Cycling empirical antibiotic therapy in hospitals: meta-analysis and models.

The rise of resistance together with the shortage of new broad-spectrum antibiotics underlines the urgency of optimizing the use of available drugs to minimize disease burden. Theoretical studies suggest that coordinating empirical usage of antibiotics in a hospital ward can contain the spread of re...

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Autores principales:	Pia Abel zur Wiesch, Roger Kouyos, Sören Abel, Wolfgang Viechtbauer, Sebastian Bonhoeffer
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Immunologic diseases. Allergy RC581-607 Biology (General) QH301-705.5
Acceso en línea:	https://doaj.org/article/1ddd3a5ab77142a5a041ecd081ac5013
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spelling	oai:doaj.org-article:1ddd3a5ab77142a5a041ecd081ac50132021-11-11T06:06:07ZCycling empirical antibiotic therapy in hospitals: meta-analysis and models.1553-73661553-737410.1371/journal.ppat.1004225https://doaj.org/article/1ddd3a5ab77142a5a041ecd081ac50132014-06-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24968123/?tool=EBIhttps://doaj.org/toc/1553-7366https://doaj.org/toc/1553-7374The rise of resistance together with the shortage of new broad-spectrum antibiotics underlines the urgency of optimizing the use of available drugs to minimize disease burden. Theoretical studies suggest that coordinating empirical usage of antibiotics in a hospital ward can contain the spread of resistance. However, theoretical and clinical studies came to different conclusions regarding the usefulness of rotating first-line therapy (cycling). Here, we performed a quantitative pathogen-specific meta-analysis of clinical studies comparing cycling to standard practice. We searched PubMed and Google Scholar and identified 46 clinical studies addressing the effect of cycling on nosocomial infections, of which 11 met our selection criteria. We employed a method for multivariate meta-analysis using incidence rates as endpoints and find that cycling reduced the incidence rate/1000 patient days of both total infections by 4.95 [9.43-0.48] and resistant infections by 7.2 [14.00-0.44]. This positive effect was observed in most pathogens despite a large variance between individual species. Our findings remain robust in uni- and multivariate metaregressions. We used theoretical models that reflect various infections and hospital settings to compare cycling to random assignment to different drugs (mixing). We make the realistic assumption that therapy is changed when first line treatment is ineffective, which we call "adjustable cycling/mixing". In concordance with earlier theoretical studies, we find that in strict regimens, cycling is detrimental. However, in adjustable regimens single resistance is suppressed and cycling is successful in most settings. Both a meta-regression and our theoretical model indicate that "adjustable cycling" is especially useful to suppress emergence of multiple resistance. While our model predicts that cycling periods of one month perform well, we expect that too long cycling periods are detrimental. Our results suggest that "adjustable cycling" suppresses multiple resistance and warrants further investigations that allow comparing various diseases and hospital settings.Pia Abel zur WieschRoger KouyosSören AbelWolfgang ViechtbauerSebastian BonhoefferPublic Library of Science (PLoS)articleImmunologic diseases. AllergyRC581-607Biology (General)QH301-705.5ENPLoS Pathogens, Vol 10, Iss 6, p e1004225 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Immunologic diseases. Allergy RC581-607 Biology (General) QH301-705.5
spellingShingle	Immunologic diseases. Allergy RC581-607 Biology (General) QH301-705.5 Pia Abel zur Wiesch Roger Kouyos Sören Abel Wolfgang Viechtbauer Sebastian Bonhoeffer Cycling empirical antibiotic therapy in hospitals: meta-analysis and models.
description	The rise of resistance together with the shortage of new broad-spectrum antibiotics underlines the urgency of optimizing the use of available drugs to minimize disease burden. Theoretical studies suggest that coordinating empirical usage of antibiotics in a hospital ward can contain the spread of resistance. However, theoretical and clinical studies came to different conclusions regarding the usefulness of rotating first-line therapy (cycling). Here, we performed a quantitative pathogen-specific meta-analysis of clinical studies comparing cycling to standard practice. We searched PubMed and Google Scholar and identified 46 clinical studies addressing the effect of cycling on nosocomial infections, of which 11 met our selection criteria. We employed a method for multivariate meta-analysis using incidence rates as endpoints and find that cycling reduced the incidence rate/1000 patient days of both total infections by 4.95 [9.43-0.48] and resistant infections by 7.2 [14.00-0.44]. This positive effect was observed in most pathogens despite a large variance between individual species. Our findings remain robust in uni- and multivariate metaregressions. We used theoretical models that reflect various infections and hospital settings to compare cycling to random assignment to different drugs (mixing). We make the realistic assumption that therapy is changed when first line treatment is ineffective, which we call "adjustable cycling/mixing". In concordance with earlier theoretical studies, we find that in strict regimens, cycling is detrimental. However, in adjustable regimens single resistance is suppressed and cycling is successful in most settings. Both a meta-regression and our theoretical model indicate that "adjustable cycling" is especially useful to suppress emergence of multiple resistance. While our model predicts that cycling periods of one month perform well, we expect that too long cycling periods are detrimental. Our results suggest that "adjustable cycling" suppresses multiple resistance and warrants further investigations that allow comparing various diseases and hospital settings.
format	article
author	Pia Abel zur Wiesch Roger Kouyos Sören Abel Wolfgang Viechtbauer Sebastian Bonhoeffer
author_facet	Pia Abel zur Wiesch Roger Kouyos Sören Abel Wolfgang Viechtbauer Sebastian Bonhoeffer
author_sort	Pia Abel zur Wiesch
title	Cycling empirical antibiotic therapy in hospitals: meta-analysis and models.
title_short	Cycling empirical antibiotic therapy in hospitals: meta-analysis and models.
title_full	Cycling empirical antibiotic therapy in hospitals: meta-analysis and models.
title_fullStr	Cycling empirical antibiotic therapy in hospitals: meta-analysis and models.
title_full_unstemmed	Cycling empirical antibiotic therapy in hospitals: meta-analysis and models.
title_sort	cycling empirical antibiotic therapy in hospitals: meta-analysis and models.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/1ddd3a5ab77142a5a041ecd081ac5013
work_keys_str_mv	AT piaabelzurwiesch cyclingempiricalantibiotictherapyinhospitalsmetaanalysisandmodels AT rogerkouyos cyclingempiricalantibiotictherapyinhospitalsmetaanalysisandmodels AT sorenabel cyclingempiricalantibiotictherapyinhospitalsmetaanalysisandmodels AT wolfgangviechtbauer cyclingempiricalantibiotictherapyinhospitalsmetaanalysisandmodels AT sebastianbonhoeffer cyclingempiricalantibiotictherapyinhospitalsmetaanalysisandmodels
_version_	1718439468831080448

Cycling empirical antibiotic therapy in hospitals: meta-analysis and models.

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