The impact of an antimicrobial cycling strategy for febrile neutropenia in a haematology unit.

Antibiotic cycling has been proposed as a strategy to combat the emergence of antimicrobial resistance but has been implemented with conflicting results. A cycling strategy including four broad-spectrum antimicrobial regimens administrated sequentially over 3-month cycles in patients with febrile neutropenia was implemented in a haematology unit, during a 2-year period (2001-2003). Compliance to the strategy ranged between 57 and 100% and overall successful clinical response was 83%. Resistance rates of Gram negatives remained either stable or decreased (for Pseudomonas aeruginosa) at the end of the cycling period and no rectal colonization with resistant pathogens was recorded during the study period. The incidence of Gram-negative infections showed a decreasing trend while Gram-positive infections and resistance rates remained unaffected and at low rates.