title: Implementation of antibiotic rotation protocol improves antibiotic susceptibility profile in a surgical intensive care unit.
abstract: BACKGROUND
  Antibiotic rotation has been proposed as a way to potentially reduce the development of antimicrobial resistant bacteria in intensive care units. We assessed the effect of an antibiotic rotation protocol on the antibiotic susceptibility profiles of three clinically relevant gram-negative microorganisms within our surgical intensive care unit (SICU).
  
  
  METHODS
  Our SICU implemented an antibiotic rotation protocol in 2003. Four antibiotics (piperacillin/tazobactam, imipenem/cilastin, ceftazidime, and ciprofloxacin) were rotated as the primary antibiotic used to treat suspected gram-negative infections every month, with the four-drug cycle being repeated every 4 months. Antibiotic susceptibility data for three microorganisms (Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae) were collected for the year before (2002) and the year after (2004) the implementation of the rotation protocol. Changes in antimicrobial susceptibility rates were analyzed for the three microorganisms. As a comparison, a similar analysis was conducted for microorganisms isolated from our medical intensive care unit, where no antibiotic rotation protocol was implemented.
  
  
  RESULTS
  Implementation of an antibiotic rotation protocol in our SICU resulted in a significant increase in the percentage of P. aeruginosa isolates sensitive to ceftazidime (67% in 2002 vs. 92% in 2004, p = 0.002) and piperacillin/tazobactam (78% in 2002 vs. 92% in 2004, p = 0.043). Isolates from the medical intensive care unit did not demonstrate an increase in antimicrobial susceptibility. In fact, the susceptibility of E. coli to piperacillin/tazobactam decreased during this time period (p = 0.047).
  
  
  CONCLUSIONS
  Implementation of an antibiotic rotation protocol in our SICU resulted in overall improvement in the antibiotic susceptibility profile of gram-negative microorganisms relative to our medical intensive care unit, where such a protocol was not used.
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors: Kyla M
authors: KM
authors: Bennett
authors: John E
authors: JE
authors: Scarborough
authors: Michelle
authors: M
authors: Sharpe
authors: Elizabeth
authors: E
authors: Dodds-Ashley
authors: Keith S
authors: KS
authors: Kaye
authors: Thomas Z
authors: TZ
authors: Hayward
authors: Steven N
authors: SN
authors: Vaslef
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002442:Ceftazidime / Q000008:administration & dosage; D002939:Ciprofloxacin / Q000008:administration & dosage; D002985:Clinical Protocols; D003422:Critical Care / Q000592:standards; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage; D015994:Incidence; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008826:Microbial Sensitivity Tests; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D010878:Piperacillin / Q000008:administration & dosage; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000078142:Tazobactam; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D015378:Imipenem; D010397:Penicillanic Acid; D002442:Ceftazidime; D000078142:Tazobactam; D010878:Piperacillin