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Título:
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Impact of diversity of antibiotic use on the development of antimicrobial resistance
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Autor/a:
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Sandiumenge, Alberto; Diaz, Emili; Rodriguez, Alejandro; Vidaur, Loreto; Canadell, Laura; Olona, Montserrat; Rué i Monné, Montserrat; Rello, Jordi
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Notas:
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Objectives: To evaluate the impact of different antibiotic strategies on acquisition of resistant microorganisms.
Methods: A prospective study was conducted over a 44 month period in a single ICU. Four empirical
antibiotic strategies for ventilator-associated pneumonia (VAP) were sequentially implemented. Over
the initial 10 months, patient-specific antibiotic therapy was prescribed; then, 4 month periods of
prioritization or restriction rotation cycles of various antimicrobial agents were implemented for a total
of 24 months; and, finally, during the last 10 months (mixing period) the first-line antibiotic for VAP was
changed following a pre-established schedule to ensure maximum heterogeneity. Antibiotic consumption
was closely monitored every month, and antimicrobial resistance patterns were regularly assessed.
Antimicrobial heterogeneity was estimated using a modified Peterson index (AHI) measuring the ratios
for the five most used antibiotics. Colonization by targeted microorganisms and susceptibility patterns
were compared with the patient-specific period.
Results: Higher diversity of antibiotic prescription was obtained during patient-specific therapy (AHI = 0.93)
or mixing periods (AHI = 0.95) than during prioritization (AHI = 0.70) or restriction periods (AHI = 0.68). High
homogeneity was associated with increases in carbapenem-resistant Acinetobacter baumannii (CR-Ab)
[relative risk (RR) 15.5; 95%CI 5.5–42.8], extended-spectrum b-lactamase (ESBL)-producing Enterobacteriaceae
(RR 4.2; 95%CI 1.9–9.3) and Enterococcus faecalis (RR 1.7; 95%CI 1.1–2.9). During the restriction
period, incidence of ESBL-producing Enterobacteriaceae and E. faecalis returned to patient-specific rates
but CR-Ab remained higher.
Conclusions: Antibiotic prescription patterns balancing the use of different antimicrobials should be
promoted to reduce the selection pressure that aids the development of resistance. |
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Materia(s):
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-Antibiotic heterogeneity
-Ventilator-associated pneumonia
-Antibiotic rotation
-Cycling antibiotics |
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Derechos:
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(c) Sandiumenge et al., 2006
info:eu-repo/semantics/restrictedAccess |
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Tipo de documento:
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article
publishedVersion |
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Editor:
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Oxford University Press
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Compartir:
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