Effect of Antibiotic Heterogeneity on the Development of Infections with Antibiotic-resistant Gram-negative Organisms in a Non-intensive Care Unit Surgical Ward

Takesue, Yoshio; Ohge, Hiroki; Sakashita, Mitsuru; Sudo, Takeshi; Murakami, Yoshiaki; Uemura, Kenichiro; Sueda, Taijiro
July 2006
World Journal of Surgery;Jul2006, Vol. 30 Issue 7, p1269
Academic Journal
Background: Heterogeneous antibiotic use has been suggested to limit the emergence of resistance, but determining the optimal strategy is difficult. Methods: We developed a new strategy, termed ''periodic antibiotic monitoring and supervision'' (PAMS) program in a non-ICU surgical ward. The 2-year prospective study was divided into a 1-year observation period and a 1-year PAMS period. The use of four major classes of antibiotics in empirical therapy for Gram-negative rod (GNR) infections was supervised. During the PAMS program, recommended, restricted, and off-supervised classes of antibiotics were changed every 3 months according to the usage pattern of the antibiotics in the preceding term. Results: Cefepime (45.5%) and imipenem/cilastatin (39.4%) were the most common antibiotics of choice during the observation period. The use of these antibiotics decreased significantly during the PAMS period, and that of fluoroquinolones and extended-spectrum penicillin/beta-lactamase inhibitor increased (4.8% vs. 21.4% and 2.4% vs. 21.4%, P < 0.01 respectively). Outcome analysis demonstrated a tendency toward reduction in the incidence of resistant GNR infections (P = 0.079) and that of Pseudomonas aeruginosa (P = 0.053). The incidence of resistant Gram-positive core infections did not decrease. Analysis of antibiotic susceptibility to GNR revealed no significant beneficial results for any antibiotics. Conclusions: As significant changes were not observed, the PAMS program is not generally applicable and heterogeneous antibiotic use as a way of reducing infections with resistant GNR in non-ICU surgical wards was not established.


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