Antibiotic rotation for febrile neutropenic patients with hematological malignancies: clinical significance of antibiotic heterogeneity
Our unit adopted the single administration of cefepime as the initial treatment for febrile episodes in neutropenic patients with hematological malignancies. However, recently, cefepime-resistant gram-negative bacteremia, including those with extended-spectrum β-lactamase (ESBL)-producers, was frequ...
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| Veröffentlicht in: | PloS one 2013-01, Vol.8 (1), p.e54190-e54190 |
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| creator | Chong, Yong Shimoda, Shinji Yakushiji, Hiroko Ito, Yoshikiyo Miyamoto, Toshihiro Kamimura, Tomohiko Shimono, Nobuyuki Akashi, Koichi |
| description | Our unit adopted the single administration of cefepime as the initial treatment for febrile episodes in neutropenic patients with hematological malignancies. However, recently, cefepime-resistant gram-negative bacteremia, including those with extended-spectrum β-lactamase (ESBL)-producers, was frequently observed in these patients. Therefore, we instituted a rotation of primary antibiotics for febrile neutropenic patients in an attempt to control antibiotic resistance.
This prospective trial was performed from August 2008 through March 2011 at our unit. After a pre-intervention period, in which cefepime was used as the initial agent for febrile neutropenia, 4 primary antibiotics, namely, piperacillin-tazobactam, ciprofloxacin, meropenem, and cefepime, were rotated at 1-month intervals over 20 months. Blood and surveillance cultures were conducted for febrile episodes, in order to assess the etiology, the resistance pattern (particularly to cefepime), and the prognosis.
In this trial, 219 patients were registered. A 65.9% reduction in the use of cefepime occurred after the antibiotic rotation. In the surveillance stool cultures, the detection rate of cefepime-resistant gram-negative isolates, of which ESBL-producers were predominant, declined significantly after the intervention (8.5 vs 0.9 episodes per 1000 patient days before and after intervention respectively, P |
| doi_str_mv | 10.1371/journal.pone.0054190 |
| format | Article |
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This prospective trial was performed from August 2008 through March 2011 at our unit. After a pre-intervention period, in which cefepime was used as the initial agent for febrile neutropenia, 4 primary antibiotics, namely, piperacillin-tazobactam, ciprofloxacin, meropenem, and cefepime, were rotated at 1-month intervals over 20 months. Blood and surveillance cultures were conducted for febrile episodes, in order to assess the etiology, the resistance pattern (particularly to cefepime), and the prognosis.
In this trial, 219 patients were registered. A 65.9% reduction in the use of cefepime occurred after the antibiotic rotation. In the surveillance stool cultures, the detection rate of cefepime-resistant gram-negative isolates, of which ESBL-producers were predominant, declined significantly after the intervention (8.5 vs 0.9 episodes per 1000 patient days before and after intervention respectively, P<0.01). Interestingly, ESBL-related bacteremia was not detected after the initiation of the trial (1.7 vs 0.0 episodes per 1000 patient days before and after intervention respectively, P<0.01). Infection-related mortality was comparable between the 2 periods.
We implemented a monthly rotation of primary antibiotics for febrile neutropenic patients. An antibiotic heterogeneity strategy, mainly performed as a cycling regimen, would be useful for controlling antimicrobial resistance among patients treated for febrile neutropenia.