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Acquisition of vancomycin-resistant enterococci during scheduled antimicrobial rotation in an intensive care unit
L A Puzniak1, J Mayfield, T Leet
1Department of Community Health, St. Louis University School of Public Health, St. Louis, MO, USA.
Abstract:
Scheduled rotation of treatment of gram-negative antimicrobial agents has been associated with reduction of serious gram-negative infections. The impact of this practice on other nosocomial infections has not been assessed. The purpose of this study was to determine if scheduled antimicrobial rotation reduced rates of acquisition of enteric vancomycin-resistant enterococci (VRE) among 740 patients admitted to an intensive care unit (ICU). The preferred gram-negative agent was ceftazidime during rotation 1 and ciprofloxacin during rotation 2. Unadjusted VRE acquisition rates were 8.5 cases per 1000 ICU days and 11.7 cases per 1000 ICU days during rotations 1 and 2, respectively (P<.01). However, scheduled antimicrobial rotation of ceftazidime with ciprofloxacin had no effect on the risk of acquiring VRE in the ICU after adjustment for known risk factors. Independent predictors of acquisition of VRE were enteral feedings, higher colonization pressure, and increased duration of anaerobic therapy. Our findings can confirm no additional beneficial or adverse effect on VRE acquisition among ICU patients as a result of this practice.
Insights
Scheduled antimicrobial rotation did not impact vancomycin-resistant enterococci (VRE) acquisition in ICUs. Risk factors for VRE included enteral feedings and longer anaerobic therapy, not the rotation strategy itself.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Stewardship
Background:
- Scheduled antimicrobial rotation of gram-negative agents may reduce infections.
- Impact on other nosocomial infections, like VRE, is not well-established.
- Intensive care units (ICUs) are high-risk environments for VRE acquisition.
Purpose of the Study:
- To assess if scheduled antimicrobial rotation reduces vancomycin-resistant enterococci (VRE) acquisition in an ICU.
- To identify risk factors associated with VRE acquisition in the ICU setting.
Main Methods:
- Prospective study involving 740 ICU patients over two rotation periods.
- Utilized ceftazidime in rotation 1 and ciprofloxacin in rotation 2 as preferred gram-negative agents.
- Analyzed VRE acquisition rates and adjusted for known risk factors.
Main Results:
- Unadjusted VRE acquisition rates were 8.5 and 11.7 per 1000 ICU days for rotation 1 and 2, respectively (P<.01).
- Scheduled antimicrobial rotation did not significantly affect VRE acquisition risk after adjusting for covariates.
- Enteral feedings, colonization pressure, and duration of anaerobic therapy were independent predictors of VRE acquisition.
Conclusions:
- Scheduled antimicrobial rotation with ceftazidime and ciprofloxacin did not influence VRE acquisition in the ICU.
- The practice showed no additional benefit or harm regarding VRE acquisition.
- Focusing on identified risk factors may be more effective in controlling VRE spread.