{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T03:05:32Z","timestamp":1784775932376,"version":"3.55.0"},"reference-count":47,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2013,4,21]]},"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Bacteria-producing extended spectrum \u03b2-lactamase (ESBL) enzymes are resistant to commonly used antimicrobials. In 2008, routine monitoring revealed a clonal hospital outbreak of ESBL-producing <jats:italic>Klebsiella pneumoniae<\/jats:italic> (ESBL-KP).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>At a 510-bed Danish university hospital, a multidisciplinary change project inspired by Kotter's <jats:italic>Eight Steps of Change<\/jats:italic> was designed. In addition to revision of antimicrobial guidelines and restriction of selected antimicrobials, the complex, managed, multi-faceted intervention comprised training and education, enhanced isolation precautions, and a series of actions to improve the infection control measures and standardise procedures across the hospital. A prospective interrupted time series design was used to analyse data collected at hospital level from January 2008 through December 2011.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Though overall antimicrobial consumption remained unaffected, the intervention led to intended, immediate and sustained reduction in the use of cefuroxime, and an increase in the use of ertapenem, piperacillin\/tazobactam and \u03b2-lactamase sensitive penicillin. Moreover, a postintervention reduction in the rate of ESBL-KP in diagnostic samples and in the incidence of ESBL-KP infections was observed. The intervention may also have reduced the need for isolation precautions and may have shortened each isolation period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The results indicate that an immediate and sustained change in the antimicrobial consumption and a decreasing rate of ESBL-KP are achievable through the application of a managed, multi-faceted intervention that does not require ongoing antibiotic stewardship.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2012-001791","type":"journal-article","created":{"date-parts":[[2013,5,24]],"date-time":"2013-05-24T00:38:33Z","timestamp":1369355913000},"page":"907-915","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["A managed multidisciplinary programme on multi-resistant <i>Klebsiella pneumoniae<\/i> in a Danish university hospital"],"prefix":"10.1136","volume":"22","author":[{"given":"Stig Ejdrup","family":"Andersen","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg, Copenhagen NV, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny Dahl","family":"Knudsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark"},{"name":"Infection Control Organisation, Copenhagen University Hospital, Bispebjerg, Copenhagen NV, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Bispebjerg Intervention Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2013,5,23]]},"reference":[{"key":"2025090411454160000_22.11.907.1","doi-asserted-by":"publisher","DOI":"10.1086\/375081"},{"key":"2025090411454160000_22.11.907.2","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1128\/AAC.42.1.53","article-title":"Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended-spectrum beta-lactamases","volume":"42","author":"Pena","year":"1998","journal-title":"Antimicrob Agents Chemother"},{"key":"2025090411454160000_22.11.907.3","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.2_suppl.391S"},{"issue":"Suppl","key":"2025090411454160000_22.11.907.4","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1097\/01.qco.0000393484.17894.05","article-title":"Antimicrobial stewardship: bridging the gap between quality care and cost","volume":"24 1","author":"Goff","year":"2011","journal-title":"Curr Opin Infect Dis"},{"key":"2025090411454160000_22.11.907.5","doi-asserted-by":"publisher","DOI":"10.2165\/11533040-000000000-00000"},{"issue":"Suppl","key":"2025090411454160000_22.11.907.6","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1111\/j.1469-0691.2007.01864.x","article-title":"Antibiotic policy and prescribing strategies for therapy of extended-spectrum beta-lactamase-producing Enterobacteriaceae: the role of piperacillin-tazobactam","volume":"14 1","author":"Peterson","year":"2008","journal-title":"Clin Microbiol Infect"},{"key":"2025090411454160000_22.11.907.7","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkm318"},{"key":"2025090411454160000_22.11.907.8","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01509-06"},{"key":"2025090411454160000_22.11.907.9","doi-asserted-by":"publisher","DOI":"10.1086\/420816"},{"key":"2025090411454160000_22.11.907.10","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00627-10"},{"key":"2025090411454160000_22.11.907.11","doi-asserted-by":"publisher","DOI":"10.1086\/507962"},{"key":"2025090411454160000_22.11.907.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2011.03.018"},{"key":"2025090411454160000_22.11.907.13","first-page":"2869","article-title":"The incidence of MRSA and ESBL-producing Enterobacteriaceae in society and in hospital-associated cases","volume":"173","author":"Skov","year":"2011","journal-title":"Ugeskr Laeger"},{"key":"2025090411454160000_22.11.907.14","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.18.4.638-656.2005"},{"key":"2025090411454160000_22.11.907.