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0054190</identifier><identifier>PMID: 23372683</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Antibiotic resistance ; Antibiotics ; Antimicrobial agents ; Antimicrobial resistance ; Bacteremia ; Bacteremia - complications ; Bacteremia - drug therapy ; Bacteremia - microbiology ; Bacteria ; Beta lactamases ; beta-Lactam Resistance - drug effects ; Biology ; Blood cancer ; Cancer ; Cefepime ; Cephalosporins - pharmacology ; Cephalosporins - therapeutic use ; Ciprofloxacin ; Ciprofloxacin - pharmacology ; Ciprofloxacin - therapeutic use ; Clinical significance ; Control methods ; Development and progression ; Drug Administration Schedule ; Drug resistance ; Drug therapy ; E coli ; Escherichia coli ; Etiology ; Female ; Fever - complications ; Fever - drug therapy ; Fever - microbiology ; Gram-negative bacteria ; Gram-Negative Bacterial Infections - complications ; Gram-Negative Bacterial Infections - drug therapy ; Gram-Negative Bacterial Infections - microbiology ; Hematologic Neoplasms - complications ; Hematologic Neoplasms - drug therapy ; Hematologic Neoplasms - microbiology ; Hematology ; Heterogeneity ; Hospitals ; Humans ; Intensive care ; Intervention ; Klebsiella pneumoniae ; Laboratories ; Male ; Medicine ; Meropenem ; Microbial drug resistance ; Middle Aged ; Mortality ; Neutropenia ; Neutropenia - complications ; Neutropenia - drug therapy ; Neutropenia - microbiology ; Neutrophils ; Patients ; Penicillanic Acid - analogs & derivatives ; Penicillanic Acid - pharmacology ; Penicillanic Acid - therapeutic use ; Piperacillin ; Piperacillin - pharmacology ; Piperacillin - therapeutic use ; Piperacillin-tazobactam ; Prospective Studies ; Studies ; Surveillance ; Tazobactam ; Thienamycins - pharmacology ; Thienamycins - therapeutic use ; University graduates</subject><ispartof>PloS one, 2013-01, Vol.8 (1), p.e54190-e54190</ispartof><rights>COPYRIGHT 2013 Public Library of Science</rights><rights>2013 Chong et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2013 Chong et al 2013 Chong et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-3a8a1ed00abfdf0a1c175be3b32d8cc796a80bd12fd54f87c2b545e95d4f081c3</citedby><cites>FETCH-LOGICAL-c692t-3a8a1ed00abfdf0a1c175be3b32d8cc796a80bd12fd54f87c2b545e95d4f081c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553165/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553165/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2101,2927,23865,27923,27924,53790,53792,79471,79472</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23372683$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Sued, Omar</contributor><creatorcontrib>Chong, Yong</creatorcontrib><creatorcontrib>Shimoda, Shinji</creatorcontrib><creatorcontrib>Yakushiji, Hiroko</creatorcontrib><creatorcontrib>Ito, Yoshikiyo</creatorcontrib><creatorcontrib>Miyamoto, Toshihiro</creatorcontrib><creatorcontrib>Kamimura, Tomohiko</creatorcontrib><creatorcontrib>Shimono, Nobuyuki</creatorcontrib><creatorcontrib>Akashi, Koichi</creatorcontrib><title>Antibiotic rotation for febrile neutropenic patients with hematological malignancies: clinical significance of antibiotic heterogeneity</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Our unit adopted the single administration of cefepime as the initial treatment for febrile episodes in neutropenic patients with hematological malignancies. However, recently, cefepime-resistant gram-negative bacteremia, including those with extended-spectrum β-lactamase (ESBL)-producers, was frequently observed in these patients. Therefore, we instituted a rotation of primary antibiotics for febrile neutropenic patients in an attempt to control antibiotic resistance.
This prospective trial was performed from August 2008 through March 2011 at our unit. After a pre-intervention period, in which cefepime was used as the initial agent for febrile neutropenia, 4 primary antibiotics, namely, piperacillin-tazobactam, ciprofloxacin, meropenem, and cefepime, were rotated at 1-month intervals over 20 months. Blood and surveillance cultures were conducted for febrile episodes, in order to assess the etiology, the resistance pattern (particularly to cefepime), and the prognosis.
In this trial, 219 patients were registered. A 65.9% reduction in the use of cefepime occurred after the antibiotic rotation. In the surveillance stool cultures, the detection rate of cefepime-resistant gram-negative isolates, of which ESBL-producers were predominant, declined significantly after the intervention (8.5 vs 0.9 episodes per 1000 patient days before and after intervention respectively, P<0.01). Interestingly, ESBL-related bacteremia was not detected after the initiation of the trial (1.7 vs 0.0 episodes per 1000 patient days before and after intervention respectively, P<0.01). Infection-related mortality was comparable between the 2 periods.
