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Rodrigo Pires dos Santos, MD, PhD, of the Hospital Infection Control Committee at the Hospital de ClÃnicas de Porto Alegre in Porto Alegre, Brazil, and colleagues, sought to evaluate the impact of ertapenem use in Pseudomonas aeruginosa carbapenem resistance, taking into account the volume of antimicrobial consumption, the consumption by the entire hospital of alcohol-based antiseptic handrub, and the density rate of invasive practices.
In this before-and-after trial in a tertiary-care university hospital in southern Brazil, the researchers evaluated Pseudomonas aeruginosa resistance rates through three study periods: period 1, before ertapenem use (17 months); period 2, during ertapenem use (33 months); and period 3, after exclusion of ertapenem (15 months). Ertapenem was first added to the hospital formulary in June 2006 and it was excluded in February 2009.
The researchers report that following introduction of ertapenem, there was a significant decrease in median consumption of imipenem or meropenem, from 2.6 to 2.2 defined daily doses (DDDs) per 100 patient-days, as well as an increase in the use of these medications after ertapenem exclusion, from 2.2 to 3.3 DDDs per 100 patient-days, by segmented regression analysis. There was no difference in the incidence density of carbapenem-resistant P. aeruginosa infection related to ertapenem use throughout the study periods; however, by multiple regression analysis, the reduction in the rate of carbapenem-resistant P. aeruginosa infection correlated significantly with the increase in the volume of alcohol used as hand sanitizer, which was from 660.7 mL per 100 patient-days in period 1 to 2,955.1 mL per 100 patient-days in period 3 (). Ertapenem use did not impact the rate of carbapenem-resistant P. aeruginosa infection.
Pires dos Santos, et al. conclude that use of alcohol-based hand sanitizer, rather than ertapenem, was associated with a reduction in the rates of carbapenem-resistant P. aeruginosa infection. They add that measures to reduce resistance must include factors other than just antimicrobial stewardship programs alone.
Reference: Pires dos Santos R, et al. Hand Hygiene, and Not Ertapenem Use, Contributed to Reduction of Carbapenem-Resistant Pseudomonas aeruginosa Rates. Infect Control Hosp Epidem. Vol. 32, No. 6, June 2011.