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2008.02.012"},{"key":"2025090411454160000_22.11.907.16","doi-asserted-by":"publisher","DOI":"10.1086\/510393"},{"key":"2025090411454160000_22.11.907.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2010.01.018"},{"key":"2025090411454160000_22.11.907.18","doi-asserted-by":"publisher","DOI":"10.1086\/319757"},{"key":"2025090411454160000_22.11.907.19","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.2.392-395.2004"},{"key":"2025090411454160000_22.11.907.20","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03530270074035"},{"key":"2025090411454160000_22.11.907.21","unstructured":"Kotter JP . The heart of change. Boston, Massachusetts: Harvard Business School Press, 2002."},{"key":"2025090411454160000_22.11.907.22","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14546-1"},{"issue":"Suppl 6","key":"2025090411454160000_22.11.907.23","first-page":"S57","article-title":"What drives change? Barriers to and incentives for achieving evidence-based practice","volume":"180","author":"Grol","year":"2004","journal-title":"Med J Aust"},{"key":"2025090411454160000_22.11.907.24","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm047"},{"key":"2025090411454160000_22.11.907.25","doi-asserted-by":"publisher","DOI":"10.1067\/mic.2001.114223"},{"key":"2025090411454160000_22.11.907.26","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkm225"},{"key":"2025090411454160000_22.11.907.27","doi-asserted-by":"publisher","DOI":"10.1007\/s13312-010-0118-y"},{"key":"2025090411454160000_22.11.907.28","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.14.1233"},{"key":"2025090411454160000_22.11.907.29","doi-asserted-by":"publisher","DOI":"10.1086\/501787"},{"key":"2025090411454160000_22.11.907.30","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/24.3.471"},{"key":"2025090411454160000_22.11.907.31","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2008.029199"},{"key":"2025090411454160000_22.11.907.32","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2009.204768"},{"key":"2025090411454160000_22.11.907.33","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2710.2002.00430.x"},{"key":"2025090411454160000_22.11.907.34","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dki147"},{"issue":"Suppl 2","key":"2025090411454160000_22.11.907.35","first-page":"S18","article-title":"Antimicrobial stewardship programs: how to start and steer a successful program","volume":"15","author":"Drew","year":"2009","journal-title":"J Manag Care Pharm"},{"key":"2025090411454160000_22.11.907.36","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7405.33"},{"key":"2025090411454160000_22.11.907.37","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2003.009597"},{"key":"2025090411454160000_22.11.907.38","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkq357"},{"key":"2025090411454160000_22.11.907.39","first-page":"115","article-title":"Double loop learning in organizations","volume":"55","author":"Argyris","year":"1977","journal-title":"Harv Bus Rev"},{"key":"2025090411454160000_22.11.907.40","unstructured":"Nielsen JCR Ry M . Leavitt revisited\u2014new light on a classic [in Danish]. Ledelse i dag 2002;(4):418\u201328."},{"key":"2025090411454160000_22.11.907.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2004.09.001"},{"key":"2025090411454160000_22.11.907.42","doi-asserted-by":"publisher","DOI":"10.1097\/01.HCM.0000318768.36901.ef"},{"key":"2025090411454160000_22.11.907.43","doi-asserted-by":"publisher","DOI":"10.1086\/502278"},{"key":"2025090411454160000_22.11.907.44","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2007.01870.x"},{"key":"2025090411454160000_22.11.907.45","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00143-10"},{"key":"2025090411454160000_22.11.907.46","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkg459"},{"key":"2025090411454160000_22.11.907.47","doi-asserted-by":"crossref","unstructured":"Grundmann H Livermore DM Giske CG . Carbapenem-non-susceptible Enterobacteriaceae in Europe: conclusions from a meeting of national experts. Euro Surveill 2010;15. pii:19711.","DOI":"10.2807\/ese.15.46.19711-en"}],"container-title":["BMJ Quality &amp; Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjqs-2012-001791","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T18:45:49Z","timestamp":1757011549000},"score":1,"resource":{"primary":{"URL":"https:\/\/qualitysafety.bmj.com\/lookup\/doi\/10.1136\/bmjqs-2012-001791"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,5,23]]},"references-count":47,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2013,10,14]]},"published-print":{"date-parts":[[2013,11]]}},"alternative-id":["10.1136\/bmjqs-2012-001791"],"URL":"https:\/\/doi.org\/10.1136\/bmjqs-2012-001791","relation":{},"ISSN":["2044-5415","2044-5423"],"issn-type":[{"value":"2044-5415","type":"print"},{"value":"2044-5423","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,5,23]]}}}