title: Risk factors for recovery of ampicillin-sulbactam-resistant Escherichia coli in hospitalized patients.
abstract: Ampicillin-sulbactam resistance in Escherichia coli is an emerging problem. This study determined risk factors for the recovery of ampicillin-sulbactam-resistant E. coli in hospitalized patients. A case-control design was used to compare two groups of case patients with control patients. The first group of case patients consisted of patients from whom nosocomially acquired ampicillin-sulbactam-resistant E. coli strains were isolated, and the second group of case patients consisted of patients from whom ampicillin-sulbactam-susceptible E. coli strains were isolated. Control patients were a random selection among 5% of all patients admitted during the same time period. Risk factors analyzed included antimicrobial drug exposure, comorbid conditions, and demographics. Univariate and multivariate analyses were performed. Ampicillin-sulbactam-resistant E. coli strains were isolated from 175 patients, and ampicillin-sulbactam-susceptible E. coli strains were isolated from 577 patients. Nine hundred thirty-four control patients were selected. Exposure to penicillin antibiotics as a class and to ampicillin and ampicillin-sulbactam individually were the only significant, independent risk factors associated with the isolation of ampicillin-sulbactam-resistant E. coli (odds ratio [OR] = 2.32 [P < 0.001], OR = 3.04 [P = 0.02], and OR = 1.72 [P = 0.04], respectively), but they were not associated with the isolation of ampicillin-sulbactam-susceptible E. coli. Interestingly, exposure to piperacillin-tazobactam tended to protect against the isolation of E. coli strains resistant to ampicillin-sulbactam, but this did not reach statistical significance (OR = 0.13; P = 0.11).
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA 02215, USA. kkaye@caregroup.harvard.edu
authors.forename: K S
authors.initials: KS
authors.lastname: Kaye
authors.forename: A D
authors.initials: AD
authors.lastname: Harris
authors.forename: H
authors.initials: H
authors.lastname: Gold
authors.forename: Y
authors.initials: Y
authors.lastname: Carmeli
mesh_terms: D000368:Aged; D000667:Ampicillin / Q000627:therapeutic use*; D000668:Ampicillin Resistance; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010406:Penicillins / Q000627:therapeutic use*; D012307:Risk Factors; D012737:Sex Factors; D013407:Sulbactam / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D000667:Ampicillin; D013407:Sulbactam