We implemented a monthly rotation of primary antibiotics for febrile neutropenic patients. An antibiotic heterogeneity strategy, mainly performed as a cycling regimen, would be useful for controlling antimicrobial resistance among patients treated for febrile neutropenia.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotic resistance</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Antimicrobial resistance</subject><subject>Bacteremia</subject><subject>Bacteremia - complications</subject><subject>Bacteremia - drug therapy</subject><subject>Bacteremia - microbiology</subject><subject>Bacteria</subject><subject>Beta lactamases</subject><subject>beta-Lactam Resistance - drug effects</subject><subject>Biology</subject><subject>Blood cancer</subject><subject>Cancer</subject><subject>Cefepime</subject><subject>Cephalosporins - pharmacology</subject><subject>Cephalosporins - therapeutic use</subject><subject>Ciprofloxacin</subject><subject>Ciprofloxacin - pharmacology</subject><subject>Ciprofloxacin - therapeutic use</subject><subject>Clinical significance</subject><subject>Control methods</subject><subject>Development and progression</subject><subject>Drug Administration Schedule</subject><subject>Drug resistance</subject><subject>Drug therapy</subject><subject>E coli</subject><subject>Escherichia coli</subject><subject>Etiology</subject><subject>Female</subject><subject>Fever - complications</subject><subject>Fever - drug therapy</subject><subject>Fever - microbiology</subject><subject>Gram-negative bacteria</subject><subject>Gram-Negative Bacterial Infections - complications</subject><subject>Gram-Negative Bacterial Infections - drug therapy</subject><subject>Gram-Negative Bacterial Infections - microbiology</subject><subject>Hematologic Neoplasms - complications</subject><subject>Hematologic Neoplasms - drug therapy</subject><subject>Hematologic Neoplasms - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chong, Yong</au><au>Shimoda, Shinji</au><au>Yakushiji, Hiroko</au><au>Ito, Yoshikiyo</au><au>Miyamoto, Toshihiro</au><au>Kamimura, Tomohiko</au><au>Shimono, Nobuyuki</au><au>Akashi, Koichi</au><au>Sued, Omar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antibiotic rotation for febrile neutropenic patients with hematological malignancies: clinical significance of antibiotic heterogeneity</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2013-01-23</date><risdate>2013</risdate><volume>8</volume><issue>1</issue><spage>e54190</spage><epage>e54190</epage><pages>e54190-e54190</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Our unit adopted the single administration of cefepime as the initial treatment for febrile episodes in neutropenic patients with hematological malignancies. However, recently, cefepime-resistant gram-negative bacteremia, including those with extended-spectrum β-lactamase (ESBL)-producers, was frequently observed in these patients. Therefore, we instituted a rotation of primary antibiotics for febrile neutropenic patients in an attempt to control antibiotic resistance.
This prospective trial was performed from August 2008 through March 2011 at our unit. After a pre-intervention period, in which cefepime was used as the initial agent for febrile neutropenia, 4 primary antibiotics, namely, piperacillin-tazobactam, ciprofloxacin, meropenem, and cefepime, were rotated at 1-month intervals over 20 months. Blood and surveillance cultures were conducted for febrile episodes, in order to assess the etiology, the resistance pattern (particularly to cefepime), and the prognosis.
In this trial, 219 patients were registered. A 65.9% reduction in the use of cefepime occurred after the antibiotic rotation. In the surveillance stool cultures, the detection rate of cefepime-resistant gram-negative isolates, of which ESBL-producers were predominant, declined significantly after the intervention (8.5 vs 0.9 episodes per 1000 patient days before and after intervention respectively, P<0.01). Interestingly, ESBL-related bacteremia was not detected after the initiation of the trial (1.7 vs 0.0 episodes per 1000 patient days before and after intervention respectively, P<0.01). Infection-related mortality was comparable between the 2 periods.
We implemented a monthly rotation of primary antibiotics for febrile neutropenic patients. An antibiotic heterogeneity strategy, mainly performed as a cycling regimen, would be useful for controlling antimicrobial resistance among patients treated for febrile neutropenia.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23372683</pmid><doi>10.1371/journal.pone.0054190</doi><tpages>e54190</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2013-01, Vol.8 (1), p.e54190-e54190 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1327799576 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Aged Aged, 80 and over Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Antibiotic resistance Antibiotics Antimicrobial agents Antimicrobial resistance Bacteremia Bacteremia - complications Bacteremia - drug therapy Bacteremia - microbiology Bacteria Beta lactamases beta-Lactam Resistance - drug effects Biology Blood cancer Cancer Cefepime Cephalosporins - pharmacology Cephalosporins - therapeutic use Ciprofloxacin Ciprofloxacin - pharmacology Ciprofloxacin - therapeutic use Clinical significance Control methods Development and progression Drug Administration Schedule Drug resistance Drug therapy E coli Escherichia coli Etiology Female Fever - complications Fever - drug therapy Fever - microbiology Gram-negative bacteria Gram-Negative Bacterial Infections - complications Gram-Negative Bacterial Infections - drug therapy Gram-Negative Bacterial Infections - microbiology Hematologic Neoplasms - complications Hematologic Neoplasms - drug therapy Hematologic Neoplasms - microbiology Hematology Heterogeneity Hospitals Humans Intensive care Intervention Klebsiella pneumoniae Laboratories Male Medicine Meropenem Microbial drug resistance Middle Aged Mortality Neutropenia Neutropenia - complications Neutropenia - drug therapy Neutropenia - microbiology Neutrophils Patients Penicillanic Acid - analogs & derivatives Penicillanic Acid - pharmacology Penicillanic Acid - therapeutic use Piperacillin Piperacillin - pharmacology Piperacillin - therapeutic use Piperacillin-tazobactam Prospective Studies Studies Surveillance Tazobactam Thienamycins - pharmacology Thienamycins - therapeutic use University graduates |
| title | Antibiotic rotation for febrile neutropenic patients with hematological malignancies: clinical significance of antibiotic heterogeneity |
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