nach oben

Erschienen in:

01.01.2006 | Original

Selection of resistance during sequential use of preferential antibiotic classes

verfasst von: Pierre Damas, Jean-Luc Canivet, Didier Ledoux, Mehran Monchi, Pierrette Melin, Monique Nys, Patrick De Mol

Erschienen in: Intensive Care Medicine | Ausgabe 1/2006

Einloggen, um Zugang zu erhalten

Abstract

Objective

To determine the effect of antibiotic class pressure on the susceptibility of bacteria during sequential periods of antibiotic homogeneity.

Design and setting

Prospective study in a mixed ICU with three separated subunits of eight, eight, and ten beds.

Patients and participants

The study examined the 1,721 patients with a length of stay longer than 2 days.

Interventions

Three different antibiotic regimens were used sequentially over 2 years as first-choice empirical treatment: cephalosporins, fluoroquinolone, or a penicillin–β-lactamase inhibitor combination. Each regimen was applied for 8 months in each subunits of the ICU, using “latin square” design.

Results

We treated 731 infections in 546 patients (32% of patients staying more than 48 h). There were 25.5 ICU-acquired infections per 1,000 patient-days. Infecting pathogens and colonizing bacteria were found in 2,739 samples from 1,666 patients (96.8%). No significant change in global antibiotic susceptibility was observed over time. However, a decrease in the susceptibility of several species was observed for antibiotics used as the first-line therapy in the unit. Selection pressure of antibiotics and occurrence of resistance during treatment was documented within an 8-month rotation period.

Conclusions

Antibiotic use for periods of several months induces bacterial resistance in common pathogens.

Eggiman P, Pittet D (2001) Infection control in the ICU. Chest 120:2059–2093CrossRefPubMed

Struelens M, Byl B, Vincent JL (1999) Antibiotic policy: a tool for controlling resistance of hospital pathogens. Clin Microbiol Infect 5:S19–S24PubMed

Goldmann DA, Weinstein RA, Wenzel RP, Tablan OC, Duma RJ, Gaynes RP, Schlosser J, Martone WJ (1996) Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals: a challenge to hospital leadership. JAMA 275:234–240CrossRefPubMed

Emmerson M (2000) Antibiotic usage and prescribing policies in the intensive care unit. Intensive Care Med 26:S26–S30CrossRefPubMed

Rice L (2001) Evolution and clinical importance of extended-spectrum beta-lactamases. Chest 119:391S–6SCrossRefPubMed

Rahal JJ, Urban C, Horn D, Freeman K, Segal-Maurer S, Maurer J, Mariano N, Marks S, Burns J, Dominick D et al (1998) Class restriction of cephalosporin use to control total cepahalosporin resistance in nosocomial Klebsiella. JAMA 280:1233–1237CrossRefPubMed

Burke JP (1998) Antibiotic resistance—squeezing the balloon? JAMA 280:1270–1271CrossRefPubMed

Du B, Chen D, Liu D, Long Y, Shi Y, Wang H, Rui X, Cui N (2003) Restriction of third-generation cephalosporin use decreases infection-related mortality. Crit Care Med 31:1088–1093CrossRefPubMed

Geissler A, Gerbeaux P, Granier I, Blanc P, Facon K, Durand-Gasselin J (2003) National use of antibiotics in the intensive care unit: Impact on microbial resistance and costs. Intensive Care Med 29:49–54PubMed

10.

Knox K, Holmes A (2002) Regulation of antimicrobial prescribing practices—a strategy for controlling nosocomial antimicrobial resistance. Int J Infect Dis 6 [Suppl 1]:S8–S13

11.

Kollef MH (2001) Is there a role for antibiotic cycling in the intensive care unit? Crit Care Med 29 [Suppl]:N135–N143

12.

Niederman MS (1997) Is “crop rotation” of antibiotics the solution to a “resistant” problem in the ICU? Am J Respir Crit Care Med 156:1029–1031PubMed

13.

Dominguez EA, Smith TL, Reed E, Sanders CC, Sanders WE (2000) A pilot study of antibiotic cycling in a hematology-oncology unit. Infect Control Hosp Epidemiol 21 [Suppl]:S4–S8

14.

Pujol M, Gudiol F (2001) Evidence for antibiotic cycling in control of resistance. Curr Opin Infect Dis 14:711–715PubMed

15.

