Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-25T23:27:35.682Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors Associated With Resistance to Ciprofloxacin in Clinical Bacterial Isolates From Intensive Care Unit Patients

Published online by Cambridge University Press:  02 January 2015

Phillip D. Levin ,
Robert A. Fowler ,
Cameron Guest ,
William J. Sibbald ,
Alex Kiss  and
Andrew E. Simor
Phillip D. Levin
Affiliation:
Departments of Critical Care, Toronto, Canada Hadassah Hebrew University Medical Center, Jerusalem, Israel
Robert A. Fowler
Affiliation:
Departments of Critical Care, Toronto, Canada Medicine, Toronto, Canada University of Toronto, Toronto, Canada
Cameron Guest
Affiliation:
Departments of Critical Care, Toronto, Canada University of Toronto, Toronto, Canada
William J. Sibbald
Affiliation:
Departments of Critical Care, Toronto, Canada Medicine, Toronto, Canada University of Toronto, Toronto, Canada
Alex Kiss
Affiliation:
Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, Canada University of Toronto, Toronto, Canada
Andrew E. Simor*
Affiliation:
Medicine, Toronto, Canada Microbiology, Toronto, Canada University of Toronto, Toronto, Canada
*
Department of Microbiology, Sunnybrook Health Sciences Centre, B121-2075 Bayview Avenue, Toronto, Ontario, CanadaM4N 3M5 (andrew.simor@sunnybrook.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine risk factors and outcomes associated with ciprofloxacin resistance in clinical bacterial isolates from intensive care unit (ICU) patients.

Design.

Prospective cohort study.

Setting.

Twenty-bed medical-surgical ICU in a Canadian tertiary care teaching hospital.

Patients.

All patients admitted to the ICU with a stay of at least 72 hours between January 1 and December 31, 2003.

Methods.

Prospective surveillance to determine patient comorbidities, use of medical devices, nosocomial infections, use of antimicrobials, and outcomes. Characteristics of patients with a ciprofloxacin-resistant gram-negative bacterial organism were compared with characteristics of patients without these pathogens.

Results.

Ciprofloxacin-resistant organisms were recovered from 20 (6%) of 338 ICU patients, representing 38 (21%) of 178 nonduplicate isolates of gram-negative bacilli. Forty-nine percent of Pseudomonas aeruginosa isolates and 29% of Escherichia coli isolates were resistant to ciprofloxacin. In a multivariate analysis, independent risk factors associated with the recovery of a ciprofloxacin-resistant organism included duration of prior treatment with ciprofloxacin (relative risk [RR], 1.15 per day [95% confidence interval {CI}, 1.08-1.23]; P < .001), duration of prior treatment with levofloxacin (RR, 1.39 per day [95% CI, 1.01-1.91]; P = .04), and length of hospital stay prior to ICU admission (RR, 1.02 per day [95% CI, 1.01-1.03]; P = .005). Neither ICU mortality (15% of patients with a ciprofloxacin-resistant isolate vs 23% of patients with a ciprofloxacin-susceptible isolate; P = .58 ) nor in-hospital mortality (30% vs 34%; P = .81 ) were statistically significantly associated with ciprofloxacin resistance.

Conclusions.

