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Implementation of antibiotic rotation protocol improves antibiotic susceptibility profile in a surgical intensive

Kyla M Bennett1, John E Scarborough, Michelle Sharpe

  • 1Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.

The Journal of Trauma
|August 19, 2007
PubMed
Abstract

Insights

Antibiotic rotation in surgical ICUs improved susceptibility of gram-negative bacteria like Pseudomonas aeruginosa. This strategy may help combat antimicrobial resistance in intensive care units.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Microbiology

Background:

  • Antibiotic rotation is a strategy to combat antimicrobial resistance in intensive care units (ICUs).
  • The study assessed the impact of antibiotic rotation on gram-negative bacteria susceptibility in a surgical ICU (SICU).

Purpose of the Study:

  • To evaluate the effect of a monthly antibiotic rotation protocol on the susceptibility profiles of key gram-negative microorganisms.
  • To compare susceptibility changes in the SICU with a medical ICU that did not implement rotation.

Main Methods:

  • Implemented a 4-month antibiotic rotation cycle (piperacillin/tazobactam, imipenem/cilastin, ceftazidime, ciprofloxacin) in the SICU starting in 2003.
  • Collected and analyzed antibiotic susceptibility data for Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae in 2002 (pre-rotation) and 2004 (post-rotation).
  • Conducted a comparative analysis using data from a medical ICU without a rotation protocol.

Main Results:

  • Significant increases in P. aeruginosa susceptibility to ceftazidime (67% to 92%) and piperacillin/tazobactam (78% to 92%) were observed in the SICU post-implementation.
  • No similar increase in antimicrobial susceptibility was noted in the medical ICU.
  • E. coli susceptibility to piperacillin/tazobactam decreased in the medical ICU (p = 0.047).

Conclusions:

  • Antibiotic rotation in the SICU led to an improved antibiotic susceptibility profile for gram-negative microorganisms.
  • The observed improvements were relative to the control medical ICU, suggesting the protocol's effectiveness.

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