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Two-year experience of cephalosporins rotation in the cardiosurgery intensive care unit

Abstract number: 1134_01_132

Beloborodova N.V., Lobatchova G.V., Vostrikova T.Y., Popov D.A.

Objectives:  

Cephalosporins are the drugs of choice in cardio surgery patients as agents with broad antibacterial spectrum and high level of safety. Traditionally, antibiotic rotation means to use the various classes of drugs. Different activity of cephalosporins against some gram-negative bacteria, causing nosocomial infections, gives the opportunity to rotate the drugs within this class. We evaluated the results of two years experience (2002–2003) of antibiotic rotation, based on monitoring of acquired resistance profile of gram-negative bacteria isolated from prolonged ventilated (more than 72 h) adult cardiosurgery patients in intensive care unit (ICU).

Methods:  

Before rotation ceftriaxon was used as a drug for empirical treatment. The proposed antibiotic rotation scheme was the 6-month cycles of cephalosporins: cefoperazon, then ceftazidim, then cefepim, based on the results of preceding microbiological monitoring. Additional antibiotics of other groups were used when indicated. Total of 151 consecutive nosocomial isolates of gram-negative enterobacteria and non-fermenting bacteria were studied. According to NCCLS recommendations, disc-diffusion test was used to determine bacterial sensitivity. Level of infectious complications and additional use of some reserve antibiotics were evaluated during each cycle.

Results:  

2269 patients were admitted. The use of P. aeruginosa-active cephalosporins of the III and IV generations resulted in elimination of this pathogen from ICU. We registered the decrease of the number of positive haemocultures from 38/221 (17.2%) before rotation to 16/164 (10.7%) by the 3th rotation cycle. In parallel, the total rate of postoperative infectious complications also decreased (47/657 (7.2%) vs. 22/489 (4.5%), p = 0.015). The need of carbapenems and vancomycin did not increase. Antibiotic susceptibility of KES (Klebsiella, Enterobacter, Serratia), P. aeruginosa, A. baumannii during our study in ICU is listed in the table (% of sensitive strains).

DrugKES (%)P.aeruginosa (%)A.baumannii (%)
1 cycle (n = 26)2 cycle (n = 37)3 cycle (n = 20)1 cycle (n = 15)2 cycle (n = 18)3 cycle (n = 3)1 cycle (n = 9)2 cycle (n = 14)3 cycle (n = 9) 
Ceftriaxone19.210.85000000
Ceflazidime7754.13073.377.810022.242.80
Cefoperazone11.610.8513.344.533.3000
Cefepime80.878.4558083.310066.785.855.5
Imipenem10010010033.455.566.7100100100
Meropenem10010010033.455.566.7100100100
Cefoperazone/ Sulbactam67.67094.510010089

Conclusion:  

Cycling of cephalosporins under microbiological monitoring in ICU is an effective method for the management of nosocomial infections in cardiac surgery.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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