title: Antibiotic cycling to decrease bacterial antibiotic resistance: a 5-year experience on a bone marrow transplant unit.
abstract: Multidrug-resistant pathogens have important effects on clinical outcomes. Antibiotic cycling is one approach to control anti-microbial resistance, but few studies have examined cycling in hematology-oncology units. Antibiotic cycling was implemented in January 1999 at our hematology-oncology unit, alternating piperacillin-tazobactam (pip-tazo) and cefepime in 3 months periods, until June 2004. Clinical isolates were compared in post- and pre-intervention periods and with the susceptibility among the solid organ transplant intensive care unit (TICU) isolates. The rate of Gram-negative isolates remained stable. Among Gram-negatives, susceptibility to cefepime and pip-tazo remained stable. There was an increase in Enterococcus spp. (P=0.007), and susceptibility to ampicillin and vancomycin decreased (odds ratio (OR): 0.04, 95% confidence interval (CI): 0.17-0.89 and OR: 0.23, 95% CI: 0.09-0.58). Compared with the TICU, there was increased susceptibility to pip-tazo and cefepime among enterics (OR: 7.32, 95% CI: 4.44-12.07 and OR: 8.82, 95% CI: 2.1-37.13) and Pseudomonas aeruginosa (OR: 4.27, 95% CI: 1.47-12.4 and OR: 4.61, 95% CI: 1.75-12.1) and decreased susceptibility to ampicillin and vancomycin among enterococci (OR: 0.44, 95% CI: 0.30-0.63 and OR: 0.38, 95% CI: 0.26-0.56). Cycling was associated with preserved antibiotic susceptibility among Gram-negatives, but with an increase in Enterococcus spp. and vancomycin and ampicillin resistance among enterococci.
authors.affiliation: Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. cadenazuluag@uthscsa.edu
authors.forename: J
authors.initials: J
authors.lastname: Cadena
authors.forename: C A
authors.initials: CA
authors.lastname: Taboada
authors.forename: D S
authors.initials: DS
authors.lastname: Burgess
authors.forename: J Z
authors.initials: JZ
authors.lastname: Ma
authors.forename: J S
authors.initials: JS
authors.lastname: Lewis
authors.forename: C O
authors.initials: CO
authors.lastname: Freytes
authors.forename: J E
authors.initials: JE
authors.lastname: Patterson
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods*; D024881:Drug Resistance, Bacterial; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000628:therapy; D006405:Hematology; D006801:Humans; D007362:Intensive Care Units; D013781:Texas; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents