This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (21)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Toltzis, P.
Right arrow Articles by Toltzis, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Toltzis, P.
Right arrow Articles by Toltzis, H.
Related Collections
Right arrow Premature & Newborn
Right arrowRelated AAP Red Book topics:
Escherichia coli and Other Gram...

PEDIATRICS Vol. 110 No. 4 October 2002, pp. 707-711

The Effect of Antibiotic Rotation on Colonization With Antibiotic-Resistant Bacilli in a Neonatal Intensive Care Unit

Philip Toltzis, MD, Michael J. Dul, PhD, Claudia Hoyen, MD, Ann Salvator, MS, Michele Walsh, MD, Laura Zetts, RN and Hasida Toltzis, MS

From the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children’s Hospital of the University Hospitals of Cleveland, Cleveland, Ohio

--> Objective. This study was designed to test whether rotation of antibiotics can reduce colonization with resistant Gram-negative bacilli in a neonatal intensive care unit (NICU).

Methods. A monthly rotation of gentamicin, piperacillin-tazobactam, and ceftazidime was compared with unrestricted antibiotic use in side-by-side NICU populations (rotation team vs control team). Pharyngeal and rectal samples were obtained 3 times a week and tested for Gram-negative bacilli resistant to each of the rotation antibiotics. Pulsed-field gel electrophoresis analysis determined the numbers of genetically discordant resistant organisms on each team. The association between colonization with a resistant bacillus (the primary outcome) and team assignment was tested.

Results. A total of 1062 infants were studied during a 1-year period. A total of 10.7% infants on the rotation team versus 7.7% on the control team were colonized with a resistant bacillus. No interteam differences were distinguishable when the numbers of genetically discordant resistant organisms were normalized to the total number of team admissions. The incidence of nosocomial infection and mortality also were similar across teams.

Conclusion. These data indicate that rotation of parenteral antibiotics according to the applied protocol has no detectable effect in decreasing the reservoir of resistant Gram-negative bacilli in a tertiary-care NICU.

Key Words: antibiotic resistance • Gram-negative bacilli • neonatal intensive care • antibiotic utilization • colonization • pulsed-field gel electrophoresis

Abbreviations: NICU, neonatal intensive care unit • PFGE, pulsed-field gel electrophoresis

Received for publication Mar 4, 2002; Accepted May 15, 2002.




This article has been cited by other articles:


Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
D Isaacs
Unnatural selection: reducing antibiotic resistance in neonatal units
Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2006; 91(1): F72 - F74.
[Abstract] [Full Text] [PDF]

Home page
 J Antimicrob ChemotherHome page
E. M. Brown and D. Nathwani
Antibiotic cycling or rotation: a systematic review of the evidence of efficacy
J. Antimicrob. Chemother., January 1, 2005; 55(1): 6 - 9.
[Abstract] [Full Text] [PDF]

Home page
 J Antimicrob ChemotherHome page
R. G. Masterton
Antibiotic cycling: more than it might seem?
J. Antimicrob. Chemother., January 1, 2005; 55(1): 1 - 5.
[Abstract] [Full Text] [PDF]

Home page
 Proc. Natl. Acad. Sci. USAHome page
C. T. Bergstrom, M. Lo, and M. Lipsitch
From The Cover: Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals
PNAS, September 7, 2004; 101(36): 13285 - 13290.
[Abstract] [Full Text] [PDF]