title: Cefoxitin resistance in community-acquired gram-negative bacillary bacteremia. Associated clinical risk factors.
abstract: Among 185 patients with nonneutropenic, community-acquired gram-negative bacillary bacteremias, clinical risk factors for cefoxitin resistance included any antibiotic taken within the last three weeks (25.6% cefoxitin resistance), long-term bladder catheterization or surgical urinary diversion (23.3%), hospitalization within the last 30 days (22.9%), and nursing home residence before admission (20.8%). Patients with none of these risk factors were less likely to have cefoxitin-resistant bacteremias (0.9%). When these risk factors were examined in the subgroups of urinary tract and non-urinary tract sources of community-acquired gram-negative bacillary bacteremia, they were also helpful in predicting sensitivity to trimethoprim-sulfamethoxazole and gentamicin. The presence of one or more of the risk factors identified may be a useful adjunct in determining initial empiric antimicrobial therapy for community-acquired gram-negative bacillary bacteremia.
mesh_terms: D002440:Cefoxitin / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D002981:Clindamycin / Q000494:pharmacology / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000635:transmission; D004338:Drug Combinations / Q000494:pharmacology / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D005839:Gentamicins / Q000494:pharmacology / Q000627:therapeutic use; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D006801:Humans; D012189:Retrospective Studies; D012306:Risk; D018805:Sepsis / Q000145:classification / Q000188:drug therapy* / Q000635:transmission; D013420:Sulfamethoxazole / Q000494:pharmacology / Q000627:therapeutic use; D014295:Trimethoprim / Q000494:pharmacology / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014546:Urinary Catheterization / Q000009:adverse effects; D014547:Urinary Diversion / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000188:drug therapy
chemical_list: D004338:Drug Combinations; D005839:Gentamicins; D002981:Clindamycin; D002440:Cefoxitin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014295:Trimethoprim; D013420:Sulfamethoxazole