Ventilator-associated Pneumonia Caused by ESKAPE Organisms
Ventilator-associated Pneumonia Caused by ESKAPE Organisms
Stewardship programs consisting of a package of measures directed to rationalizing antimicrobial use, such as antimicrobial restriction, antimicrobial cycling or de-escalation, have been proposed to curb resistance and preserve efficacy of the existing agents. However, these strategies are not always easy to implement and their use remains controversial. Mathematical models using theoretical scenarios have predicted the superiority of heterogeneous antibiotic strategies over temporary peaks on antimicrobial pressure resulting from homogeneous antibiotic patterns for prevention of antimicrobial resistance. However, in the clinical field there is no consensus on the best strategy to guarantee antimicrobial diversity, mainly due to difficulties in measuring the degree of heterogeneity attained with the implementation of a given antimicrobial strategy. Using a previously proposed index to quantify diversity of antimicrobial use, our group evaluated the impact of three different strategies of antimicrobial empirical prescription for VAP on the emergence of ESKAPE pathogens. Although incidence of ESKAPE organisms was similar among periods, ESKAPEresistant strains increased significantly after implementation of strategies favouring homogeneous antimicrobial use, mostly due to an increase of carbapenem-resistant A. baumannii (Fig. 1). This finding was not only of academic interest, as it may be associated with changes in ICU mortality and duration of mechanical ventilation.
(Enlarge Image)
Figure 1.
Percentage of ESKAPE pathogens isolated from VAP episodes. Modified with permission from figure 4 of Sandiumenge et al. *P<0.05 for scheduling period (homgeneous antimicrobial pattern) with respect to patient-specific period (diverse antimicrobial pattern). **P<0.05 for scheduling period with respect to mixing period (diverse antimicrobial pattern). CRAB, carbapenem-resistant Acinetobacter baumannii; ESBL, extended spectrum betalactamase; MRPA, multiresistant Pseudomonas aeruginosa; MRSA, methicillin-resistant **Staphylococcus aureus.
Prevention Strategies
Stewardship programs consisting of a package of measures directed to rationalizing antimicrobial use, such as antimicrobial restriction, antimicrobial cycling or de-escalation, have been proposed to curb resistance and preserve efficacy of the existing agents. However, these strategies are not always easy to implement and their use remains controversial. Mathematical models using theoretical scenarios have predicted the superiority of heterogeneous antibiotic strategies over temporary peaks on antimicrobial pressure resulting from homogeneous antibiotic patterns for prevention of antimicrobial resistance. However, in the clinical field there is no consensus on the best strategy to guarantee antimicrobial diversity, mainly due to difficulties in measuring the degree of heterogeneity attained with the implementation of a given antimicrobial strategy. Using a previously proposed index to quantify diversity of antimicrobial use, our group evaluated the impact of three different strategies of antimicrobial empirical prescription for VAP on the emergence of ESKAPE pathogens. Although incidence of ESKAPE organisms was similar among periods, ESKAPEresistant strains increased significantly after implementation of strategies favouring homogeneous antimicrobial use, mostly due to an increase of carbapenem-resistant A. baumannii (Fig. 1). This finding was not only of academic interest, as it may be associated with changes in ICU mortality and duration of mechanical ventilation.
(Enlarge Image)
Figure 1.
Percentage of ESKAPE pathogens isolated from VAP episodes. Modified with permission from figure 4 of Sandiumenge et al. *P<0.05 for scheduling period (homgeneous antimicrobial pattern) with respect to patient-specific period (diverse antimicrobial pattern). **P<0.05 for scheduling period with respect to mixing period (diverse antimicrobial pattern). CRAB, carbapenem-resistant Acinetobacter baumannii; ESBL, extended spectrum betalactamase; MRPA, multiresistant Pseudomonas aeruginosa; MRSA, methicillin-resistant **Staphylococcus aureus.
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