BACKGROUND: Six years after initiating a monthly antibiotic cycling protocol in the surgical intensive care unit (SICU), we retrospectively reviewed antibiogram-derived sensitivities of predominant gram-negative pathogens before and after antibiotic cycling. We also examined susceptibility patterns in the medical intensive care unit (MICU) where antibiotic cycling is not practiced. MATERIALS AND METHODS: Antibiotic cycling protocol was implemented in the SICU starting in 2003, with monthly rotation of piperacillin/tazobactam, imipenem/cilastin, and ceftazidime. SICU antibiogram data from positive clinical cultures for years 2000 and 2002 were included in the pre-cycling period, and those from 2004 to 2009 in the cycling period. RESULTS: Profiles of SICU pseudomonal isolates before (n = 116) and after (n = 205) implementing antibiotic cycling showed statistically significant improvements in susceptibility to ceftazidime (66% versus 81%; P = 0.003) and piperacillin/tazobactam (75% versus 85%; P = 0.021), while susceptibility to imipenem remained unaltered (70% in each case; P = 0.989). Susceptibility of E. coli isolates to piperacillin/tazobactam improved significantly (46% versus 83%; P < 0.0005), trend analysis showing this improvement to persist over the study period (P = 0.025). Similar findings were not observed in the MICU. Review of 2004-2009 antibiotic prescription practices showed monthly heterogeneity in the SICU, and a 2-fold higher prescribing of piperacillin/tazobactam in the MICU (P < 0.0001). CONCLUSIONS: Six years into antibiotic cycling, we found either steady or improved susceptibilities of clinically relevant gram-negative organisms in the SICU. How much of this effect is from cycling is unknown, but the antibiotic heterogeneity provided by this practice justifies its ongoing use.
BACKGROUND: Six years after initiating a monthly antibiotic cycling protocol in the surgical intensive care unit (SICU), we retrospectively reviewed antibiogram-derived sensitivities of predominant gram-negative pathogens before and after antibiotic cycling. We also examined susceptibility patterns in the medical intensive care unit (MICU) where antibiotic cycling is not practiced. MATERIALS AND METHODS: Antibiotic cycling protocol was implemented in the SICU starting in 2003, with monthly rotation of piperacillin/tazobactam, imipenem/cilastin, and ceftazidime. SICU antibiogram data from positive clinical cultures for years 2000 and 2002 were included in the pre-cycling period, and those from 2004 to 2009 in the cycling period. RESULTS: Profiles of SICU pseudomonal isolates before (n = 116) and after (n = 205) implementing antibiotic cycling showed statistically significant improvements in susceptibility to ceftazidime (66% versus 81%; P = 0.003) and piperacillin/tazobactam (75% versus 85%; P = 0.021), while susceptibility to imipenem remained unaltered (70% in each case; P = 0.989). Susceptibility of E. coli isolates to piperacillin/tazobactam improved significantly (46% versus 83%; P < 0.0005), trend analysis showing this improvement to persist over the study period (P = 0.025). Similar findings were not observed in the MICU. Review of 2004-2009 antibiotic prescription practices showed monthly heterogeneity in the SICU, and a 2-fold higher prescribing of piperacillin/tazobactam in the MICU (P < 0.0001). CONCLUSIONS: Six years into antibiotic cycling, we found either steady or improved susceptibilities of clinically relevant gram-negative organisms in the SICU. How much of this effect is from cycling is unknown, but the antibiotic heterogeneity provided by this practice justifies its ongoing use.
Authors: Timothy H Dellit; Robert C Owens; John E McGowan; Dale N Gerding; Robert A Weinstein; John P Burke; W Charles Huskins; David L Paterson; Neil O Fishman; Christopher F Carpenter; P J Brennan; Marianne Billeter; Thomas M Hooton Journal: Clin Infect Dis Date: 2006-12-13 Impact factor: 9.079
Authors: David K Warren; Holly A Hill; Liana R Merz; Marin H Kollef; Mary K Hayden; Victoria J Fraser; Scott K Fridkin Journal: Crit Care Med Date: 2004-12 Impact factor: 7.598
Authors: Kyla M Bennett; John E Scarborough; Michelle Sharpe; Elizabeth Dodds-Ashley; Keith S Kaye; Thomas Z Hayward; Steven N Vaslef Journal: J Trauma Date: 2007-08
Authors: Robert L Smith; Heather L Evans; Tae W Chong; Shannon T McElearney; Traci L Hedrick; Brian R Swenson; W Michael Scheld; Timothy L Pruett; Robert G Sawyer Journal: Surg Infect (Larchmt) Date: 2008-08 Impact factor: 2.150
Authors: Christiane P Goulart; Mentar Mahmudi; Kristina A Crona; Stephen D Jacobs; Marcelo Kallmann; Barry G Hall; Devin C Greene; Miriam Barlow Journal: PLoS One Date: 2013-02-13 Impact factor: 3.240
Authors: Andrew N Ginn; Agnieszka M Wiklendt; Heather F Gidding; Narelle George; James S O'Driscoll; Sally R Partridge; Brian I O'Toole; Rita A Perri; Joan Faoagali; John E Gallagher; Jeffrey Lipman; Jonathan R Iredell Journal: PLoS One Date: 2012-06-25 Impact factor: 3.240
Authors: Nazaret Cobos-Trigueros; Mar Solé; Pedro Castro; Jorge Luis Torres; Mariano Rinaudo; Elisa De Lazzari; Laura Morata; Cristina Hernández; Sara Fernández; Alex Soriano; José María Nicolás; Josep Mensa; Jordi Vila; José Antonio Martínez Journal: PLoS One Date: 2016-03-16 Impact factor: 3.240
Authors: Pia Abel zur Wiesch; Roger Kouyos; Sören Abel; Wolfgang Viechtbauer; Sebastian Bonhoeffer Journal: PLoS Pathog Date: 2014-06-26 Impact factor: 6.823
Authors: Santi M Mandal; Ludovico Migliolo; Osmar N Silva; Isabel C M Fensterseifer; Celio Faria-Junior; Simoni C Dias; Amit Basak; Tapas K Hazra; Octávio L Franco Journal: Sci Rep Date: 2014-08-11 Impact factor: 4.379