| Cefepime restriction improves gram-negative overall resistance patterns in neonatal intensive care unit. | |
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MedLine Citation:
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PMID: 17625777 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Antibiotic restriction can be useful in maintaining bacterial susceptibility. The objective of this study was verify if restriction of cefepime, the most frequently used cephalosporin in our neonatal intensive care unit (NICU), would ameliorate broad-spectrum susceptibility of Gram-negative isolates. Nine hundred and ninety-five premature and term newborns were divided into 3 cohorts, according to the prevalence of cefepime use in the unit: Group 1 (n=396) comprised patients admitted from January 2002 to December 2003, period in which cefepime was the most used broad-spectrum antibiotic. Patients in Group 2 (n=349) were admitted when piperacillin/tazobactam replaced cefepime (January to December 2004) and in Group 3 (n=250) when cefepime was reintroduced (January to September 2005). Meropenem was the alternative third-line antibiotic for all groups. Multiresistance was defined as resistance to 2 or more unrelated antibiotics, including necessarily a third or fourth generation cephalosporin, piperacillin/tazobactam or meropenem. Statistics involved Kruskal-Wallis, Mann-Whitney and logrank tests, Kaplan-Meier analysis. Groups were comparable in length of stay, time of mechanical ventilation, gestational age and birth weight. Ninety-eight Gram-negative isolates were analyzed. Patients were more likely to remain free of multiresistant isolates by Kaplan-Meier analysis in Group 2 when compared to Group 1 (p=0.017) and Group 3 (p=0.003). There was also a significant difference in meropenem resistance rates. Cefepime has a greater propensity to select multiresistant Gram-negative pathogens than piperacillin/tazobactam and should not be used extensively in neonatal intensive care. |
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Authors:
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Orlei Ribeiro de Araujo; Dafne Cardoso Bourguignon da Silva; Ana Regina Diegues; Ronaldo Arkader; Eloíza Aparecida Ferreira Cabral; Marta Rodriguez Afonso; Maria Eduarda Louzada; Andréa de Cássia Stéfano Albertoni |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases Volume: 11 ISSN: 1413-8670 ISO Abbreviation: Braz J Infect Dis Publication Date: 2007 Apr |
Date Detail:
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Created Date: 2007-07-12 Completed Date: 2008-02-01 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9812937 Medline TA: Braz J Infect Dis Country: Brazil |
Other Details:
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Languages: eng Pagination: 277-80 Citation Subset: IM |
Affiliation:
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Hospital e Maternidade Santa Marina, São Paulo, SP, Brazil. orlei@uol.com.br |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anti-Bacterial Agents
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administration & dosage* Cephalosporins / administration & dosage* Cohort Studies Drug Resistance, Multiple, Bacterial / drug effects* Gram-Negative Bacterial Infections / drug therapy*, microbiology Humans Infant, Newborn Infant, Premature Intensive Care Units, Neonatal* Microbial Sensitivity Tests Penicillanic Acid / administration & dosage, analogs & derivatives Piperacillin / administration & dosage Prospective Studies Thienamycins / administration & dosage Time Factors |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents; 0/Cephalosporins; 0/Thienamycins; 157044-21-8/piperacillin-tazobactam combination product; 61477-96-1/Piperacillin; 87-53-6/Penicillanic Acid; 88040-23-7/cefepime; 96036-03-2/meropenem |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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