LAUTENBACH E, FISHMAN NO, BILKER WB, CASTIGLIONI A, METLAY JP, EDELSTEIN PH, STROM BL; Interscience Conference on Antimicrobial Agents and Chemotherapy (41st : 2001 : Chicago, Ill.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2001 Dec 16-19; 41: abstract no. K-1181.

University of Pennsylvania, Philadelphia, PA

BACKGROUND: FQ resistance has increased markedly in recent years. The emergence of FQ resistance in EC and KP, which together account for up to 25% of all nosocomial infections, is particularly concerning. Identification of risk factors for FQ resistance in these pathogens is vital in designing strategies to address these trends. METHODS: To identify risk factors for nosocomial FQ resistance, a case-control study of hospitalized patients with EC and KP infections was conducted at two University of Pennsylvania hospitals between January 1, 1998 and June 30, 1999. 123 patients with FQ-resistant infections (cases) were compared to 70 randomly-selected patients with FQ-susceptible infections (controls). RESULTS: Of 193 total patients, 149 (77%) and 44 (23%) had EC and KP infections, respectively. The most common sites of infection were urinary = 131 (68%), and primary bloodstream = 25 (13%). Of 123 cases, 74 (60%) were admitted from a LTCF compared to 17 (24%) of 70 controls [unadjusted OR (95%CI) = 4.71 (2.46, 9.01)]. Independent risk factors [adjusted OR (95%CI)] for FQ resistance were: 1) recent FQ use [5.25 (1.81, 15.26)]; 2) LTCF residence [3.65 (1.64, 8.15)]; 3) recent aminoglycoside (AG) use [8.86 (1.71, 45.99)]; and 4) older age [1.03 (1.01, 1.06)]. CONCLUSIONS: Recent FQ use, LTCF residence, recent AG use, and older age were independent risk factors for FQ resistance in EC and KP infections. Efforts to control FQ resistance should focus on decreasing inappropriate use and overuse of FQs and AGs. The impact of the LTCF on FQ resistance, not appreciated to date, highlights the need to better define the epidemiology of FQ resistance in these settings. Our results also demonstrate the importance of including all healthcare settings in efforts to address emergence of resistance.

Publication Types:

• Meeting Abstracts

Keywords:

• Anti-Bacterial Agents
• Case-Control Studies
• Cross Infection
• Escherichia coli
• Escherichia coli Infections
• Fluoroquinolones
• Hospitals
• Humans
• Infection
• Karnofsky Performance Status
• Klebsiella pneumoniae
• Long-Term Care
• Pennsylvania
• Risk Factors

Other ID:

• GWAIDS0029196

UI: 102268828

From Meeting Abstracts