Pilot study of antibiotic cycling in a pediatric intensive care unit

Moss, William J.; Beers, M. Claire; Johnson, Elizabeth; Nichols, David G.; Perl, Trish M.; Dick, James D.; Veltri, Michael A.

doi:10.1097/00003246-200208000-00034

Cited by 42 publications

(34 citation statements)

References 34 publications

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“…Strategi ini terbukti dapat meminimalkan munculnya resistensi terhadap antibiotik. 22 Namun Toltzis dkk dalam penelitian strategi rotasi antibiotik di NICU tiap bulan selama satu tahun menyimpulkan bahwa strategi ini tidak terbukti menurunkan resistensi bakteri Gram negatif. Kegagalan ini disebabkan karena rotasi yang diterapkan terlalu cepat, paling tidak dibutuhkan waktu dua bulan untuk dapat Keberhasilan suatu strategi antibiotik pada satu unit/ rumah sakit tergantung pada kemampuan menjawab pertanyaan: apakah perubahan yang terjadi merupakan suatu perbaikan ?…”

Section: Strategi Intervensi Menurunkan Resistensi Terhadap Antibiotikunclassified

Infeksi Bakteri Gram Negatif di ICU Anak: epidemiologi, manajemen antibiotik dan pencegahan

Adisasmito

Hadinegoro²

2016

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Rumah sakit dan unit perawatan intensif (ICU) merupakan breeding ground atau tempatberkembangnya bakteri yang resisten/multiresisten antibiotik, disebabkan penggunaanalat invasif, kontak yang sering antara staf rumah sakit dengan pasien sehinggamemudahkan terjadi transmisi infeksi, intensitas penggunaan antibiotik yang tinggi sertapenggunaan antibiotik empiris yang berlebihan. Hal tersebut terjadi karena pasien yangdirawat di ICU pada umumnya menderita penyakit berat dan dalam kondisiimunokompromais.1,2Bakteri Gram negatif mempunyai tingkat resistensi tinggi karena mempunyai mekanismeresistensi yang multipel. Mekanisme resistensi bakteri Gram negatif terhadap antibiotikb laktam, terutama disebabkan karena bakteri Gram negatif menghasilkan enzim blaktamase. Berdasarkan hal tersebut, dapat dipastikan bahwa infeksi oleh bakteri Gramnegatif merupakan ancaman, terutama pada pasien imunokompromais

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Section: Strategi Intervensi Menurunkan Resistensi Terhadap Antibiotikunclassified

Infeksi Bakteri Gram Negatif di ICU Anak: epidemiologi, manajemen antibiotik dan pencegahan

Adisasmito

Hadinegoro²

2016

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“…Without staff buy in, effective implementation of a cycling protocol would be impossible. While cycling of antibiotics to decrease antimicrobial resistance has been studied previously (2,12), issues of compliance with the protocol have not been addressed in a consistent manner. The clear definition and designation of antibiotic classes as either on or off cycle, as established by a predetermined cycling protocol and time parameters, allow for the quantitative analysis of the cycling protocol implementation in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Moss et al examined compliance by totaling the amount of on May 9, 2018 by guest http://aac.asm.org/ each antibiotic used per month in the study unit in standardized units and then rated the application as either pro or con antibiotic cycling use (12). Pro use supported the cycling regimen, whereas con use was detrimental to the impact of the regimen.…”

Section: Discussionmentioning

confidence: 99%

“…Strategies to limit antibiotic resistance include increased adherence to infection control measures, therapeutic antibiotic substitution, prudent prescribing of antibiotics, and pharmacy-based computer antibiotic management programs (6,9,13,18). In addition, the cycling or rotation of antibiotics for empirical therapy has been examined as a method for preventing the development of antimicrobial resistance (2,3,5,8,10,12,14,15).…”

mentioning

confidence: 99%

“…Mathematical modeling suggests that heterogeneous antibiotic use may limit the emergence of resistance (15). Some studies demonstrate that cycling or switching of antibiotics with a gram-negative spectrum of activity may affect antibiotic resistance patterns within the ICU and may decrease the incidence of antibiotic-resistant gramnegative infections and infection-related mortality (5,12,14). In previous studies of antibiotic cycling, factors influencing compliance with rotation protocols have not always been analyzed.…”

mentioning

confidence: 99%

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Effects of an Antibiotic Cycling Program on Antibiotic Prescribing Practices in an Intensive Care Unit

Merz

Warren

Kollef³

et al. 2004

Antimicrob Agents Chemother

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Various interventions have been proposed to combat the increase of antibiotic resistance and influence antibiotic prescribing practices. A prospective cohort study in a medical intensive care unit was conducted to determine the effect of an antibiotic cycling program on patterns of antibiotic use and to determine patient factors associated with cycling adherence. Four major classes of antibiotics for empirical therapy of suspected gram-negative bacterial infections were rotated at 3-and 4-month intervals. During the study, 1,003 patients received antibiotic therapy with at least one of the study drugs; of the 792 receiving cycle antibiotics during the cycling period, 598 (75.5%) received an on-cycle drug. Compared to the baseline, cycling recommendations increased the use of the target cycle agent: the use of cephalosporins increased during cycle 1 (56 to 64% of total antibiotic days, P < 0.001), fluoroquinolone use increased in cycle 2 (24 to 55%, P < 0.001), carbapenem use increased during cycle 3 (14 to 38%, P < 0.001), and use of extended-spectrum penicillins increased in cycle 4 (5 to 36%, P < 0.001). Overall, 48% of total cycle antibiotic days were compliant with the cycling protocol. On average, 8.8 days per patient were spent receiving on-cycle drugs (range, 1 to 109). Cycle periods that specified carbapenem and fluoroquinolone use had the highest number of off-cycle days (62 and 64%). Predictors of on-cycle antibiotic use were increased severity of illness, as measured by an acute physiology and chronic health evaluation II score, and greater length of intensive care unit stay. In conclusion, the successful implementation of this cycling protocol increased antibiotic heterogeneity over time in the study unit.

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Methicillin‐ResistantStaphylococcusaureus

2006

Wiley Handbook of Current and Emerging Drug Therapies

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Pilot study of antibiotic cycling in a pediatric intensive care unit

Cited by 42 publications

References 34 publications

Infeksi Bakteri Gram Negatif di ICU Anak: epidemiologi, manajemen antibiotik dan pencegahan

Infeksi Bakteri Gram Negatif di ICU Anak: epidemiologi, manajemen antibiotik dan pencegahan

Effects of an Antibiotic Cycling Program on Antibiotic Prescribing Practices in an Intensive Care Unit

Methicillin‐ResistantStaphylococcusaureus

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