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Post-Transplant Events

Antibiotic cycling to decrease bacterial antibiotic resistance: a 5-year experience on a bone marrow transplant unit

Bone Marrow Transplantation volume 40, pages 151–155 (2007)Cite this article

Abstract

Multidrug-resistant pathogens have important effects on clinical outcomes. Antibiotic cycling is one approach to control anti-microbial resistance, but few studies have examined cycling in hematology–oncology units. Antibiotic cycling was implemented in January 1999 at our hematology–oncology unit, alternating piperacillin-tazobactam (pip-tazo) and cefepime in 3 months periods, until June 2004. Clinical isolates were compared in post- and pre-intervention periods and with the susceptibility among the solid organ transplant intensive care unit (TICU) isolates. The rate of Gram-negative isolates remained stable. Among Gram-negatives, susceptibility to cefepime and pip-tazo remained stable. There was an increase in Enterococcus spp. (P=0.007), and susceptibility to ampicillin and vancomycin decreased (odds ratio (OR): 0.04, 95% confidence interval (CI): 0.17–0.89 and OR: 0.23, 95% CI: 0.09–0.58). Compared with the TICU, there was increased susceptibility to pip-tazo and cefepime among enterics (OR: 7.32, 95% CI: 4.44–12.07 and OR: 8.82, 95% CI: 2.1–37.13) and Pseudomonas aeruginosa (OR: 4.27, 95% CI: 1.47–12.4 and OR: 4.61, 95% CI: 1.75–12.1) and decreased susceptibility to ampicillin and vancomycin among enterococci (OR: 0.44, 95% CI: 0.30–0.63 and OR: 0.38, 95% CI: 0.26–0.56). Cycling was associated with preserved antibiotic susceptibility among Gram-negatives, but with an increase in Enterococcus spp. and vancomycin and ampicillin resistance among enterococci.

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Acknowledgements

We thank University Hospital Clinical Microbiology Laboratory and James H Jorgensen, PhD, for their assistance with microbiological data, and Cynthia Kelly, MT(ASCP), for technical assistance with the typing of the enterococcal isolates.

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Authors and Affiliations

  1. Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    J Cadena

  2. Department of Medicine, Division of Hematology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    C A Taboada & C O Freytes

  3. School of Pharmacy, The University of Texas at Austin, Austin, TX, USA

    D S Burgess

  4. Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    J Z Ma

  5. Department of Clinical Pharmacy and Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA,

    J S Lewis II & J E Patterson

  6. Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA

    C O Freytes & J E Patterson

  7. Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    J E Patterson

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  1. J Cadena
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  2. C A Taboada
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Correspondence to J Cadena.

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Cadena, J., Taboada, C., Burgess, D. et al. Antibiotic cycling to decrease bacterial antibiotic resistance: a 5-year experience on a bone marrow transplant unit. Bone Marrow Transplant 40, 151–155 (2007). https://doi.org/10.1038/sj.bmt.1705704

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