Antibiotic Heterogeneity Optimizes Antimicrobial Prescription and Enables Resistant Pathogen Control in the Intensive Care Unit

Antibiotic Heterogeneity Optimizes Antimicrobial Prescription and Enables Resistant Pathogen Control in the Intensive Care Unit

To cite this article:
Greta L. Piper and Lewis J. Kaplan. Surgical Infections. -Not available-, ahead of print. doi:10.1089/sur.2012.121.

Online Ahead of Print: August 22, 2012

Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.

Address correspondence to:
Dr. Lewis J. Kaplan
Section of Trauma, Surgical Critical Care, and Surgical Emergencies
Department of Surgery

Yale University School of Medicine

330 Cedar Street, BB-310
New Haven, CT 06520

E-mail: Lewis.Kaplan@yale.edu

Presented at a Symposium of the Thirty-first Annual Meeting of the Surgical Infection Society, Palm Beach, Florida, May 13, 2011.

Abstract

Background: Multi-drug-resistant organisms (MDRO) complicate care increasingly on the general ward and in the emergency department, operating room, and intensive care unit (ICU). Whereas barrier precautions are important in limiting transmission of MDRO between patients, few tactics have been defined that reduce the genesis of MDRO.

Method: Review of pertinent English-language literature.

Results: Antibiotic heterogeneity practices, as part of an overall antimicrobial drug stewardship program, offer one readily deployable means to reduce selection pressure for MDRO development in the ICU. The data underpinning this approach and data derived from its use indicate that, especially in surgical ICUs, heterogeneity of antibiotic prescribing can preserve or restore microbial ecology, reduce the prevalence of MDRO and the incidence of infections caused thereby, and facilitate the implementation and effectiveness of other antibiotic-sparing tactics, such as de-escalation.

Conclusion: Heterogeneity of antibiotic prescribing is effective in preventing the dissemination of MDRO pathogens.

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