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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.
Abstract:
The purpose of this study was to determine the impact of a scheduled change of antibiotic classes, used for the empiric treatment of suspected gram-negative bacterial infections, on the incidence of ventilator-associated pneumonia and nosocomial bacteremia. Six hundred eighty patients undergoing cardiac surgery were evaluated. During a 6-mo period (i.e., the before-period), our traditional practice of prescribing a third generation cephalosporin (ceftazidime) for the empiric treatment of suspected gram-negative bacterial infections was continued. This was followed by a 6-mo period (i.e., the after-period) during which a quinolone (ciprofloxacin) was used in place of the third-generation cephalosporin. The incidence of ventilator-associated pneumonia was significantly decreased in the after-period (n = 327) compared with the before-period (n = 353) (6.7 versus 11.6%; p = 0.028). This was primarily due to a significant reduction in the incidence of ventilator-associated pneumonia attributed to antibiotic-resistant gram-negative bacteria (0.9 versus 4.0%; p = 0.013). Similarly, we observed a lower incidence of bacteremia attributed to antibiotic-resistant gram-negative bacteria in the after-period compared with the before-period (0.3 versus 1.7%; p = 0.125). These data suggest that a scheduled change of antibiotic classes can reduce the incidence of ventilator-associated pneumonia attributed to antibiotic-resistant gram-negative bacteria.
Insights
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).
- 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.