Am. J. Respir. Crit. Care Med., Volume 156, Number 4, October 1997, 1040-1048

Scheduled Change of Antibiotic Classes
A Strategy to Decrease the Incidence of Ventilator-associated Pneumonia

MARIN H. KOLLEF, JON VLASNIK, LINDA SHARPLESS, CHRISTINA PASQUE, DENISE MURPHY, and VICTORIA FRASER

Department of Internal Medicine, Pulmonary and Critical Care Division, Division of Infectious Diseases, Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, and Department of Pharmacy, Department of Infection Control, Department of Nursing, Barnes-Jewish Hospital, St. Louis, Missouri

The purpose of this study was to determine the impact of a scheduled change of antibiotic classes, used for the empiric treatment of suspected gram-negative bacterial infections, on the incidence of ventilator-associated pneumonia and nosocomial bacteremia. Six hundred eighty patients undergoing cardiac surgery were evaluated. During a 6-mo period (i.e., the before-period), our traditional practice of prescribing a third generation cephalosporin (ceftazidime) for the empiric treatment of suspected gram-negative bacterial infections was continued. This was followed by a 6-mo period (i.e., the after-period) during which a quinolone (ciprofloxacin) was used in place of the third-generation cephalosporin. The incidence of ventilator-associated pneumonia was significantly decreased in the after-period (n = 327) compared with the before-period (n = 353) (6.7 versus 11.6%; p = 0.028). This was primarily due to a significant reduction in the incidence of ventilator-associated pneumonia attributed to antibiotic-resistant gram-negative bacteria (0.9 versus 4.0%; p = 0.013). Similarly, we observed a lower incidence of bacteremia attributed to antibiotic-resistant gram-negative bacteria in the after-period compared with the before-period (0.3 versus 1.7%; p = 0.125). These data suggest that a scheduled change of antibiotic classes can reduce the incidence of ventilator-associated pneumonia attributed to antibiotic-resistant gram-negative bacteria.

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