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Published on: February 9, 2011
Meropenem use and colonization by antibiotic-resistant Gram-negative bacilli in a pediatric intensive care unit
Philip Toltzis1, Michael Dul, Mary Ann O'Riordan
1Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA. pxt2@case.edu
Objective:
The carbapenems are broad-spectrum beta-lactam antibiotics with activity against most organisms encountered in the pediatric intensive care unit (PICU). In anticipation of their increased use in critically ill children, we measured the effect of sustained meropenem use on the pattern of Gram-negative bacillus colonization in patients admitted to a tertiary care PICU.
Design:
: Prospective preintervention/postintervention comparison.
Setting:
Medical/surgical PICU.
Patients:
Consecutive PICU admissions over 2.5 yrs.
Interventions:
After a 6-mo baseline period, all children with serious infections admitted to the PICU during the subsequent 2 yrs were administered meropenem. The incidence of colonization by Gram-negative bacilli resistant to one of a battery of broad-spectrum parenteral agents, and by organisms resistant specifically to meropenem, during the baseline period was compared with the period of preferred meropenem use.
Results:
During the period of preferred meropenem use, the amount of meropenem used increased >seven-fold, whereas the use of other advanced generation beta-lactams was reduced by nearly 80%. The mean prevalence of colonization by antibiotic-resistant bacilli in general was not statistically altered during the period of meropenem preference (7.3 organisms/100 patient-days, vs. 9.4 organisms/100 patient-days at baseline, p < 0.09). The prevalence of colonization by Gram-negative organisms resistant specifically to meropenem was 0.61 organisms/100 patient-days during the baseline period vs. 1.04 organisms/100 patient-days during the period of meropenem preference (p < 0.30). The incidence of nosocomial infections did not change, and the prevalence of nosocomial infections caused by meropenem-resistant organisms was always <1% of all admissions during the period of meropenem preference.
Conclusion:
There was no statistically detectable effect on the prevalence of colonization by Gram-negative organisms resistant to one or more classes of broad-spectrum parenteral antibiotics, or to colonization by organisms resistant specifically to meropenem, when meropenem was the preferred antibiotic in a PICU.
Insights
Increased meropenem use in pediatric intensive care units (PICUs) did not significantly alter Gram-negative bacillus colonization rates. This study found no detectable effect on resistance to meropenem or other broad-spectrum antibiotics.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Antimicrobial Stewardship
Background:
- Carbapenems, like meropenem, are vital broad-spectrum antibiotics for treating infections in pediatric intensive care units (PICUs).
- Understanding the impact of increased meropenem use on antimicrobial resistance patterns is crucial for effective treatment strategies in critically ill children.
Purpose of the Study:
- To evaluate the effect of sustained meropenem use on Gram-negative bacillus colonization in a tertiary care PICU.
- To assess changes in resistance patterns to meropenem and other broad-spectrum antibiotics.
Main Methods:
- A prospective preintervention/postintervention study design was employed in a medical/surgical PICU.
- Data were collected over a 2.5-year period, including a 6-month baseline and a 2-year period of preferred meropenem use.
- Colonization incidence by Gram-negative bacilli resistant to broad-spectrum agents and specifically to meropenem was compared between periods.
Main Results:
- Meropenem use increased over seven-fold, while other advanced beta-lactam use decreased by 80%.
- No statistically significant alteration in the mean prevalence of colonization by antibiotic-resistant bacilli was observed (7.3 vs. 9.4 organisms/100 patient-days).
- Prevalence of colonization by meropenem-resistant Gram-negative organisms showed a non-significant increase (0.61 vs. 1.04 organisms/100 patient-days).
Conclusions:
- Sustained preferred use of meropenem in a PICU setting did not lead to a statistically significant increase in colonization by resistant Gram-negative organisms.
- The incidence of nosocomial infections remained unchanged, with meropenem-resistant organisms causing less than 1% of infections during the study period.
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