PATERSON DL, NDIRANGU M, CLARKE L, BANDLAMURI S, DONSKEY C; Interscience Conference on Antimicrobial Agents and Chemotherapy (43rd: 2003: Chicago, Ill.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43: abstract no. K-1418.
Univ. of Pittsburgh Med. Ctr., Pittsburgh, PA.
BACKGROUND: Some clinical studies have shown a lower risk of VRE, ESBL producers and C. difficile, with PTZ therapy compared to 3rd generation cephalosporins. However other studies have shown that drugs with anti-anaerobic effects may have deleterious effects on GI flora and therefore may lead to persistence of colonization with some organisms. Thus, we evaluated the comparative risk of superinfections in a large series of patients treated with either PTZ or CEF. METHODS: 200 consecutive pts in ICU who were given either PTZ or CEF were evaluated as a QA project. Cultures from clinical specimens for 1 month prior to, and 1 month after, the starting date of PTZ or CEF were recorded. Additionally surveillance rectal swabs for VRE were performed weekly. RESULTS: 24% had VRE colonization or infection in the 30 d. after PTZ use compared to 25% receiving CEF (p>0.20). 2 of the PTZ treated patients and 5 of the CEF treated patients had known prior VRE colonization. 11 patients were found to be colonized with VRE while actually receiving PTZ and 12 while receiving CEF. There were no significant differences in subsequent infections with ESBL producers (1% after PTZ vs. 6% after CEF; p=0.12) or C. difficile (3% after PTZ vs. 4% after CEF). Excluding patients with prior fungal isolates, 27% treated with PTZ and 28% treated with CEF had Candida spp. from a clinical specimen in the 30 d. after PTZ or CEF use. 5% of PTZ treated patients had isolation of a PTZ resistant GNB during or after PTZ treatment (P. aeruginosa 1, Enterobacter spp. 2, E. coli 1, C. koseri 1) compared to 6% of CEF treated patients with isolation of a CEF resistant GNB during or after CEF treatment (P. aeruginosa 3, K. oxytoca 2, E. coli 1). CONCLUSIONS: Although prior studies have shown that PTZ may be "protective" against colonization with VRE, more than 20% of patients treated with PTZ developed VRE colonization in this institution. The risks of superinfection appeared similar with PTZ or CEF.
Publication Types:
Keywords:
- Cephalosporins
- Enterococcus
- Family
- Humans
- Infection Control
- Intensive Care Units
- Penicillanic Acid
- Piperacillin
- cefepime
- etiology
- tazobactam
Other ID:
UI: 102264416
From Meeting Abstracts