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Use of Amoxicillin-Clavulanate and Resistance in Escherichia coli Over a 4-Year Period

Published online by Cambridge University Press:  02 January 2015

Stephanie Natsch ,
Christian Conrad ,
Cora Hartmeier  and
Beat Schmid
Stephanie Natsch
Affiliation:
Clinical Pharmacy, Hospital of Schaffhausen, Switzerland
Christian Conrad
Affiliation:
Department of Infection Control, Hospital of Schaffhausen, Switzerland
Cora Hartmeier
Affiliation:
Hospital Pharmacy, Hospital of Schaffhausen, Switzerland
Beat Schmid*
Affiliation:
Department of Pharmacy and Laboratory, Hospital of Schaffhausen, Switzerland
*
Hospital Pharmacy, Hospital of Schaffhausen, CH-8208 Schauffhausen, Switzerland
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Abstract

Objective:

To reduce the use of amoxicillin-clavulanate after high-resistance rates in Escherichia coli were detected.

Design:

Intervention study; the interventions were introduced successively over a 4-year period while closely monitoring the resistance patterns.

Setting:

A 260-bed acute-care hospital in Switzerland.

Interventions:

Introduction of therapeutic guidelines for specific departments or indications, which proposed alternative antibiotics to amoxicillin-clavulanate. The perioperative prophylactic use of amoxicillin-clavulanate was eliminated completely.

Results:

The absolute amount of amoxicillin-clavulanate consumed decreased by 23%, from 24.8 g per 100 patient days in 1992 to 18.5 g per 100 patient days in 1995. The number of courses, a parameter that takes the prophylactic use into account, decreased by 62% from 2.3 per 100 patient days in 1992 to 0.9 per 100 patient days in 1995. The percentage of sensitive strains increased from 54.9% (n=512) in 1992 and 54.0% (n=506) in 1993 to 72.1% (n=546) in 1994 and 83.1% (n=668) in 1995. No major changes were detected for other antimicrobials, such as cotrimoxazole, tetracycline, or cefuroxime, used in this 4-year period.

Conclusions:

A decrease in the use of amoxicillin-clavulanate was followed by an increase in susceptibility of E coli to it. It was not possible to prove a causative relationship. Only a temporal association was discovered. The reduction of the use of amoxicillin-clavulanate was achieved through the implementation of treatment guidelines, facilitated through a close collaboration among the clinical pharmacists, the infection control practitioner, the microbiology laboratory, and the physicians in charge of the respective departments.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 9 , September 1998 , pp. 653 - 656
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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