title: Decreased resistance of Pseudomonas aeruginosa with restriction of ciprofloxacin in a large teaching hospital's intensive care and intermediate care units.
abstract: OBJECTIVE
  To examine the effect of restricting ciprofloxacin on the resistance of nosocomial gram-negative bacilli, including Pseudomonas aeruginosa, to antipseudomonal carbapenems.
  
  
  METHODS
  Interrupted time-series analysis.
  
  
  METHODS
  Tertiary care teaching hospital with 11 intensive care and intermediate care units with a total of 295 beds.
  
  
  METHODS
  All nosocomial isolates of P. aeruginosa.
  
  
  METHODS
  Restriction of ciprofloxacin.
  
  
  RESULTS
  There was a significant decreasing trend observed in the percentage (P = .0351) and the rate (P = .0006) of isolates of P. aeruginosa that were resistant to antipseudomonal carbapenems following the restriction of ciprofloxacin. There was also a significant decreasing trend observed in the percentage (P = .0017) and the rate (P = .0001) of isolates of ciprofloxacin-resistant P. aeruginosa. The rate of cefepime-resistant P. aeruginosa isolates declined (P = .004) but the percentage of cefepime-resistant P. aeruginosa isolates did not change. There were no significant changes observed in the rate or the percentage of piperacillin-tazobactam-resistant P. aeruginosa isolates. There were no significant changes observed in the susceptibilities of nosocomial Enterobacteriaciae or Acinetobacter baumannii isolates that were resistant to carbapenems. Over the study period there was a significant increase in the use of carbapenems (P = .0134); the use of ciprofloxacin decreased significantly (P = .0027). There were no significant changes in the use of piperacillin-tazobactam or cefepime.
  
  
  CONCLUSIONS
  Restriction of ciprofloxacin was associated with a decreased resistance of P. aeruginosa isolates to antipseudomonal carbapenems and ciprofloxacin in our hospital's intermediate care and intensive care units. There were no changes observed in the susceptibilities of nosocomial Enterobacteriaciae or A. baumannii to carbapenems, despite increased carbapenem use. Reducing ciprofloxacin use may be a means of controlling multidrug-resistant P. aeruginosa.
authors.affiliation: Vidant Medical Center, Greenville, North Carolina, USA. lewisjon@ecu.edu
authors.forename: G Jonathan
authors.initials: GJ
authors.lastname: Lewis
authors.forename: Xiangming
authors.initials: X
authors.lastname: Fang
authors.forename: Michael
authors.initials: M
authors.lastname: Gooch
authors.forename: Paul P
authors.initials: PP
authors.lastname: Cook
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D017723:Drug Utilization Review; D006784:Hospitals, Teaching / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data; D009657:North Carolina; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects*
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin