Article (Scientific journals)
The effects of antibiotic cycling and mixing on antibiotic resistance in intensive care units: a cluster-randomised crossover trial.
van Duijn, Pleun Joppe; Verbrugghe, Walter; Jorens, Philippe Germaine et al.
2018In The Lancet Infectious Diseases, 18 (4), p. 401-409
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Keywords :
Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents/pharmacology/therapeutic use; Carrier State/epidemiology/microbiology; Cross-Over Studies; Drug Resistance, Bacterial; Drug Therapy/methods; Europe/epidemiology; Female; Gram-Negative Bacteria/drug effects/isolation & purification; Gram-Negative Bacterial Infections/drug therapy/epidemiology/microbiology; Humans; Intensive Care Units; Male; Middle Aged; Prevalence
Abstract :
[en] BACKGROUND: Whether antibiotic rotation strategies reduce prevalence of antibiotic-resistant, Gram-negative bacteria in intensive care units (ICUs) has not been accurately established. We aimed to assess whether cycling of antibiotics compared with a mixing strategy (changing antibiotic to an alternative class for each consecutive patient) would reduce the prevalence of antibiotic-resistant, Gram-negative bacteria in European intensive care units (ICUs). METHODS: In a cluster-randomised crossover study, we randomly assigned ICUs to use one of three antibiotic groups (third-generation or fourth-generation cephalosporins, piperacillin-tazobactam, and carbapenems) as preferred empirical treatment during 6-week periods (cycling) or to change preference after every consecutively treated patient (mixing). Computer-based randomisation of intervention and rotated antibiotic sequence was done centrally. Cycling or mixing was applied for 9 months; then, following a washout period, the alternative strategy was implemented. We defined antibiotic-resistant, Gram-negative bacteria as Enterobacteriaceae with extended-spectrum beta-lactamase production or piperacillin-tazobactam resistance, and Acinetobacter spp and Pseudomonas aeruginosa with piperacillin-tazobactam or carbapenem resistance. Data were collected for all admissions during the study. The primary endpoint was average, unit-wide, monthly point prevalence of antibiotic-resistant, Gram-negative bacteria in respiratory and perineal swabs with adjustment for potential confounders. This trial is registered with ClinicalTrials.gov, number NCT01293071. FINDINGS: Eight ICUs (from Belgium, France, Germany, Portugal, and Slovenia) were randomly assigned and patients enrolled from June 27, 2011, to Feb 16, 2014. 4069 patients were admitted during the cycling periods in total and 4707 were admitted during the mixing periods. Of these, 745 patients during cycling and 853 patients during mixing were present during the monthly point-prevalence surveys, and were included in the main analysis. Mean prevalence of the composite primary endpoint was 23% (168/745) during cycling and 22% (184/853) during mixing (p=0.64), yielding an adjusted incidence rate ratio during mixing of 1.039 (95% CI 0.837-1.291; p=0.73). There was no difference in all-cause in-ICU mortality between intervention periods. INTERPRETATION: Antibiotic cycling does not reduce the prevalence of carriage of antibiotic-resistant, Gram-negative bacteria in patients admitted to the ICU. FUNDING: European Union Seventh Framework Programme.
Disciplines :
Anesthesia & intensive care
Author, co-author :
van Duijn, Pleun Joppe
Verbrugghe, Walter
Jorens, Philippe Germaine
Spohr, Fabian
Schedler, Dirk
Deja, Maria
Rothbart, Andreas
Annane, Djillali
Lawrence, Christine
Nguyen Van, Jean-Claude
Misset, Benoît ;  Université de Liège - CHU > Soins Intensifs
Jereb, Matjaz
Seme, Katja
Sifrer, Franc
Tomic, Viktorija
Estevez, Francisco
Carneiro, Jandira
Harbarth, Stephan
Eijkemans, Marinus Johannes Cornelis
Bonten, Marc
More authors (10 more) Less
Language :
English
Title :
The effects of antibiotic cycling and mixing on antibiotic resistance in intensive care units: a cluster-randomised crossover trial.
Publication date :
2018
Journal title :
The Lancet Infectious Diseases
ISSN :
1473-3099
eISSN :
1474-4457
Publisher :
The Lancet Publishing Group, United Kingdom
Volume :
18
Issue :
4
Pages :
401-409
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Copyright (c) 2018 Elsevier Ltd. All rights reserved.
Available on ORBi :
since 21 February 2020

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