Mixing it up: Antibiotic cycling in the SICU

* Corresponding author. Department of Pedia NY 11040, USA. Tel.: þ1 718 470 3636; fax: þ E-mail address: jprince@nshs.edu (J.M. Pr 0022-4804/$ e see front matter a 2013 Elsev doi:10.1016/j.jss.2012.04.026 As antimicrobial resistancedand gram-negative resistance in particulardhas grown as a major health care concern, more attention is being paid to the application of “antibiotic heterogeneity” in the critical care setting. There seems to be no consensus, however, regarding whether antibiotic cycling/ rotation or mixing represents the optimal approach to decreasing resistance patterns. It is therefore with particular attention that we read the article by Sarraf-Yazdi et al. on the long-term effect of an antibiotic rotation schedule in a surgical intensive care unit (SICU) [1], as this study contributes promising data and a new approach to the debate. Several authors have concluded that antibiotic cycling/ rotation in the critical care settingmay be of no benefit at all in terms of reducing gram-negative antimicrobial resistance [2e4], while others claim it may even lead to increased gramnegative resistance [5,6]. Why, then, does this study claim such effective long-term results with rotation where others could not? It may be in the fact that they might not be truly rotating antibiotics to begin with. They might instead be applying the “controlled mixing” model suggested by others [7,8] that the current authors themselves alluded to.