title: Epidemiological investigation of fluoroquinolone resistance in infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae.
abstract: The incidence of infections due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK) has increased markedly in recent years. Treatment is difficult because of frequent multidrug resistance. Although fluoroquinolones offer effective therapy for ESBL-EK infections, their usefulness is threatened by increasing fluoroquinolone resistance. To identify risk factors for fluoroquinolone resistance in ESBL-EK infections, a case-control study of all patients with ESBL-EK infections from 1 June 1997 through 30 September 1998 was conducted. Of 77 ESBL-EK infections, 43 (55.8%) were resistant to fluoroquinolones. Independent risk factors for fluoroquinolone resistance were fluoroquinolone use (odds ratio [OR], 11.20; 95% confidence interval [CI], 1.99-63.19), aminoglycoside use (OR, 5.83; 95% CI, 1.12-30.43), and long-term care facility residence (OR, 3.39; 95% CI, 1.06-10.83). The genotypes of fluoroquinolone-resistant ESBL-EK isolates were closely related. Efforts should be directed at modification of these risk factors to preserve the utility of fluoroquinolones in the treatment of ESBL-EK infections.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA 19104-6021, USA. elautenb@mail.med.upenn.edu
authors.forename: E
authors.initials: E
authors.lastname: Lautenbach
authors.forename: B L
authors.initials: BL
authors.lastname: Strom
authors.forename: W B
authors.initials: WB
authors.lastname: Bilker
authors.forename: J B
authors.initials: JB
authors.lastname: Patel
authors.forename: P H
authors.initials: PH
authors.lastname: Edelstein
authors.forename: N O
authors.initials: NO
authors.lastname: Fishman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D004926:Escherichia coli / Q000187:drug effects* / Q000201:enzymology; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D015994:Incidence; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D001618:beta-Lactamases