Carbapenem stewardship: positive impact on hospital ecology

INTRODUCTION: Excessive group 2 carbapenem use may result in decreased bacterial susceptibility. OBJECTIVE: We evaluated the impact of a carbapenem stewardship program, restricting imipenem and meropenem use. METHODS: Ertapenem was mandated for ESBL-producing Enterobacteriaceae infections in the absence of non-fermenting Gram-negative bacilli (GNB) from April 2006 to March 2008. Group 2 carbapenems were restricted for use against GNB infections susceptible only to carbapenems and suspected GNB infections in unstable patients. Cumulative susceptibility tests were done for nosocomial pathogens before and after restriction using Clinical and Laboratory Standards Institute (CLSI) guide-lines.Vitek System or conventional identification methods were performed and susceptibility testing done by disk diffusion according to CLSI.Antibiotic consumption (t-test) and susceptibilities (McNemar's test) were determined. RESULTS: The defined daily doses (DDD) of group 2 carbapenems declined from 61.1 to 48.7 DDD/1,000 patient-days two years after ertapenem introduction (p = 0.027). Mean ertapenem consumption after restriction was 31.5 DDD/1,000 patient-days. Following ertapenem introduction no significant susceptibility changes were noticed among Gram-positive cocci. The most prevalent GNB were P. aeruginosa, Klebsiella pneumoniae, and Acinetobacter spp. There was no change in P. aeruginosa susceptibility to carbapenems. Significantly improved P. aeruginosa and K. pneumoniae ciprofloxacin susceptibilities were observed, perhaps due to decreased group 2 carbapenem use. K. pneumoniae susceptibility to trimethoprim-sulfamethoxazole improved. CONCLUSION: Preferential use of ertapenem resulted in reduced group 2 carbapenem use, with a positive impact on P. aeruginosa and K. pneumoniae susceptibility.

Novos táxons de Cerambycidae (Coleoptera) neotropicais da coleção Herbert Schmid, Viena, Áustria

São descritos novos táxons: Cerambycinae, Hesperophanini: Paracorupella gen. nov., espécie-tipo, P. pallida sp. nov., daVenezuela; Ibidionini, Compsina: Stenoidion schmidi sp. nov., da Guiana Francesa; Necydalopsini: Eucharassus nigratus sp. nov., da Colômbia. Lamiinae, Pteropliini: Kuauna gen. nov., espécie tipo, K. schmidi sp. nov., da Venezuela; Apomecynini, Rosalba suiaba sp. nov., do Brasil; Desmiphorini: Malthonea piraiuba sp. nov., da Costa Rica; Colobotheini: Sangaris spilota sp. nov., do Equador; Hemilophini: Adesmus icambi sp. nov., Icaunauna gen. nov., espécie-tipo, I. aurantium sp. nov., Cotysomerida gen. nov., espécie-tipo, C. lampyroides.

Novos táxons de Apomecynini (Coleoptera, Cerambycidae, Lamiinae)

Novos táxons descritos: Tethystola cincta sp. nov. e Rosalba formosa sp. nov. da Bolívia (Santa Cruz); Adetus stellatus sp. nov. da Costa Rica (Cartago); Acrepidopterum capilosum sp. nov. de Honduras (Ilha Roatán); Irundiaba gen. nov. espécie-tipo, I. waorani sp. nov. do Equador (Napo). Novo nome Neopoticatuca é proposto para Potiatuca Martins & Galileo, 2007 (Cerambycinae, Ibidionini) non Potiatuca Galileo & Martins, 2006 (Lamiinae, Apomecynini); Neopotiatuca brevis (Martins & Galileo, 2007) comb. nov.