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Pilot study of antibiotic cycling in a pediatric intensive care unit
William J Moss1, M Claire Beers, Elizabeth Johnson
1Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Insights
Antibiotic cycling in pediatric intensive care units was safe and showed a trend toward reducing antibiotic-resistant bacteria colonization and bloodstream infections. Further randomized trials are needed to confirm these findings.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Antibiotic resistance is a growing threat in healthcare settings, particularly in intensive care units (ICUs).
- Colonization and infection with antibiotic-resistant bacteria (ARB) pose significant risks to critically ill patients.
Purpose of the Study:
- To evaluate the safety and effectiveness of antibiotic cycling as a strategy to reduce ARB colonization and infection.
- To assess the impact of antibiotic cycling on ARB prevalence in a pediatric medical-surgical ICU.
Main Methods:
- An open, observational pilot study was conducted in a 16-bed pediatric ICU over 18 months.
- Three classes of broad-spectrum antibiotics were systematically cycled every 3 months for empirical therapy.
- Colonization with ARB was monitored via surveillance cultures, alongside rates of nosocomial bloodstream infections.
Main Results:
- Antibiotic cycling was found to be safe, with no increase in antibiotic resistance or emergence of new organisms.
- A non-significant trend was observed in the prevalence of children colonized with ARB, decreasing from 29% to 24% (p =.41).
- The prevalence of antibiotic-resistant bloodstream infections showed a similar non-significant trend (p =.29).
Conclusions:
- Antibiotic cycling appears to be a safe and potentially viable strategy to mitigate the emergence of antibiotic resistance in ICUs.
- A larger, randomized controlled trial is recommended to definitively establish the efficacy of antibiotic cycling.
Objective:
This pilot study was performed to determine the safety and size of effect of antibiotic cycling to reduce colonization and infection with antibiotic-resistant bacteria.
Design:
Open, observational study.
Setting:
The study was performed in a 16-bed pediatric medical-surgical intensive care unit.
Patients:
Critically ill children requiring antibiotic therapy.
Interventions:
Three antibiotic classes were systematically cycled for 3-month intervals over 18 months. Antibiotic regimens were used for all empirical therapy and continued if the bacterial isolate was susceptible.
Measurements:
The primary outcome was colonization with antibiotic-resistant bacteria, determined by surveillance cultures obtained twice monthly from all patients in the unit. Rates of antibiotic-resistant, nosocomial blood stream infections, and risks of colonization over calendar time in the intensive care unit were also evaluated.
Main Results:
The cycling of broad-spectrum, empirical antibiotics was safe and did not generate increased antibiotic resistance nor select for new organisms. Over the study period, the trend in prevalence of children colonized with antibiotic-resistant bacteria was from 29% to 24% (p =.41). The effect on prevalence of resistant blood stream infections was similar (p =.29). Changes in individual risks of colonization with resistant bacteria over calendar time were consistent with the ecologic effect in size and direction.
Conclusions:
Results of this pilot intervention suggest that cycling antibiotics may be a safe and viable strategy to minimize the emergence of antibiotic resistance in intensive care units. A definitive study will require a randomized and controlled trial of only four pediatric intensive care units over an 18-month period.