title: Risk Factors for Ciprofloxacin Resistance in Bloodstream Infections Due to Extended-Spectrum beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae.
abstract: The present study was conducted to identify risk factors for ciprofloxacin resistance in bloodstream infections due to extended-spectrum beta -lactamase-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK). ESBL production was determined in stored E. coli and K. pneumoniae blood isolates from January, 1998, to December, 2002, by National Committee for Clinical Laboratory Standards (NCCLS) guidelines and/or double-disk synergy test. Antimicrobial susceptibility was determined by the disk diffusion test method. A total of 133 patients with ESBL-EK bacteremia were analyzed retrospectively. A total of 80 (60.2%) patients experienced bacteremia due to strains resistant to ciprofloxacin. There were no significant differences in age, sex, and APACHE II score between the ciprofloxacin-resistant group (CIP-R) and-susceptible group (CIPS). The most common primary site of infection in CIP-R was pancreaticobiliary tract infection (46/80, 57.5%) and that in CIP-S was unknown primary site (23/53, 43.4%). Independent risk factors for ciprofloxacin resistance were: prior use of fluoroquinolones (OR, 5.53; 95% CI, 1.56-25.42, p = 0.032), indwelling urinary catheter (OR, 3.68; 95% CI, 1.27-10.67, p = 0.017), and invasive procedure within 72 hr prior to bacteremia (OR, 4.03; 95% CI, 1.44-11.25, p = 0.008). Our data suggest that strategies designed to reduce the ciprofloxacin resistance rate in ESBL-EK strains should focus on limiting the use of fluoroquinolones and minimizing invasive procedures, including insertion of a urinary catheter.
authors.affiliation: Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
authors.forename: Dong Min
authors.initials: DM
authors.lastname: Kim
authors.forename: Wan Beom
authors.initials: WB
authors.lastname: Park
authors.forename: Ki-Deok
authors.initials: KD
authors.lastname: Lee
authors.forename: Hong Bin
authors.initials: HB
authors.lastname: Kim
authors.forename: Myoung-Don
authors.initials: MD
authors.lastname: Oh
authors.forename: Eui-Chong
authors.initials: EC
authors.lastname: Kim
authors.forename: Kang-Won
authors.initials: KW
authors.lastname: Choe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology*; D016022:Case-Control Studies; D002939:Ciprofloxacin / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D002939:Ciprofloxacin; D001618:beta-Lactamases