Autor/a:
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Cobos-Trigueros, Nazaret; Solé, Mar; Castro, Pedro; Torres, Jorge Luis; Rinaudo, Mariano; Lazzari, Elisa de; Morata, Laura; Hernández, Cristina; Fernández, Sara (Fernández García); Soriano Viladomiu, Alex; Nicolás Arfelis, Josep Maria; Mensa Pueyo, Josep; Vila Estapé, Jordi; Martínez, José Antonio (Martínez Martínez)
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Abstract:
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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. |