The present study included three periods: (1) a 12-month prerestriction and control period in 2001; (2) a 12-month restriction
period with reduced ceftazidime prescribing in favor of piperacillin-tazobactam (2002); (3) and a 24 month postrestriction
period (2003–2004). Note that, for results,
P represents the difference between 2002 and 2001;
P′, the difference between 2003 and 2001; and
P″, the difference between 2004 and 2001. No changes in hygiene practices were observed during these three periods. The purpose
of this study was to assess the effect of reducing ceftazidime use in an intensive care unit (ICU) upon Gram-negative bacterial
resistance, particularly as regards
Pseudomonas aeruginosa. During the three periods of the study, patients were similar concerning age, Simplified Acute Physiology Score (SAPSII),
the site of nosocomial infection, and the requirements for mechanical ventilation (75% in 2001, 76% in 2002, 74% in 2003,
and 85% in 2004). The most commonly isolated pathogens were
P. aeruginosa, Acinetobacter baumannii, and
Enterobacteriaceae. The use of ceftazidime decreased significantly from 12.6% in 2001 to 9% in 2002, to 3% in 2003 (
P′ = 0.0009), and 2.6% in 2004 (
P″ = 0.0001) in favor of piperacillin-tazobactam (0% 2001 to 3.7% in 2003;
P′ = 0.002; and 5% in 2004;
P″ = 0.0001). Simultaneously, we observed a significant decrease in isolates of
P. aeruginosa resistant to piperacillin-tazobactam (
P = 0.03;
P′ = 0.004;
P″ = 0.009), and those resistant to imipenem in 2003 (
P′ = 0.008). We also noted a significant decrease in
A.
baumannii isolates resistant to ceftazidime (
P′ = 0.01;
P″ = 0.0004) and those resistant to imipenem in both 2002 and 2004 (
P = 0.03;
P″ = 0.04), and a considerable decrease in isolates of
Klebsiella pneumoniae producing expanded spectrum betalactamase (ESBL) in 2003 and 2004 (
P′ = 0.04;
P″ = 6.10
−5). In contrast, we noted an increase in penicillinase-producing isolates of
K. pneumoniae, from 6% in 2001 to 16% in 2002 (p = 0.01), 20% in 2003 (
P′ = 0.001), and 32% in 2004 (
P″ = 10
−6). We concluded that restriction of ceftazidime use was demonstrated to be efficient in reducing antimicrobial resistance,
especially to
K. pneumoniae ESBL.
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