title: Epidemiological risk factors for isolation of ceftriaxone-resistant versus -susceptible citrobacter freundii in hospitalized patients.
abstract: Antimicrobial resistance is an emerging problem among nosocomial bacteria. Risk factors for the recovery of ceftriaxone-resistant (CRCF) or -susceptible (CSCF) Citrobacter freundii in clinical cultures from hospitalized patients were determined by using a case-case-control study design. CRCF was isolated from 43 patients (case group 1) and CSCF was isolated from 87 patients (case group 2) over a 3-year period. Risk factors for CRCF were exposure to imipenem (odds ratio [OR], 7.5; 95% confidence interval [CI], 1.2 to 45.4), broad-spectrum cephalosporins (OR, 6.9; 95% CI, 1.8 to 26.7), vancomycin (OR, 3.0; 95% CI, 1.2 to 7.4), or piperacillin-tazobactam (OR, 2.6; 95% CI, 1.1 to 6.2), as well as hospital length of stay >or=1 week (OR, 3.6; 95% CI, 1.3 to 10.2) and intensive care unit (ICU) stay (OR, 2.6; 95% CI, 1.1 to 6.2). Risk factors for CSCF were peripheral vascular disease (OR, 23.2; 95% CI, 4.3 to 124.6), AIDS (OR, 9.5; 95% CI, 1.6 to 55.5), cerebrovascular disease (OR, 4.2; 95% CI, 1.6 to 10.8), and ICU stay (OR, 3.1; 95% CI, 1.8 to 5.4).
authors.affiliation: Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. pkim@medicine.umaryland.edu
authors.forename: Peter W
authors.initials: PW
authors.lastname: Kim
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
authors.forename: Mary-Claire
authors.initials: MC
authors.lastname: Roghmann
authors.forename: J Glenn
authors.initials: JG
authors.lastname: Morris
authors.forename: Arjun
authors.initials: A
authors.lastname: Strinivasan
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
mesh_terms: D016022:Case-Control Studies; D002443:Ceftriaxone / Q000494:pharmacology*; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000494:pharmacology*; D002561:Cerebrovascular Disorders / Q000150:complications; D016971:Citrobacter freundii / Q000187:drug effects*; D003422:Critical Care; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D004756:Enterobacteriaceae Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D002511:Cephalosporins; D002443:Ceftriaxone