ICU patients are at risk of developing infections due to ciprofloxacin-resistant organisms. Variables associated with ciprofloxacin resistance include prior use of fluoroquinolones and duration of hospitalization prior to ICU admission. Recognition of these risk factors may influence antibiotic treatment decisions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 3 , March 2007 , pp. 331 - 336
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Fridkin, SK, Steward, CD, Edwards, J, et al. Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals: project ICARE phase 2. Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals. Clin Infect Dis 1999;29:245–252.Google Scholar
2.Archibald, L, Phillips, L, Monnet, D, et al. Antimicrobial resistance in isolates from inpatients and outpatients in the United States: increasing importance of the intensive care unit. Clin Infect Dis 1997;24:211–215.Google Scholar
3. NNIS System. National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
4.Bryce, EA, Smith, JA. Focused microbiological surveillance and gram-negative β-lactamase-mediated resistance in an intensive care unit. Infect Control Hosp Epidemiol 1995;16:331–334.CrossRefGoogle Scholar
5.Livermore, DM, Yuan, M. Antibiotic resistance and production of extended-spectrum β-lactamases amongst Klebsiella spp from intensive care units in Europe. J Antimicrob Chemother 1996;38:409–424.Google Scholar
6.Neuhauser, MM, Weinstein, RA, Rydman, R, et al. Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use. JAMA 2003;289:885–888.Google Scholar
7.Hanberger, H, Garcia-Rodriguez, J-A, Gobernado, M, et al. Antibiotic susceptibility among aerobic gram-negative bacilli in intensive care units in 5 European countries. JAMA 1999;281:67–71.Google Scholar
8.Kollef, MH, Fraser, VJ. Antibiotic resistance in the intensive care unit. Ann Intern Med 2001;134:298–314.Google Scholar
9.Carmeli, Y, Troillet, N, Karchmer, AW, et al. Health and economic outcomes of antibiotic resistance in Pseudomonas aeruginosa. Arch Intern Med 1999;159:1127–1132.Google Scholar
10.Carlet, J, Ben Ali, A, Chalfine, A. Epidemiology and control of antibiotic resistance in the intensive care unit. Curr Opin Infect Dis 2004;17:309–316.Google Scholar
11.Lautenbach, E, Strom, BL, Nachamkin, I, et al. Longitudinal trends in fluoroquinolone resistance among Enterobacteriaceae isolates from inpatients and outpatients, 1989-2000: differences in the emergence and epidemiology of resistance across organisms. Clin Infect Dis 2004;38:655–662.Google Scholar
12. WHO Collaborating Centre for Drug Statistics Methodology Web site. Available at: http://www.whocc.no/atcddd/. Accessed January 18, 2007.Google Scholar
13.Garner, JS, Jarvis, WR, Emori, TG, et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
14.Papia, G, Louie, M, Traila, A, et al. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to hospital: is it cost-effective? Infect Control Hosp Epidemiol 1999;20:473–477.Google Scholar
15.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.CrossRefGoogle ScholarPubMed
16.Clinical and Laboratory Standards Institute / NCCLS. Performance Standards for Antimicrobial Susceptibility Testing; Fifteenth Informational Supplement. CLSI/NCCLS document M100-S15. Wayne, PA: Clinical and Laboratory Standards Institute; 2005.Google Scholar
17.Cheong, H-J, Yoo, C-W, Sohn, J-W, et al. Bacteremia due to quinolone-resistant Escherichia coli in a teaching hospital in South Korea. Clin Infect Dis 2001;33:48–53.Google Scholar
18.Gentry, C, Flournoy, DJ, Reinert, R. Analysis of antimicrobial resistance among gram-negative bacilli and antimicrobial use in intensive care unit patients for 5 years in a Veterans Affairs medical center. Am J Infect Control 2002;30:411–416.CrossRefGoogle Scholar
19.Zervos, MJ, Hershberger, E, Nicolau, DP, et al. Relationship between fluoroquinolone use and changes in susceptibility to fluoroquinolones of selected pathogens in 10 United States teaching hospitals, 1991-2000. Clin Infect Dis 2003;37:1643–1648.CrossRefGoogle ScholarPubMed
20.MacDougall, C, Harpe, SE, Powell, JP, et al. Pseudomonas aeruginosa, Staphylococcus aureus, and fluoroquinolone use. Emerg Infect Dis 2005;11:1197–1204.CrossRefGoogle ScholarPubMed
21.Aubert, G, Carricajo, A, Vautrin, A-C, et al. Impact of restricting fluoroquinolone prescription on bacterial resistance in an intensive care unit. / Hosp Infect 2005;59:83–89.Google Scholar
22.Polk, RE, Johnson, CK, McClish, D, et al. Predicting hospital rates of fluoroquinolone-resistant Pseudomonas aeruginosa from fluoroquinolone use in US hospitals and their surrounding communities. Clin Infect Dis 2004;39:497–503.CrossRefGoogle ScholarPubMed
23.Paterson, DL, Mulazimoglu, L, Casellas, JM, et al. Epidemiology of ciprofloxacin resistance and its relationship to extended-spectrum β-lactamase production in Klebsiella pneumoniae isolates causing bacteremia. Clin Infect Dis 2000;30:473–478.Google Scholar
24.Lautenbach, E, Fishman, NO, Bilker, WB, et al. Risk factors for fluoroquinolone resistance in nosocomial Escherichia coli and Klebsiella pneumoniae infections. Arch Intern Med 2002;162:2469–2477.Google Scholar
25.Ray, GT, Baxter, R, DeLorenze, GN. Hospital-level rates of fluoroquinolone use and the risk of hospital-acquired infection with ciprofloxacin-non-susceptible Pseudomonas aeruginosa. Clin Infect Dis 2005;41:441–449.Google Scholar
26.Muder, RR, Brennen, C, Goetz, AM, et al. Association with prior fluoroquinolone therapy of widespread ciprofloxacin resistance among gram-negative isolates in a Veterans Affairs medical center. Antimicrob Agents Chemother 1991;35:256–258.Google Scholar
27.Carmeli, Y, Troillet, N, Eliopoulos, GM, et al. Emergence of antibiotic-resistant Pseudomonas aeruginosa: comparison of risks associated with different antipseudomonal agents. Antimicrob Agents Chemother 1999;43:1379–1382.Google Scholar
28.Richard, P, Delangle, M-H, Merrien, D, et al. Fluoroquinolone use and fluoroquinolone resistance: is there an association? Clin Infect Dis 1994;19:54–59.Google Scholar
29.El Amari, EB, Chamot, E, Auckenthaler, R, et al. Influence of previous exposure to antibiotic therapy on the susceptibility pattern of Pseudomonas aeruginosa bacteremic isolates. Clin Infect Dis 2001;33:1859–1864.Google Scholar
30.Harbarth, S, Harris, AD, Carmeli, Y, et al. Parallel analysis of individual and aggregated data on antibiotic exposure and resistance in gram-negative bacilli. Clin Infect Dis 2001;33:1462–1468.Google Scholar
31.Huotari, K, Tarkka, E, Valtonen, V, et al. Incidence and risk factors for nosocomial infections caused by fluoroquinolone-resistant Escherichia coli. Eur J Clin Microbiol Infect Dis 2003;22:492–495.Google Scholar
32.Gilbert, DN, Kohlhepp, SJ, Slama, KA, et al. Phenotypic resistance of Staphylococcus aureus, selected Enterobacteriaceae, and Pseudomonas aeruginosa after single and multiple in vitro exposures to ciprofloxacin, levofloxacin, and trovafloxacin. Antimicrob Agents Chemother 2001;45:883–892.Google Scholar
33.Ortiz, J, Vila, MC, Soriano, G, et al. Infections caused by Escherichia coli resistant to norfloxacin in hospitalized cirrhotic patients. Hepatology 1999;29:1064–1069.Google Scholar
34.Lautenbach, E, Metlay, JP, Bilker, WB, et al. Association between fluoroquinolone resistance and mortality in Escherichia coli and Klebsiella pneumoniae infections: the role of inadequate empirical antimicrobial therapy. Clin Infect Dis 2005;41:923–929.Google Scholar