Antibiotic restriction does not alter endemic colonization with resistant Gram-negative rods in a pediatric intensive care unit

Objective: To test whether a ceftazidime restriction policy in a pediatric intensive care unit (ICU) could decrease the endemic rate of colonization with ceftazidime-resistant Gram-negative bacilli. Design: Prospective, pre- vs, postintervention study. Setting: University hospital pediatric ICU. Patients: Consecutive children admitted to the pediatric ICU over a 19-mo period. Interventions: After an observation period in which antibiotic use was not controlled, ceftazidime was prohibited unless the patient's microbiological results indicated that the drug was necessary for cure. Aminoglycoside use was not regulated. The size of the endemic reservoir of ceftazidime- and tobramycin-resistant organisms was determined by daily nasopharyngeal and rectal swab specimens obtained on all admissions to the ICU. Measurements and Main Results: Despite a 96% reduction in ceftazidime use, the incidence density (number of isolates/100 patient-days) of ceftazidime-resistant organisms increased through the course of the study, from 1,57 to 2.16, The incidence density of tobramycin-resistant organisms was unchanged. Ceftazidime restriction resulted in a small but nonsignificant decrease in the proportion of ceftazidime-resistant organisms acquired late (beyond 72 hrs) in the patients' ICU course (56.5% vs. 45.9%), However, there was a more substantial decrease in the proportion of ceftazidime-resistant organisms derived from species known to harbor derepressible amp C beta-lactamases (68.2% vs. 45.9%, p < .05). Conclusions: These data indicate that antibiotic restriction policies in an ICU fail to diminish the size of the endemic reservoir of antibiotic-resistant Gram-negative rods, and suggest that such policies in the absence of broader efforts to limit antibiotic use will have little impact.