Risk Factors for Ciprofloxacin Resistance in Bloodstream Infections Due to Extended-Spectrum beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae.
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.
Kang
Cheol-In
CI
Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Kim
Sung-Han
SH
Kim
Dong Min
DM
Park
Wan Beom
WB
Lee
Ki-Deok
KD
Kim
Hong Bin
HB
Oh
Myoung-Don
MD
Kim
Eui-Chong
EC
Choe
Kang-Won
KW
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*
D002939:Ciprofloxacin; D001618:beta-Lactamases