97-8.65]).

Conclusions.

The effect of antimicrobial formulary interventions intended to curb emergence of ESBL-EK may differ substantially across institutions, perhaps as a result of differences in patient populations. Variability in the epidemiological profiles of ESBL-EK isolates at different hospitals must be considered when designing interventions to respond to these pathogens.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 3 , March 2006 , pp. 279 - 286
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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