Antibiotic Rotation in ICU Does Not Reduce Prevalence of Antibiotic-Resistant Bacteria
Carbapenems were used most frequently, followed by third-generation and fourth-generation cephalosporins, and piperacillin-tazobactam.
Antibiotic cycling did not reduce the prevalence of antibiotic-resistant Gram-negative bacteria among patients in European intensive care units (ICUs), according to findings published in the Lancet Infectious Diseases.
Eight ICUs from Belgium, France, Germany, Portugal, and Slovenia were enrolled in a cluster-randomized crossover study (Clinicaltrial.gov: NCT01293071) from June 2011 to February 2014. Each ICU was randomly assigned to an antibiotic cycling regimen (third-generation or fourth-generation cephalosporins, piperacillin-tazobactam, and carbapenems as preferred treatment for 6-week periods), or a mixing regimen (changing preference after every consecutively treated patient). Cycling or mixing regimens were in place for 9 months, followed by a washout period and implementation of an alternative strategy. The primary end point was average, unit-wide, monthly point prevalence of antibiotic-resistant Gram-negative bacteria in respiratory and perineal swabs with adjustment for potential confounders.