Cefepime use in a pediatric intensive care unit reduces colonization with resistant bacilli.
BACKGROUND
Cefepime has activity against many hospital-acquired Gram-negative pathogens resistant to earlier beta-lactam antibiotics. This study was designed to test whether preferential use of cefepime in a pediatric intensive care unit could reduce enteric colonization with antibiotic-resistant Gram-negative rods.


METHODS
After a 6-month period of uncontrolled antibiotic use, cefepime was preferentially used during 2 years as treatment for nosocomial or serious community-acquired infection. Rectal swab specimens were obtained daily on every patient regardless of antibiotic exposure during the 6 months of uncontrolled antibiotic use and during the first and last 6 months of the 2 years of cefepime preference. The study outcome was rectal colonization with a facultative Gram-negative rod resistant to at least one of four antibiotics: cefepime; ceftazidime; gentamicin; or piperacillin-tazobactam.


RESULTS
The incidence of colonization by a resistant organism decreased only slightly during the first 6 months of cefepime use. By contrast, the number of antibiotic-resistant bacilli isolated from rectal swab specimens diminished from 27.6/100 patients during the baseline period to 12.9/100 patients by the last 6 months of the 2 years of cefepime preference (P < 0.01). The proportion of patients harboring at least one resistant organism decreased from 11.6% to 7.4% during the same time period (P < 0.01). A decrease in colonization with resistant organisms occurred for all the tested resistance phenotypes, including cefepime.


CONCLUSIONS
Cefepime may possess a low potential for promoting bacillary resistance in critically ill patients, suggesting that its preferential use might be a key element in limiting the presence of antibiotic resistance in the intensive care unit.
Toltzis
Philip
P
Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA.
Dul
Michael
M
O'Riordan
Mary Ann
MA
Salvator
Ann
A
Rosolowski
Bonnie
B
Toltzis
Hasida
H
Blumer
Jeffrey L
JL
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D000077723:Cefepime; D002511:Cephalosporins / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy; D004352:Drug Resistance, Microbial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000254:growth & development*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D008826:Microbial Sensitivity Tests; D012680:Sensitivity and Specificity
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime