title: Fluoroquinolones protective against cephalosporin resistance in gram-negative nosocomial pathogens.
abstract: In a matched case-control study, we studied the effect of prior receipt of fluoroquinolones on isolation of three third-generation cephalosporin-resistant gram-negative nosocomial pathogens. Two hundred eighty-two cases with a third-generation cephalosporin-resistant pathogen (203 with Enterobacter spp., 50 with Pseudomonas aeruginosa, and 29 with Klebsiella pneumoniae) were matched on length of stay to controls in a 1:2 ratio. Case-patients and controls were similar in age (mean 62 years) and sex (54% male). Variables predicting third-generation cephalosporin resistance were surgery (p = 0.005); intensive care unit stay (p < 0.001); and receipt of a b-lactam/b-lactamase inhibitor (p < 0.001), a ureidopenicillin (p = 0.002), or a third-generation cephalosporin (p < 0.001). Receipt of a fluoroquinolone was protective against isolation of a third-generation cephalosporin-resistant pathogen (p = 0.005). Interventional studies are required to determine whether replacing third-generation cephalosporins with fluoroquinolones will be effective in reducing cephalosporin resistance and the effect of such interventions on fluoroquinolone resistance.
authors.affiliation: Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA. mschwabe@bidmc.harvard.edu
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Schwaber
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
authors.forename: Howard S
authors.initials: HS
authors.lastname: Gold
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
mesh_terms: D016022:Case-Control Studies; D018550:Cephalosporin Resistance / Q000187:drug effects*; D015897:Comorbidity; D016001:Confidence Intervals; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D024841:Fluoroquinolones