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Related Experiment Videos

Scheduled change of antibiotic classes: a strategy to decrease the incidence of ventilator-associated pneumonia

M H Kollef1, J Vlasnik, L Sharpless

  • 1Department of Internal Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.

American Journal of Respiratory and Critical Care Medicine
|November 14, 1997
PubMed
Summary

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Switching empiric antibiotics for Gram-negative infections reduced ventilator-associated pneumonia (VAP). This change decreased VAP caused by antibiotic-resistant bacteria, improving patient outcomes in cardiac surgery settings.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Pharmacology

Background:

  • Ventilator-associated pneumonia (VAP) and nosocomial bacteremia are significant healthcare-associated infections.
  • Antibiotic resistance in Gram-negative bacteria poses a growing challenge in clinical practice.
  • Empiric antibiotic selection is crucial for managing suspected Gram-negative bacterial infections.

Purpose of the Study:

  • To evaluate the effect of a scheduled antibiotic class switch on VAP and nosocomial bacteremia incidence.
  • To assess the impact of changing empiric antibiotic therapy on antibiotic-resistant Gram-negative bacterial infections.

Main Methods:

  • A quasi-experimental study design comparing two 6-month periods in 680 cardiac surgery patients.
  • Before-period: empiric treatment with ceftazidime (a third-generation cephalosporin).

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  • After-period: empiric treatment with ciprofloxacin (a quinolone).

    • Main Results:

    • VAP incidence significantly decreased from 11.6% to 6.7% (p=0.028) in the after-period.
    • A significant reduction in VAP due to antibiotic-resistant Gram-negative bacteria was observed (4.0% vs 0.9%, p=0.013).
    • Bacteremia incidence attributed to antibiotic-resistant Gram-negative bacteria showed a downward trend (1.7% vs 0.3%, p=0.125).

    Conclusions:

    • Scheduled antibiotic class rotation can effectively reduce VAP incidence, particularly that caused by resistant Gram-negative pathogens.
    • This strategy may be beneficial in preventing and controlling antibiotic resistance in hospital settings.
    • Antimicrobial stewardship programs incorporating scheduled antibiotic changes warrant consideration.