Kollef MH, Vlasnik J, Sharpless L, Pasque C, Murphy D, Fraser D (1997) Scheduled change of antibiotic classes. A strategy to decrease the incidence of ventilator-assisted pneumonia. Am J Respir Crit Care Med 156:1040–1048PubMed

16.

Gruson D, Hilbert G, Vargas F, Valentino R, Bebear C, Allery A, Bebear C, Gbikpi-Benissan, Cardinaud JP (2000) Rotation and restricted use of antibiotics in a medical intensive care unit. Am J Respir Crit Care Med 162:837–843PubMed

17.

Kollef MH, Ward S, Sherman G, Prentice D, Schaiff R, Huey W, Fraser VJ (2000) Inadequate treatment of nosocomial infections is associated with certain empiric antibiotic choices. Crit Care Med 28:3456–3464CrossRefPubMed

18.

Raymond D, Pelletier SJ, Crabtree T, Gleason T, Hamm L, Pruett T, Sawyer R (2001) Impact of a rotating empiric antibiotic schedule on infections mortality in an intensive care unit. Crit Care Med 29:1101–1108CrossRefPubMed

19.

Gruson D, Hilbert F, Valentino R, Bui N, Pereyre S, Bebear C, Bebear CM, Gbikpi-Benissan G (2003) Strategy of antibiotic rotation: long-term effect on incidence and susceptibilities of Gram-negative bacilli responsible for ventilator-associated pneumonia. Crit Care Med 31:1908–1914CrossRefPubMed

20.

Kollef M, Fraser V (2001) Antibiotic resistance in the intensive care unit. Ann Intern Med 134:298–314PubMed

21.

Fridkin SK, Gaynes RP (1999) Antimicrobial resistance in intensive care units. Clin Chest Med 20:303–316CrossRefPubMed

22.

Fridkin SK (2003) Routine cycling of antimicrobial agents as an infection-control measure. Clin Infect Dis 36:1438–1444CrossRefPubMed

23.

Ochs MM, McCusker MP, Bains M, Hancock RE (1999) Negative regulation of the pseudomonas aeruginosa outer membrane porine oprD selective for imipenem and basic amino acids. Antimicrob Agents Chemother 43:1085–1090PubMed

24.

Livermore DM (2002) Multiple mechanisms of antimicrobial resistance in pseudomonas aeruginosa: our worst nightmare? Clin Infect Dis 34:634–40CrossRefPubMed

25.

Harbarth S, Harris AD, Carmeli Y, Samore MH (2001) Parallel analysis of individual and aggregated data on antibiotic exposure and resistance in gram-negative bacilli. Clin Infect Dis 33:1462–1468CrossRefPubMed

26.

Bonten MJ, Austin DA, Lipsitch M (2001) Understanding the spread of antibiotic resistant pathogens in hospitals: mathematical models as tools for control. Clin Infect Dis 33:1739–1746CrossRefPubMed

27.

Loon HJ van, Vriens MR, Fluit AC, Troelstra A, van der Werken C, Verhoef J, Bonten M (2005) Antibiotic rotation and development of gram-negative antibiotic resistance. Am J Respir Crit Care Med 171:480–487CrossRefPubMed

28.

Bonhoeffer S, Lipsitch M, Levin BR (1997) Evaluating treatment protocols to prevent antibiotic resistance. Proc Natl Acad Sci USA 94:12106–12111CrossRefPubMed

29.

Bergstrom C, Lo M, Lipsitch M (2004) Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals. Proc Natl Acad Sci USA 101:13285–13290CrossRefPubMed

30.

Cheol-In K, Sung-Hang K, Wam Beom P, Ki-Deok L, Hong-Bin K, Eui-Chong K, Myoung-Don O, Kang-Won C (2004) Bloodstream Infections due to extended-spectrum betalactamase-producing Escherichia Coli and Klebsiella pneumoniae: Risk factors for mortality and treatment outcome, with special emphasis on antimicrobial therapy. Antimicrob Agents Chemother 48:4574–4581CrossRefPubMed

Titel: Selection of resistance during sequential use of preferential antibiotic classes
verfasst von: Pierre Damas
Jean-Luc Canivet
Didier Ledoux
Mehran Monchi
Pierrette Melin
Monique Nys
Patrick De Mol
Publikationsdatum: 01.01.2006
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 1/2006
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-005-2805-z

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Selection of resistance during sequential use of preferential antibiotic classes