Longitudinal comparative trial of antibiotic cycling and mixing on emergence of gram negative bacterial resistance in a pediatric medical intensive care unit
| Autor: | Muralidharan Jayashree, Sukhsagar Ratol, Sahul Bharti, Pallab Ray, Vikas Gautam, Sunit Singhi |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Critical Care medicine.drug_class Antibiotics Kaplan-Meier Estimate Critical Care and Intensive Care Medicine Intensive Care Units Pediatric law.invention Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine Antibiotic resistance law Internal medicine Drug Resistance Bacterial Gram-Negative Bacteria medicine Humans Longitudinal Studies Prospective Studies Child Gram Proportional Hazards Models business.industry Incidence (epidemiology) Infant 030208 emergency & critical care medicine Drug Resistance Microbial Comparative trial Intensive care unit Anti-Bacterial Agents 030228 respiratory system Medical intensive care unit Child Preschool Female Cycling business Gram-Negative Bacterial Infections Algorithms |
| Zdroj: | Journal of critical care. 56 |
| ISSN: | 1557-8615 |
| Popis: | To compare antibiotic mixing vs. cycling with respect to acquisition of resistance and PICU mortality.Children between1 month to 12 years admitted to a medical PICU were enrolled over three phases (baseline, mixing and cycling) with washout interval of 3 months following each antibiotic strategy. Following a baseline phase, empiric gram negative antibiotic protocol for suspected HCAI, was sequentially subjected to mixing and cycling using Latin Square methodology. Surveillance cultures were taken at admission, 48 h, weekly thereafter and within 2 days of PICU discharge. Acquisition of resistance and PICU mortality were primary and secondary outcomes respectively.778 children were enrolled; 99 baseline, 146 mixing, 362 cycling, and 171 during two washout phases. Proportion of children with acquired resistance at baseline (56.6%) was significantly higher than mixing (22.6%) and cycling (18.51%) (p .0001). Adjusted hazards of acquired resistance (HR:0.82; 95% CI: 0.53-1.25, p = .352), and PICU mortality (RR1.07; 95% CI: 0.71-1.60, p = .72) were similar in cycling and mixing strategies.Acquisition of resistance was significantly lower in both mixing and cycling as compared to baseline phase. Both were similar with respect to risk of antibiotic resistance as well as incidence of HCAI and PICU mortality. |
| Databáze: | OpenAIRE |
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