Impact of rational antibiotic usage on occurrence of vancomycin-resistant enterococci in hematological patients

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Year of publication 2001
Type Article in Periodical
Magazine / Source Clinical Microbiology and Infection
MU Faculty or unit

Faculty of Science

Field Microbiology, virology
Description Objectives: The hematological patients are jeopardised by staphylococci and enterococci from the group of Gram-positive bacteria. Especially great danger for the hematological patients are the vancomycin-resistant enterococci that may be a very big therapeutic problem in some cases. Methods: Enterococci were isolated from clinical samples of patients hospitalised at the Department of Hemato-oncology of University Hospital in Olomouc, Czech Republic, during period 1995-2000. The usage of antibiotics was expressed as the number of defined daily doses (DDD) per 1000 bed-days (RDDD) during the observation periods according to the following formula: RDDD=DDD x 1000/NB (NB=number of bed-days). To evaluate the selection pressure of antibiotics and occurrence of VRE, we used each six-month interval from 1st half of 1997 to 1st half of 2000. Results: In total, 1918 strains were isolated in the Department of Hemato-oncology, from which 138 (7.2%) were identified as VRE. The percentage of VRE in the mentioned department was within the interval 1.7-15.1%. The highest occurrence (15.1%) was detected in the second half of 1998. In the following periods, the number of VRE gradually decreased to the value of 6.1% in the first half of 2000. The application of glycopeptides has decreased by 68.2% after evaluating the period of 1997-2000. A distinct decline is accomplished especially in vancomycin. A distinct decline (by 75.3%) is achieved in the case of IIIrd generation cephalosporins as well. The selection pressure of fluoroquinolones was not reduced until 1999, when the usage of these antimicrobial preparations decreased by 47.3% compared to 1997 and compared to 1998 by 46.4%. Conclusion: Based on the comparison of the selection pressure progress of antibiotics and the percentage of VRE in each period of observation, we can assume the influence of the application of each antibiotic group on the occurrence of VRE. A distinct decline of the application of third-generation cephalosporins, glycopeptides and fluoroquinolones and its replacement with penicillin antibiotics combined with inhibitors of bacterial beta-lactamases (amoxicillin/clavulanic acid, ampicillin/sulbactam, piperacillin/tazobactam), had a great influence on the cessation of the increasing occurrence of VRE and a following decline of its occurrence from 15.1% in the second half of 1998 to 6.1% in the first half of 2000.
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