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dc.contributor.authorSandiumenge, Alberto
dc.contributor.authorDiaz, Emili
dc.contributor.authorRodriguez, Alejandro
dc.contributor.authorVidaur, Loreto
dc.contributor.authorCanadell, Laura
dc.contributor.authorOlona, Montserrat
dc.contributor.authorRué i Monné, Montserrat
dc.contributor.authorRello, Jordi
dc.date.accessioned2016-05-27T07:46:52Z
dc.date.issued2006
dc.identifier.issn0305-7453
dc.identifier.urihttp://hdl.handle.net/10459.1/57103
dc.description.abstractObjectives: To evaluate the impact of different antibiotic strategies on acquisition of resistant microorganisms. Methods: A prospective study was conducted over a 44 month period in a single ICU. Four empirical antibiotic strategies for ventilator-associated pneumonia (VAP) were sequentially implemented. Over the initial 10 months, patient-specific antibiotic therapy was prescribed; then, 4 month periods of prioritization or restriction rotation cycles of various antimicrobial agents were implemented for a total of 24 months; and, finally, during the last 10 months (mixing period) the first-line antibiotic for VAP was changed following a pre-established schedule to ensure maximum heterogeneity. Antibiotic consumption was closely monitored every month, and antimicrobial resistance patterns were regularly assessed. Antimicrobial heterogeneity was estimated using a modified Peterson index (AHI) measuring the ratios for the five most used antibiotics. Colonization by targeted microorganisms and susceptibility patterns were compared with the patient-specific period. Results: Higher diversity of antibiotic prescription was obtained during patient-specific therapy (AHI = 0.93) or mixing periods (AHI = 0.95) than during prioritization (AHI = 0.70) or restriction periods (AHI = 0.68). High homogeneity was associated with increases in carbapenem-resistant Acinetobacter baumannii (CR-Ab) [relative risk (RR) 15.5; 95%CI 5.5–42.8], extended-spectrum b-lactamase (ESBL)-producing Enterobacteriaceae (RR 4.2; 95%CI 1.9–9.3) and Enterococcus faecalis (RR 1.7; 95%CI 1.1–2.9). During the restriction period, incidence of ESBL-producing Enterobacteriaceae and E. faecalis returned to patient-specific rates but CR-Ab remained higher. Conclusions: Antibiotic prescription patterns balancing the use of different antimicrobials should be promoted to reduce the selection pressure that aids the development of resistance.ca_ES
dc.language.isoengca_ES
dc.publisherOxford University Pressca_ES
dc.relation.isformatofReproducció del document publicat a https://doi.org/10.1093/jac/dkl097ca_ES
dc.relation.ispartofJournal of Antimicrobial Chemotherapy, 2006, vol. 57, núm. 6, p. 1197-1204ca_ES
dc.rights(c) Sandiumenge et al., 2006ca_ES
dc.subjectAntibiotic heterogeneityca_ES
dc.subjectVentilator-associated pneumoniaca_ES
dc.subjectAntibiotic rotationca_ES
dc.subjectCycling antibioticsca_ES
dc.titleImpact of diversity of antibiotic use on the development of antimicrobial resistanceca_ES
dc.typearticleca_ES
dc.identifier.idgrec009200
dc.type.versionpublishedVersionca_ES
dc.rights.accessRightsinfo:eu-repo/semantics/restrictedAccessca_ES
dc.identifier.doihttps://doi.org/10.1093/jac/dkl097
dc.date.embargoEndDate10000-01-01


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