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.
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.
Authors: Enrique Cerdá; Ana Abella; Miguel A de la Cal; José A Lorente; Paloma García-Hierro; Hendrick K F van Saene; Inmaculada Alía; Ainhoa Aranguren Journal: Ann Surg Date: 2007-03 Impact factor: 12.969
Authors: K de With; F Allerberger; S Amann; P Apfalter; H-R Brodt; T Eckmanns; M Fellhauer; H K Geiss; O Janata; R Krause; S Lemmen; E Meyer; H Mittermayer; U Porsche; E Presterl; S Reuter; B Sinha; R Strauß; A Wechsler-Fördös; C Wenisch; W V Kern Journal: Infection Date: 2016-06 Impact factor: 3.553
Authors: Mark J DiNubile; Joseph W Chow; Vilas Satishchandran; Adam Polis; Mary R Motyl; Murray A Abramson; Hedy Teppler Journal: Antimicrob Agents Chemother Date: 2005-08 Impact factor: 5.191
Authors: Cornelius Remschmidt; Sandra Schneider; Elisabeth Meyer; Barbara Schroeren-Boersch; Petra Gastmeier; Frank Schwab Journal: Dtsch Arztebl Int Date: 2017-12-15 Impact factor: 5.594
Authors: David L Paterson; Carlene A Muto; Magdaline Ndirangu; Peter K Linden; Brian A Potoski; Blair Capitano; Robert A Bonomo; David C Aron; Curtis J Donskey Journal: Antimicrob Agents Chemother Date: 2007-11-19 Impact factor: 5.191
Authors: Steven J Drews; Susan E Richardson; Rick Wray; Renee Freeman; Carol Goldman; Laurie Streitenberger; Derek Stevens; Cristina Goia; Danuta Kovach; Jason Brophy; Anne G Matlow Journal: Can J Infect Dis Med Microbiol Date: 2008-05 Impact factor: 2.471
Authors: Cornelius Remschmidt; Michael Behnke; Axel Kola; Luis A Peña Diaz; Anna M Rohde; Petra Gastmeier; Frank Schwab Journal: Antimicrob Resist Infect Control Date: 2017-09-13 Impact factor: 4.887