RT Journal
A1 Rahal JJ, Urban C, Horn D, et al
T1 CLass restriction of cephalosporin use to control total cephalosporin resistance in nosocomial klebsiella
JF JAMA
JO JAMA
YR 1998
FD October 14
VO 280
IS 14
SP 1233
OP 1237
DO 10.1001/jama.280.14.1233
UL http://dx.doi.org/10.1001/jama.280.14.1233
AB Context.— 
                  Resistance to most or all cephalosporin antibiotics in Klebsiella species has developed in many European and North American
hospitals during the past 2 decades.Objective.— 
                  To determine if restriction of use of the cephalosporin class of antibiotics
would reduce the incidence of patient infection or colonization by cephalosporin-resistant Klebsiella.Design.— 
                  A before-after comparative 2-year trial.Setting.— 
                  A 500-bed, university-affiliated community hospital in Queens, NY.Patients.— 
                  All adult medical and surgical hospital inpatients.Intervention.— 
                  A new antibiotic guideline excluded the use of cephalosporins except
for pediatric infection, single-dose surgical prophylaxis, acute bacterial
meningitis, spontaneous bacterial peritonitis, and outpatient gonococcal infection.
All other cephalosporin use required prior approval by the infectious disease
section.Main Outcome Measure.— 
                  Incidence of patient infection or colonization by ceftazidime-resistant Klebsiella during 1995 (control period) compared with 1996
(intervention period).Results.— 
                  An 80.1% reduction in hospital-wide cephalosporin use occurred in 1996
compared with 1995. This was accompanied by a 44.0% reduction in the incidence
of ceftazidime-resistant Klebsiella infection and
colonization throughout the medical center (P<.01),
a 70.9% reduction within all intensive care units (P<.001),
and an 87.5% reduction within the surgical intensive care unit (P<.001). A concomitant 68.7% increase in the incidence of imipenem-resistant Pseudomonas aeruginosa occurred throughout the medical
center (P<.01). All such isolates except one were
susceptible to other antibiotics.Conclusion.— 
                  Extensive cephalosporin class restriction significantly reduced nosocomial,
plasmid-mediated, cephalosporin-resistant Klebsiella
infection and colonization. This occurred at the price of increased imipenem
resistance in P aeruginosa, which remained susceptible
to other agents. Thus, an overall reduction in multiply-resistant pathogens
was achieved within 1 year.