Cefepime use in a pediatric intensive care unit reduces colonization with resistant bacilli
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Published on: January 22, 2021
Philip Toltzis1, Michael Dul, Mary Ann O'Riordan
1Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA.
Insights
Preferential use of cefepime in a pediatric intensive care unit significantly reduced antibiotic-resistant Gram-negative rod colonization. This strategy may help limit antibiotic resistance in critically ill patients.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Cefepime exhibits activity against Gram-negative pathogens resistant to older beta-lactams.
- Hospital-acquired infections pose a significant challenge in pediatric intensive care units (PICUs).
Purpose of the Study:
- To evaluate if prioritizing cefepime use in a PICU could decrease enteric colonization by antibiotic-resistant Gram-negative rods.
- To assess the impact of a cefepime-focused antibiotic strategy on antimicrobial resistance patterns.
Main Methods:
- A 2-year study involving preferential cefepime use for infections in a PICU.
- Rectal swab specimens were collected daily to monitor colonization by resistant Gram-negative rods.
- Resistance was assessed against cefepime, ceftazidime, gentamicin, and piperacillin-tazobactam.
Main Results:
- Colonization by antibiotic-resistant bacilli decreased from 27.6 to 12.9 per 100 patients (P < 0.01).
- The proportion of patients colonized with resistant organisms fell from 11.6% to 7.4% (P < 0.01).
- Reductions in resistance were observed across all tested phenotypes, including cefepime resistance.
Conclusions:
- Cefepime demonstrated a low potential for promoting bacillary resistance in critically ill pediatric patients.
- Preferential cefepime use may be an effective strategy for controlling antibiotic resistance in intensive care settings.
Background:
Cefepime has activity against many hospital-acquired Gram-negative pathogens resistant to earlier beta-lactam antibiotics. This study was designed to test whether preferential use of cefepime in a pediatric intensive care unit could reduce enteric colonization with antibiotic-resistant Gram-negative rods.
Methods:
After a 6-month period of uncontrolled antibiotic use, cefepime was preferentially used during 2 years as treatment for nosocomial or serious community-acquired infection. Rectal swab specimens were obtained daily on every patient regardless of antibiotic exposure during the 6 months of uncontrolled antibiotic use and during the first and last 6 months of the 2 years of cefepime preference. The study outcome was rectal colonization with a facultative Gram-negative rod resistant to at least one of four antibiotics: cefepime; ceftazidime; gentamicin; or piperacillin-tazobactam.
Results:
The incidence of colonization by a resistant organism decreased only slightly during the first 6 months of cefepime use. By contrast, the number of antibiotic-resistant bacilli isolated from rectal swab specimens diminished from 27.6/100 patients during the baseline period to 12.9/100 patients by the last 6 months of the 2 years of cefepime preference (P < 0.01). The proportion of patients harboring at least one resistant organism decreased from 11.6% to 7.4% during the same time period (P < 0.01). A decrease in colonization with resistant organisms occurred for all the tested resistance phenotypes, including cefepime.
Conclusion:
Cefepime may possess a low potential for promoting bacillary resistance in critically ill patients, suggesting that its preferential use might be a key element in limiting the presence of antibiotic resistance in the intensive care unit.
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