Faculty Collaboration Database

Outbreak of resistant Pseudomonas aeruginosa infections during a quarterly cycling antibiotic regimen. Surg Infect (Larchmt) 2008 Apr;9(2):139-52

Date

04/23/2008

Pubmed ID

18426346

DOI

10.1089/sur.2006.102

Scopus ID

2-s2.0-42449088882 (requires institutional sign-in at Scopus site)   27 Citations

Abstract

BACKGROUND: Antibiotic cycling or rotation of antimicrobial agent classes has been proposed to combat antimicrobial resistance.

METHODS: A prospective cohort study was conducted in a medical intensive care unit (ICU) of a university hospital between December 1, 2000, and September 30, 2002, as part of a three-center trial under the aegis of the U.S. Centers for Disease Control and Prevention. Patients admitted to the medical ICU for > 48 h were enrolled, and demographic and microbiological data were collected until discharge or death. Baseline data were collected for four months (12/1/00 to 3/31/01) and compared with data collected after institution of a quarterly cycling regimen (cycle order: Cefepime, ciprofloxacin, piperacillin-tazobactam, imipenem-cilastatin) for the empiric treatment of gram-negative infections (4/01/01 to 9/30/02).

RESULTS: Of 1,074 consecutive admissions, 301 were enrolled, 59 during baseline and 242 during the cycling periods. An outbreak of multi-drug resistant Pseudomonas aeruginosa followed cycle 2 (cefepime), coinciding with cycles 3 and 4 (ciprofloxacin and piperacillin-tazobactam) (80.0 and 73.7 vs. 37.3 isolates/100 patients enrolled for cycles 3/4 and baseline, respectively; p = 0.04). Acinetobacter spp. were isolated less frequently during the cycling periods (15.3 vs. 1.2 isolates/100 patients for baseline and cycling periods, respectively; p > or = 0.01). The crude hospital mortality rate was similar (24/59 [41%] baseline vs. 73/242 [30%] cycling; p = 0.16) between periods. However, the percentage of patients admitted to the medical ICU who subsequently acquired an infection followed by in-hospital death was higher at baseline than during cycling: 15/59 (25.4%) vs. 33/242 (13.6%)(p = 0.04).

CONCLUSIONS: In this study, the cycling strategy was not definitively associated with beneficial changes in unit epidemiology and in fact may have contributed to an outbreak of multi-drug resistant P. aeruginosa.

Author List

Hedrick TL, Schulman AS, McElearney ST, Smith RL, Swenson BR, Evans HL, Truwit JD, Scheld WM, Sawyer RG

MESH terms used to index this publication - Major topics in bold

Aged
Anti-Bacterial Agents
Cross Infection
Disease Outbreaks
Drug Administration Schedule
Drug Resistance, Multiple, Bacterial
Female
Gram-Negative Bacterial Infections
Humans
Intensive Care Units
Male
Middle Aged
Patient Care Planning
Patient Compliance
Prospective Studies
Pseudomonas Infections
Pseudomonas aeruginosa