Ceftriaxone and ciprofloxacin restriction in an intensive care unit: less incidence of Acinetobacter spp. and improved susceptibility of Pseudomonas aeruginosa

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.