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dc.contributor.author | Cobos-Trigueros, Nazaret |
---|---|
dc.contributor.author | Solé, Mar |
dc.contributor.author | Castro, Pedro |
dc.contributor.author | Torres, Jorge Luis |
dc.contributor.author | Rinaudo, Mariano |
dc.contributor.author | Lazzari, Elisa de |
dc.contributor.author | Morata, Laura |
dc.contributor.author | Hernández-Munain, Cristina |
dc.contributor.author | Fernández, Sara (Fernández García) |
dc.contributor.author | Soriano Viladomiu, Alex |
dc.contributor.author | Nicolás Arfelis, Josep Maria |
dc.contributor.author | Mensa Pueyo, Josep |
dc.contributor.author | Vila Estapé, Jordi |
dc.contributor.author | Martínez, José Antonio (Martínez Martínez) |
dc.date | 2016-05-19T09:52:47Z |
dc.date | 2016-05-19T09:52:47Z |
dc.date | 2016-03-16 |
dc.date | 2016-05-10T15:01:27Z |
dc.identifier | 1932-6203 |
dc.identifier | 26982807 |
dc.identifier.uri | http://hdl.handle.net/2445/98675 |
dc.description | OBJECTIVE: To compare the effect of two strategies of antibiotic use (mixing vs. cycling) on the acquisition of resistant microorganisms, infections and other clinical outcomes. METHODS: Prospective cohort study in an 8-bed intensive care unit during 35- months in which a mixing-cycling policy of antipseudomonal beta-lactams (meropenem, ceftazidime/piperacillin-tazobactam) and fluoroquinolones was operative. Nasopharyngeal and rectal swabs and respiratory secretions were obtained within 48h of admission and thrice weekly thereafter. Target microorganisms included methicillin-resistant S. aureus, vancomycin-resistant enterococci, third-generation cephalosporin-resistant Enterobacteriaceae and non-fermenters. RESULTS: A total of 409 (42%) patients were included in mixing and 560 (58%) in cycling. Exposure to ceftazidime/piperacillin-tazobactam and fluoroquinolones was significantly higher in mixing while exposure to meropenem was higher in cycling, although overall use of antipseudomonals was not significantly different (37.5/100 patient-days vs. 38.1/100 patient-days). There was a barely higher acquisition rate of microorganisms during mixing, but this difference lost its significance when the cases due to an exogenous Burkholderia cepacia outbreak were excluded (19.3% vs. 15.4%, OR 0.8, CI 0.5-1.1). Acquisition of Pseudomonas aeruginosa resistant to the intervention antibiotics or with multiple-drug resistance was similar. There were no significant differences between mixing and cycling in the proportion of patients acquiring any infection (16.6% vs. 14.5%, OR 0.9, CI 0.6-1.2), any infection due to target microorganisms (5.9% vs. 5.2%, OR 0.9, CI 0.5-1.5), length of stay (median 5 d for both groups) or mortality (13.9 vs. 14.3%, OR 1.03, CI 0.7-1.3). CONCLUSIONS: A cycling strategy of antibiotic use with a 6-week cycle duration is similar to mixing in terms of acquisition of resistant microorganisms, infections, length of stay and mortality. |
dc.format | 14 p. |
dc.format | application/pdf |
dc.language | eng |
dc.publisher | Public Library of Science (PLoS) |
dc.relation | Reproducció del document publicat a: http://dx.doi.org/10.1371/journal.pone.0150274 |
dc.relation | PLoS One, 2016, vol. 11, num. 3, p. e0150274 |
dc.relation | http://dx.doi.org/10.1371/journal.pone.0150274 |
dc.rights | cc by (c) Cobos-Trigueros et al., 2016 |
dc.rights | http://creativecommons.org/licenses/by/3.0/es/ |
dc.rights | info:eu-repo/semantics/openAccess |
dc.subject | Antibiòtics |
dc.subject | Infeccions del tracte urinari |
dc.subject | Antibiotics |
dc.subject | Urinary tract infections |
dc.title | Evaluation of a Mixing versus a Cycling Strategy of Antibiotic Use in Critically-Ill Medical Patients: Impact on Acquisition of Resistant Microorganisms and Clinical Outcomes |
dc.type | info:eu-repo/semantics/article |
dc.type | info:eu-repo/semantics/publishedVersion |