caa a22 4500 388035048 CHVBK 20180307125002.0 cr unu---uuuuu 161130e199809 xx s 000 0 eng 10.1086/647893 doi S0195941700005841 pii (NATIONALLICENCE)cambridge-10.1086/647893 Use of Amoxicillin-Clavulanate and Resistance in Escherichia coli Over a 4-Year Period [Elektronische Daten] 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. Copyright © The Society for Healthcare Epidemiology of America 1998 Natsch Stephanie Clinical Pharmacy, Hospital of Schaffhausen, Switzerland Conrad Christian Department of Infection Control, Hospital of Schaffhausen, Switzerland Hartmeier Cora Hospital Pharmacy, Hospital of Schaffhausen, Switzerland Schmid Beat Department of Pharmacy and Laboratory, Hospital of Schaffhausen, Switzerland Infection Control & Hospital Epidemiology Cambridge University Press 19/9(1998-09), 653-656 0899-823X 19:9<653 1998 19 ICE https://doi.org/10.1086/647893 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1086/647893 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Natsch Stephanie Clinical Pharmacy, Hospital of Schaffhausen, Switzerland NATIONALLICENCE 700 1- Conrad Christian Department of Infection Control, Hospital of Schaffhausen, Switzerland NATIONALLICENCE 700 1- Hartmeier Cora Hospital Pharmacy, Hospital of Schaffhausen, Switzerland NATIONALLICENCE 700 1- Schmid Beat Department of Pharmacy and Laboratory, Hospital of Schaffhausen, Switzerland NATIONALLICENCE 773 0- Infection Control & Hospital Epidemiology Cambridge University Press 19/9(1998-09), 653-656 0899-823X 19:9<653 1998 19 ICE CC0 http://creativecommons.org/publicdomain/zero/1.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-cambridge