Please use this identifier to cite or link to this item: https://doi.org/10.1186/1471-2334-13-523
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dc.titleEvaluation of ertapenem use with impact assessment on extended-spectrum beta-lactamases (ESBL) production and gram-negative resistance in Singapore general hospital (SGH)
dc.contributor.authorLim, C.L.L
dc.contributor.authorLee, W
dc.contributor.authorLee, A.L.C
dc.contributor.authorLiew, L.T.T
dc.contributor.authorNah, S.C
dc.contributor.authorWan, C.N
dc.contributor.authorChlebicki, M.P
dc.contributor.authorKwa, A.L.H
dc.date.accessioned2020-10-27T11:15:06Z
dc.date.available2020-10-27T11:15:06Z
dc.date.issued2013
dc.identifier.citationLim, C.L.L, Lee, W, Lee, A.L.C, Liew, L.T.T, Nah, S.C, Wan, C.N, Chlebicki, M.P, Kwa, A.L.H (2013). Evaluation of ertapenem use with impact assessment on extended-spectrum beta-lactamases (ESBL) production and gram-negative resistance in Singapore general hospital (SGH). BMC Infectious Diseases 13 (1) : 523. ScholarBank@NUS Repository. https://doi.org/10.1186/1471-2334-13-523
dc.identifier.issn14712334
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/181542
dc.description.abstractBackground: Ertapenem (preferred choice for ESBL-producing organisms) use exhibited an increasing trend from 2006 to 2008. As extensive use of ertapenem might induce the mutation of resistant bacteria strains to ertapenem, we aimed to assess the appropriateness and impact of ertapenem-use, on ESBL production, the trends of gram-negative bacterial resistance and on the utilization of other antibiotics in our institution. Methods: Inpatients who received a dose of ertapenem during 1 January 2006 to 31 December 2008, were reviewed. Pertinent patient clinical data was extracted from the pharmacy databases and assessed for appropriateness based on dose and indication. Relevant data from Network for Antimicrobial Resistance Surveillance (Singapore) (NARSS) was extracted, to cross-correlate with ertapenem via time series to assess its impact on hospital epidemiology, trends of gram-negative resistance and consumption of other antibiotics from 2006 to mid-2010. Results: 906 cases were reviewed. Ertapenem therapy was appropriate in 72.4% (93.7% success rate). CNS adverse events were noted in 3.2%. Readmission rate (30-day) due to re-infection (same pathogen) was 5.5%. Fifty cases had cultures growing Pseudomonas aeruginosa within 30 days of ertapenem initiation, with 25 cases growing carbapenem-resistant Pseudomonas aeruginosa.Ertapenem use increased from 0.45 DDD/100 patient days in 2006 to 1.2 DDD/100 patient days in mid-2010. Overall, the increasing trend of ertapenem consumption correlated with 1) increasing incidence-densities of ciprofloxacin-resistant/cephalosporin-resistant E. coli at zero time lag; 2) increasing incidence-densities of ertapenem-resistant Escherichia. coli and Klebsiella spp. at zero time lag; 3) increasing incidence-density of carbapenem-resistant Pseudomonas aeruginosa, at zero time lag.Increasing ertapenem consumption was significantly correlated with decreasing consumption of cefepime (R2 = 0.37344) 3 months later. It was significantly correlated with a decrease in imipenem consumption (R2 = 0.31081), with no time lag but was correlated with subsequent increasing consumption of meropenem (R2 = 0.4092) 6 months later.Conclusion: Ertapenem use was appropriate. Increasing Ertapenem consumption did not result in a decreasing trend of ESBL producing enterobacteriaceae and could result in the selection for multi-drug resistant bacteria. © 2013 Lim et al.; licensee BioMed Central Ltd.
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceUnpaywall 20201031
dc.subjectaminoglycoside antibiotic agent
dc.subjectantibiotic agent
dc.subjectantifungal agent
dc.subjectantivirus agent
dc.subjectcarbapenem
dc.subjectcefepime
dc.subjectceftriaxone
dc.subjectcephalosporin
dc.subjectcephalosporin derivative
dc.subjectciprofloxacin
dc.subjectclindamycin
dc.subjectertapenem
dc.subjectextended spectrum beta lactamase
dc.subjectimipenem
dc.subjectmacrolide
dc.subjectmeropenem
dc.subjectpenicillin derivative
dc.subjectpolypeptide antibiotic agent
dc.subjectquinoline derived antiinfective agent
dc.subjectsulfonamide
dc.subjectadult
dc.subjectantibiotic resistance
dc.subjectantibiotic therapy
dc.subjectarticle
dc.subjectbacterial growth
dc.subjectbacterium culture
dc.subjectcentral nervous system disease
dc.subjectconfusion
dc.subjectcorrelation analysis
dc.subjectdrug efficacy
dc.subjectdrug fever
dc.subjectdrug indication
dc.subjectdrug safety
dc.subjectdrug utilization
dc.subjectEnterobacteriaceae
dc.subjecteosinophilia
dc.subjectEscherichia coli
dc.subjectgastrointestinal symptom
dc.subjectgeneral hospital
dc.subjectGram negative bacterium
dc.subjecthealth impact assessment
dc.subjecthospital patient
dc.subjecthospital readmission
dc.subjecthuman
dc.subjectincidence
dc.subjectKlebsiella
dc.subjectmajor clinical study
dc.subjectmiddle aged
dc.subjectmortality
dc.subjectmultidrug resistance
dc.subjectnonhuman
dc.subjectPseudomonas aeruginosa
dc.subjectreinfection
dc.subjectretrospective study
dc.subjectseizure
dc.subjectSingapore
dc.subjecttime series analysis
dc.subjecturticaria
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAnti-Bacterial Agents
dc.subjectBacterial Proteins
dc.subjectbeta-Lactamases
dc.subjectbeta-Lactams
dc.subjectCarbapenems
dc.subjectCephalosporins
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectDrug Resistance, Multiple, Bacterial
dc.subjectFemale
dc.subjectGram-Negative Bacteria
dc.subjectGram-Negative Bacterial Infections
dc.subjectHospitals, General
dc.subjectHumans
dc.subjectImipenem
dc.subjectMale
dc.subjectMicrobial Sensitivity Tests
dc.subjectMiddle Aged
dc.subjectRetrospective Studies
dc.subjectSingapore
dc.subjectThienamycins
dc.subjectYoung Adult
dc.typeArticle
dc.contributor.departmentDUKE-NUS MEDICAL SCHOOL
dc.description.doi10.1186/1471-2334-13-523
dc.description.sourcetitleBMC Infectious Diseases
dc.description.volume13
dc.description.issue1
dc.description.page523
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