title: Ceftriaxone and ciprofloxacin restriction in an intensive care unit: less incidence of Acinetobacter spp. and improved susceptibility of Pseudomonas aeruginosa.
abstract: OBJECTIVE
  To determine whether restricting the use of ceftriaxone and ciprofloxacin could significantly reduce colonization and infection with resistant Gram-negative bacilli (r-GNB).
  
  
  METHODS
  A two-phase prospective study (before/after design) was conducted in an intensive care unit in two time periods (2004-2006). During phase 1, there was no antibiotic restriction. During phase 2, use of ceftriaxone or ciprofloxacin was restricted.
  
  
  RESULTS
  Atotal of 200 patients were prospectively evaluated. In phase 2, the use of ceftriaxone was reduced by 93.6% (P = 0.0001) and that of ciprofloxacin by 65.1% (P = 0.041), accompanied by a 113.8% increase in use of ampicillin-sulbactam (P = 0.002).During phase 1, 48 GNB were isolated [37 r-GNB (77.1%) and 11 non-r-GNB (22.9%)], compared with a total of 64 during phase 2 [27 r-GNB (42.2%) and 37 non-r-GNB (57.8%)](P = 0.0002). Acinetobacter spp. was isolated 13 times during phase 1 and 3 times in phase 2 (P = 0.0018). The susceptibility of Pseudomonas aeruginosa to ciprofloxacin increased from 40.0% in phase 1 to 100.0% in phase 2 (P = 0.0108).
  
  
  CONCLUSIONS
  Restriction of ceftriaxone and ciprofloxacin reduced colonization by Acinetobacter spp. and improved the susceptibility profile of P. aeruginosa.
authors.affiliation: Cátedra de Enfermedades Infecciosas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. jcmedina1@gmail.com
authors.forename: Julio César
authors.initials: JC
authors.lastname: Medina Presentado
authors.forename: Daniela
authors.initials: D
authors.lastname: Paciel López
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Berro Castiglioni
authors.forename: Jorge
authors.initials: J
authors.lastname: Gerez
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D000328:Adult; D000368:Aged; D002443:Ceftriaxone / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D003953:Diagnosis-Related Groups; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004352:Drug Resistance, Microbial; D024901:Drug Resistance, Multiple, Bacterial; D004335:Drug and Narcotic Control; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D015163:Superinfection; D014583:Uruguay / Q000453:epidemiology
chemical_list: D002939:Ciprofloxacin; D002443:Ceftriaxone