Reduced use of third-generation cephalosporins decreases the acquisition of extended-spectrum beta-lactamase-producing Klebsiella pneuatonme

OBJECTIVES: To identify risk factors for the respiratory acquisition of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae among patients admitted to a neurosurgical intensive care unit (NSICU) and to modify them without changing general infection control measures. DESIGN: Nested case-control and intervention study. SETTING: A 1,200-bed, tertiary-care teaching hospital with a 17-bed NSICU. METHODS: Sputa of all patients admitted to the NSICU were cultured weekly during the study. From October 2002 through February 2003, 29 case-patients from whose sputum ESBL-producing K pneumoniae was isolated were detected and 59 controls-patients were randomly selected among patients without any positive isolate of ESBL-producing K pneumoniae. After analyzing the risk factors, we intervened to modify them and compared the acquisition rate of ESBL-producing K pneumoniae before (October 2002 to February 2003) and after (April to August 2003) the intervention. RESULTS: Multivariate analysis showed that prior exposure to third-generation cephalosporins (TGCs) (OR, 6.0; CI95, 1.9 to 18.6; P =.002) was an independent risk factor of ESBL-producing K. pneumoniae acquisition. The neurosurgical team was notified of the result, and the infectious diseases specialist visited the NSICU three times a week to regulate TGC use during the intervention period. Patients admitted before the intervention were older than patients admitted after. The respiratory acquisition of ESBL-producing K pneumoniae per 1,000 patient-days (13.5 [CI95, 8.9 to 18.1] vs 2.7 [CI95, 0.9 to 4.6]) and the antimicrobial use density of TGCs (38.2 +/- 5.0 vs 17.3 +/- 2.6; P < .001) decreased significantly after the intervention. CONCLUSION: Prior exposure to TGCs was an independent risk factor for the respiratory acquisition of ESBL-producing K pneumoniae, and less use of TGCs was associated with a decrease in acquisition.