Impact of a Stewardship-Initiated Restriction on Empirical Use of Ciprofloxacin on Nonsusceptibility of Escherichia coli Urinary Isolates to Ciprofloxacin

被引:12
作者
O'Brien, Kristen A. [1 ]
Zhang, Jingwen [2 ]
Mauldin, Patrick D. [2 ]
Gomez, Juanmanuel [2 ]
Hurst, John M. [3 ]
Boger, M. Sean [2 ]
Bosso, John A. [2 ,4 ]
机构
[1] Mercer Univ, Coll Pharm, Dept Pharm Practice, Atlanta, GA USA
[2] Med Univ S Carolina, Coll Med, Dept Med, Charleston, SC 29425 USA
[3] Med Univ South Carolina Hosp, Dept Pharm Serv, Charleston, SC USA
[4] South Carolina Coll Pharm, Dept Clin Pharm & Outcome Sci, Charleston, SC USA
来源
PHARMACOTHERAPY | 2015年 / 35卷 / 05期
关键词
antimicrobial resistance; stewardship; E; coli; urinary tract infections; MORBIDLY OBESE-PATIENTS; VANCOMYCIN PHARMACOKINETICS; ADULT PATIENTS; POPULATION; CLEARANCE; CHILDREN; REGIMEN; SOCIETY;
D O I
10.1002/phar.1590
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
STUDY OBJECTIVE To evaluate the impact of a stewardship-initiated restriction on empirical use of ciprofloxacin on the nonsusceptibility of Escherichia coli urinary isolates to ciprofloxacin over time while controlling for the use of other key antibiotics with gram-negative activity. DESIGN Retrospective single-center study. SETTING Large tertiary and quaternary care academic medical center. ISOLATES Of 3714 E. coli urinary isolates. MEASUREMENTS AND MAIN RESULTS The susceptibilities of the E. coli urinary isolates to ciprofloxacin, ceftriaxone, cefepime, piperacillin-tazobactam, meropenem, trimethoprim-sulfamethoxazole, and nitrofurantoin obtained over a 7-year period (January 1, 2006-December 31, 2012) from adult inpatients were evaluated for potential relationships with antibiotic use over time by using multiple variable regression analysis. After introduction of the restriction on empirical use of ciprofloxacin in the first quarter of 2011, ciprofloxacin use declined from 141.1-39.8 defined daily doses/1000 patient-days, and the percentage of E. coli isolates that were not susceptible to ciprofloxacin decreased from 41.5-32.8%. With all antibiotics evaluated included in the model, no apparent relationships were found between the percentage of E. coli isolates nonsusceptible to ciprofloxacin and antibiotic use. However, when nonsignificant variables were eliminated (p>0.20), ciprofloxacin use was found to be positively associated with the percentage of E. coli isolates nonsusceptible to ciprofloxacin (p=0.037), whereas ceftriaxone use was negatively associated (p=0.045). CONCLUSION The restriction and subsequent reduction of ciprofloxacin use was found to have a positive effect on the susceptibility of E. coli urinary isolates to ciprofloxacin.
引用
收藏
页码:464 / 469
页数:6
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