# name
Evaluation of a Mixing versus a Cycling Strategy of Antibiotic
                Use in Critically-Ill Medical Patients: Impact on Acquisition of
                Resistant Microorganisms and Clinical Outcomes

# metadata.dc.contributor.author[].value
Martínez, José Antonio (Martínez Martínez)

# metadata.dc.description.abstract[].value
OBJECTIVE: To compare the effect of two strategies of antibiotic
                use (mixing vs. cycling) on the acquisition of resistant
                microorganisms, infections and other clinical outcomes. METHODS:
                Prospective cohort study in an 8-bed intensive care unit during
                35- months in which a mixing-cycling policy of antipseudomonal
                beta-lactams (meropenem, ceftazidime/piperacillin-tazobactam)
                and fluoroquinolones was operative. Nasopharyngeal and rectal
                swabs and respiratory secretions were obtained within 48h of
                admission and thrice weekly thereafter. Target microorganisms
                included methicillin-resistant S. aureus, vancomycin-resistant
                enterococci, third-generation cephalosporin-resistant
                Enterobacteriaceae and non-fermenters. RESULTS: A total of 409
                (42%) patients were included in mixing and 560 (58%) in cycling.
                Exposure to ceftazidime/piperacillin-tazobactam and
                fluoroquinolones was significantly higher in mixing while
                exposure to meropenem was higher in cycling, although overall
                use of antipseudomonals was not significantly different
                (37.5/100 patient-days vs. 38.1/100 patient-days). There was a
                barely higher acquisition rate of microorganisms during mixing,
                but this difference lost its significance when the cases due to
                an exogenous Burkholderia cepacia outbreak were excluded (19.3%
                vs. 15.4%, OR 0.8, CI 0.5-1.1). Acquisition of Pseudomonas
                aeruginosa resistant to the intervention antibiotics or with
                multiple-drug resistance was similar. There were no significant
                differences between mixing and cycling in the proportion of
                patients acquiring any infection (16.6% vs. 14.5%, OR 0.9, CI
                0.6-1.2), any infection due to target microorganisms (5.9% vs.
                5.2%, OR 0.9, CI 0.5-1.5), length of stay (median 5 d for both
                groups) or mortality (13.9 vs. 14.3%, OR 1.03, CI 0.7-1.3).
                CONCLUSIONS: A cycling strategy of antibiotic use with a 6-week
                cycle duration is similar to mixing in terms of acquisition of
                resistant microorganisms, infections, length of stay and
                mortality.

# metadata.dc.relation.isformatof[].value
Reproducció del document publicat a:
                http://dx.doi.org/10.1371/journal.pone.0150274

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Evaluation of a Mixing versus a Cycling Strategy of Antibiotic
                Use in Critically-Ill Medical Patients: Impact on Acquisition of
                Resistant Microorganisms and Clinical Outcomes