tailieunhanh - Báo cáo y học: "Rotating antibiotics in the intensive care unit: feasible, apparently beneficial, but questions remain"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Rotating antibiotics in the intensive care unit: feasible, apparently beneficial, but questions remain. | Available online http content 6 1 009 Commentary Rotating antibiotics in the intensive care unit feasible apparently beneficial but questions remain Jean-Claude Pechère Professor Department of Genetics and Microbiology University of Geneva Switzerland Correspondence Jean-Claude Pechère jcpechere@ Published online 11 January 2002 Critical Care 2002 6 9-10 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Rotating antibiotics in the intensive care unit may result in less infections caused by resistant organisms and in even less mortality. The selection of super-resistant organisms associated with the rotation strategy cannot be excluded however and many practical issues will have to be addressed before antibiotic rotation can be routinely recommended. Keywords antibiotic resistance rotation policy Raymond et al. from the University of Virginia USA published work into rotating empirical antibiotics in an intensive care unit in June 2001 1 . This was the first time that a quarterly rotation of empirical antibiotics used for 1 year was compared with the previous year of non-protocol-driven use in critically ill patients. The research showed that rotation was associated with a significant reduction in infection episodes caused by Gram-negative antibiotic-resistant organisms. The paper also showed that rotating antibiotics resulted in a lower incidence of Gram-positive coccal infections less methicillin-resistant Staphylococcus aureus MRSA and gentamicin-resistant enterococci infections and a clear reduction in mortality associated with infection. In fact antibiotic rotation was an independent predictor of survival. The Raymond et al. paper was welcomed news because we are clearly facing an antibiotic crisis 2 3 . Bacterial resistance is progressing faster than the number of new antibiotics available to the clinician resulting in higher costs and poorer outcomes 4 . To meet this challenge new strategies that optimise the use