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Cefepime use in a pediatric intensive care unit reduces colonization with resistant bacilli
Philip Toltzis1, Michael Dul, Mary Ann O'Riordan
1Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA.
The Pediatric Infectious Disease Journal
|February 15, 2003
Summary
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.