EFFECT OF ANTIBIOTIC DIVERSITY ON VENTILATOR ASSOCIATED PNEUMONIA CAUSED BY ESKAPE ORGANISMS.
Chest. 2011 Jun 9;
Authors: Sandiumenge A, Lisboa T, Gomez F, Hernandez P, Canadell L, Rello J
ABSTRACT BACKGROUND: To test in the clinical ground that antimicrobial diversity prevents from resistance and impacts on ESKAPE VAP. METHODS: Three different strategies of antimicrobial empirical prescription for VAP were consecutively implemented in an ICU: Patient-specific(10 months); Scheduling: sequential quarterly priorization(12 months), or restriction(12 months) of antimicrobials and Mixing (10 months). Periods were compared measuring the antimicrobial heterogeneity index(AHI). Incidence and resistance patterns of VAP caused by ESKAPE(Enterococcus faecium,Staphylococcus aureus, Klebsiella spp,Acinetobacter baumannii,Pseudomonas aeruginosa and Enterobacter spp) were compared. RESULTS: Overall, 127 microbiological documented VAP episodes were documented. ESKAPE VAP increased significantly during Scheduling (AHI 0.65) compared to Patient-specific (AHI 0.88) and Mixing (AHI 0.87) periods: (RR 2.67 and 3.84, respectively). This was associated with a significant (p<0.05) increase of Carbapenem-resistant Acinetobacter baumannii during Scheduling(15.0%) when compared to Patient-specific(2,4%) and Mixing(0%) periods. ICU mortality of resistant-ESKAPE-VAP patients doubled mortality of non-ESKAPE VAP patients (RR 2.25;95%CI 1.67-9.48). 30-day-MV-free days significantly increased 5 days of MV in patients with Resistant-ESKAPE VAP. CONCLUSIONS: Antibiotic strategies promoting diversity may prevent resistance due to ESKAPE organisms, improving use of health-care resources.
PMID: 21659436 [PubMed - as supplied by publisher]