Muralidharan Jayashree1, Sunit Singhi2, Pallab Ray3, Vikas Gautam3, Sukhsagar Ratol2, Sahul Bharti4. 1. Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, India. Electronic address: mjshree@hotmail.com. 2. Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, India. 3. Department of Medical Microbiology, PGIMER, Chandigarh, India. 4. Build Healthy India Movement (Research based NGO), Chandigarh, India.
Abstract
PURPOSE: To compare antibiotic mixing vs. cycling with respect to acquisition of resistance and PICU mortality. MATERIALS AND METHODS: Children between >1 month to 12 years admitted to a medical PICU were enrolled over three phases (baseline, mixing and cycling) with washout interval of 3 months following each antibiotic strategy. Following a baseline phase, empiric gram negative antibiotic protocol for suspected HCAI, was sequentially subjected to mixing and cycling using Latin Square methodology. Surveillance cultures were taken at admission, 48 h, weekly thereafter and within 2 days of PICU discharge. Acquisition of resistance and PICU mortality were primary and secondary outcomes respectively. RESULTS: 778 children were enrolled; 99 baseline, 146 mixing, 362 cycling, and 171 during two washout phases. Proportion of children with acquired resistance at baseline (56.6%) was significantly higher than mixing (22.6%) and cycling (18.51%) (p < .0001). Adjusted hazards of acquired resistance (HR:0.82; 95% CI: 0.53-1.25, p = .352), and PICU mortality (RR1.07; 95% CI: 0.71-1.60, p = .72) were similar in cycling and mixing strategies. CONCLUSIONS: Acquisition of resistance was significantly lower in both mixing and cycling as compared to baseline phase. Both were similar with respect to risk of antibiotic resistance as well as incidence of HCAI and PICU mortality.
PURPOSE: To compare antibiotic mixing vs. cycling with respect to acquisition of resistance and PICU mortality. MATERIALS AND METHODS:Children between >1 month to 12 years admitted to a medical PICU were enrolled over three phases (baseline, mixing and cycling) with washout interval of 3 months following each antibiotic strategy. Following a baseline phase, empiric gram negative antibiotic protocol for suspected HCAI, was sequentially subjected to mixing and cycling using Latin Square methodology. Surveillance cultures were taken at admission, 48 h, weekly thereafter and within 2 days of PICU discharge. Acquisition of resistance and PICU mortality were primary and secondary outcomes respectively. RESULTS: 778 children were enrolled; 99 baseline, 146 mixing, 362 cycling, and 171 during two washout phases. Proportion of children with acquired resistance at baseline (56.6%) was significantly higher than mixing (22.6%) and cycling (18.51%) (p < .0001). Adjusted hazards of acquired resistance (HR:0.82; 95% CI: 0.53-1.25, p = .352), and PICU mortality (RR1.07; 95% CI: 0.71-1.60, p = .72) were similar in cycling and mixing strategies. CONCLUSIONS: Acquisition of resistance was significantly lower in both mixing and cycling as compared to baseline phase. Both were similar with respect to risk of antibiotic resistance as well as incidence of HCAI and PICU mortality.