• Muralidharan Jayashree, Sunit Singhi, Pallab Ray, Vikas Gautam, Sukhsagar Ratol, and Sahul Bharti.
• Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, India. Electronic address: mjshree@hotmail.com.
• J Crit Care. 2020 Apr 1; 56: 243-248.

PurposeTo compare antibiotic mixing vs. cycling with respect to acquisition of resistance and PICU mortality.Materials And MethodsChildren between >1 month to 12 years admitted to a medical PICU were enrolled over three phases (baseline, mixing and cycling) with washout interval of 3 months following each antibiotic strategy. Following a baseline phase, empiric gram negative antibiotic protocol for suspected HCAI, was sequentially subjected to mixing and cycling using Latin Square methodology. Surveillance cultures were taken at admission, 48 h, weekly thereafter and within 2 days of PICU discharge. Acquisition of resistance and PICU mortality were primary and secondary outcomes respectively.Results778 children were enrolled; 99 baseline, 146 mixing, 362 cycling, and 171 during two washout phases. Proportion of children with acquired resistance at baseline (56.6%) was significantly higher than mixing (22.6%) and cycling (18.51%) (p < .0001). Adjusted hazards of acquired resistance (HR:0.82; 95% CI: 0.53-1.25, p = .352), and PICU mortality (RR1.07; 95% CI: 0.71-1.60, p = .72) were similar in cycling and mixing strategies.ConclusionsAcquisition of resistance was significantly lower in both mixing and cycling as compared to baseline phase. Both were similar with respect to risk of antibiotic resistance as well as incidence of HCAI and PICU mortality.Copyright © 2020. Published by Elsevier Inc.

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