title: Scheduled change of antibiotic classes: a strategy to decrease the incidence of ventilator-associated pneumonia.
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.
authors.affiliation: Department of Internal Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Kollef
authors.forename: J
authors.initials: J
authors.lastname: Vlasnik
authors.forename: L
authors.initials: L
authors.lastname: Sharpless
authors.forename: C
authors.initials: C
authors.lastname: Pasque
authors.forename: D
authors.initials: D
authors.lastname: Murphy
authors.forename: V
authors.initials: V
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology; D002442:Ceftazidime / Q000008:administration & dosage / Q000627:therapeutic use; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*
chemical_list: D000890:Anti-Infective Agents; D002511:Cephalosporins; D002939:Ciprofloxacin; D002442:Ceftazidime