Abstract

MEDINA PRESENTADO, Julio César; PACIEL LOPEZ, Daniela; BERRO CASTIGLIONI, Maximiliano  and  GEREZ, Jorge. Ceftriaxone and ciprofloxacin restriction in an intensive care unit: less incidence of Acinetobacter spp. and improved susceptibility of Pseudomonas aeruginosa. Rev Panam Salud Publica [online]. 2011, vol.30, n.6, pp. 603-609. ISSN 1020-4989.  http://dx.doi.org/10.1590/S1020-49892011001200018.

OBJETIVO: To determine whether restricting the use of ceftriaxone and ciprofloxacin couldsignificantly reduce colonization and infection with resistant Gram-negative bacilli (r-GNB). METHODS: A   two-phase prospective   study   (before/after design)   was   conducted   in   an intensive care unit in two time periods (2004-2006). During phase 1, there was no antibiotic restriction. During phase 2, use of ceftriaxone or ciprofloxacin was restricted. RESULTS: Atotal of   200 patients   were   prospectively   evaluated.   In   phase 2,   the   use of  ceftriaxone was reduced by  93.6%  (P  =  0.0001)  and  that  of  ciprofloxacin by  65.1% (P = 0.041), accompanied by a 113.8% increase in use of ampicillin-sulbactam (P = 0.002).During  phase  1,  48  GNB  were  isolated  [37  r-GNB  (77.1%)  and  11  non-r-GNB  (22.9%)], compared with a total of 64 during phase 2 [27 r-GNB (42.2%) and 37 non-r-GNB (57.8%)](P = 0.0002). Acinetobacter spp. was isolated 13 times during phase 1 and 3 times in phase 2 (P = 0.0018). The susceptibility of Pseudomonas aeruginosa to ciprofloxacin increased from 40.0% in phase 1 to 100.0% in phase 2 (P = 0.0108). CONCLUSIONS: Restriction   of   ceftriaxone   and   ciprofloxacin reduced colonization by Acinetobacter spp. and improved the susceptibility profile of P. aeruginosa.

Keywords : Drug  resistance,  multiple; Acinetobacter   baumannii; Pseudomonas   aeruginosa; anti-bacterial agents; Uruguay.