Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jun 9;9(6):e99101.
doi: 10.1371/journal.pone.0099101. eCollection 2014.

Effects of Group 1 versus Group 2 carbapenems on the susceptibility of Acinetobacter baumannii to carbapenems: a before and after intervention study of carbapenem-use stewardship

Young Kyung Yoon  1 , Kyung Sook Yang  2 , Seung Eun Lee  3 , Hyun Jeong Kim  3 , Jang Wook Sohn  1 , Min Ja Kim  1
Affiliations

Effects of Group 1 versus Group 2 carbapenems on the susceptibility of Acinetobacter baumannii to carbapenems: a before and after intervention study of carbapenem-use stewardship

Young Kyung Yoon et al. PLoS One. .

Abstract

Objective: Antimicrobial stewardship programs have been proposed for reducing bacterial resistance in the hospital environment. The purpose of this study was to investigate the impact of a carbapenem-use stewardship program on the susceptibility of Acinetobacter baumannii to Group 2 carbapenems.

Methods: A before and after intervention study was conducted at a university hospital from September 2008 to February 2013. Three study periods were defined: Phase I, pre-intervention (months 1-18); Phase II, a postintervention period during which ertapenem use was mandated but carbapenem use was not restricted (months 19-36); and Phase III, a postintervention period during which Group 2 carbapenem use was restricted (months 37-54).

Results: During the study period, intervention resulted in diminished consumption of Group 2 carbapenems (antimicrobial use density (AUD): 21.3±6.0 in Phase I, 18.8±6.0 in Phase II, 16.1±4.4 in Phase III; P = 0.028) and increased consumption of ertapenem (AUD: 2.7±1.7 in Phase I, 7.2±4.5 in Phase II, 9.1±5.3 in Phase III; P<0.001). The use of autoregressive-error models showed that in contrast with ertapenem use, the use of Group 2 carbapenem during the previous one month was positively and significantly associated with a subsequent increase in the proportion of carbapenem-resistant A. baumannii (CRAB) (P = 0.031).

Conclusions: Implementing a carbapenem-use stewardship program featuring the preferential use of ertapenem for treating appropriate indications of infection resulted in reduced use of Group 2 carbapenems and had a positive impact on the susceptibility of A. baumannii to carbapenems. This approach could be integrated into CRAB-control strategies in hospitals.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: This study was supported in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp. The authors are in no way related with the employment, consultancy, patents, product development and marketing, etc., at Merck Sharp & Dohme. The opinions expressed in this paper are only those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. Particularly, this does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Trends of carbapenem-resistant Acinetobacter baumannii isolates (%) and carbapenem use (AUD, defined daily dose per 1,000 patient-days) during the study period.
See this image and copyright information in PMC

References

    1. Peleg AY, Seifert H, Paterson DL (2008) Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev 21: 538–582. - PMC - PubMed
    1. Perez F, Hujer AM, Hujer KM, Decker BK, Rather PN, et al. (2007) Global challenge of multidrug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother 51: 3471–3484. - PMC - PubMed
    1. Sunenshine RH, Wright MO, Maragakis LL, Harris AD, Song X, et al. (2007) Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization. Emerg Infect Dis 13: 97–103. - PMC - PubMed
    1. Lee NY, Lee HC, Ko NY, Chang CM, Shih HI, et al. (2007) Clinical and economic impact of multidrug resistance in nosocomial Acinetobacter baumannii bacteremia. Infect Control Hosp Epidemiol 28: 713–719. - PubMed
    1. Fishbain J, Peleg AY (2010) Treatment of Acinetobacter infections. Clin Infect Dis 51: 79–84. - PubMed

Publication types

MeSH terms