Scheduled change of antibiotic classes a strategy to decrease the incidence of ventilator-associated pneumonia

Marin H. Kollef, Jon Vlasnik, Linda Sharpless, Christina Pasque, Denise Murphy, Victoria Fraser

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Abstract

The purpose of this study was to determine the impact of a scheduled change of antibiotic classes, used for the empiric treatment of suspected gram-negative bacterial infections, on the incidence of ventilator-associated pneumonia and nosocomial bacteremia. Six hundred eighty patients undergoing cardiac surgery were evaluated. During a 6-mo period (i.e., the before-period), our traditional practice of prescribing a third generation cephalosporin (ceftazidime) for the empiric treatment of suspected gram-negative bacterial infections was continued. This was followed by a 6-mo period (i.e., the after-period) during which a quinolone (ciprofloxacin) was used in place of the third-generation cephalosporin. The incidence of ventilator-associated pneumonia was significantly decreased in the after-period (n = 327) compared with the before-period (n = 353) (6.7 versus 11.6%; p = 0.028). This was primarily due to a significant reduction in the incidence of ventilator-associated pneumonia attributed to antibiotic-resistant gram-negative bacteria (0.9 versus 4.0%; p = 0.013). Similarly, we observed a lower incidence of bacteremia attributed to antibiotic-resistant gram-negative bacteria in the after-period compared with the before-period (0.3 versus 1.7%; p = 0.125). These data suggest that a scheduled change of antibiotic classes can reduce the incidence of ventilator-associated pneu-monia attributed to antibiotic-resistant gram-negative bacteria.

Original languageEnglish
Pages (from-to)1040-1048
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Volume156
Issue number4 PART I
DOIs
StatePublished - Jan 1 1997

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