title: Relationship between ceftriaxone use and resistance to third-generation cephalosporins among clinical strains of Enterobacter cloacae.
abstract: OBJECTIVE
  To investigate the potential correlation between the use of extended-spectrum cephalosporins (ESCs) and resistance to this antibiotic class among clinical isolates of Enterobacter cloacae in a university-affiliated hospital.
  
  
  METHODS
  Data on antimicrobial resistance and antimicrobial use concerning E. cloacae and ESCs were collected over a 4 year period. Various statistical tools were used to explore the potential relationship.
  
  
  RESULTS
  From 1999 to 2002, the proportion of E. cloacae isolates resistant to ESCs increased from 24.3% to 29.6%. (P=0.04), and the quantity of ESCs prescribed and given did not change. Within the subclass constituted by first-line ESCs, the proportion of ceftriaxone increased from 64.3% to 77.6% and the proportion of cefotaxime decreased accordingly, from 35.7% to 22.4%. Statistical analyses showed that E. cloacae resistance to ESCs correlated with ceftriaxone use regardless of the other ESCs. For every defined daily dose of ceftriaxone per 1000 patient days used in our hospital, resistance of E. cloacae isolates to ESCs increased by 1.36%.
  
  
  CONCLUSIONS
  This study demonstrates a specific correlation between ceftriaxone use and the development of resistance in E. cloacae clinical isolates. The high biliary elimination of ceftriaxone compared with other ESCs may be responsible for a greater impact of this antibiotic on the digestive flora.
authors.affiliation: Service d'Hygiène Hospitalière et d'Epidémiologie Moléculaire, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France.
authors.forename: A
authors.initials: A
authors.lastname: Muller
authors.forename: J M
authors.initials: JM
authors.lastname: Lopez-Lozano
authors.forename: X
authors.initials: X
authors.lastname: Bertrand
authors.forename: D
authors.initials: D
authors.lastname: Talon
mesh_terms: D002439:Cefotaxime / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use*; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D004363:Drug Utilization; D016972:Enterobacter cloacae / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006785:Hospitals, University; D006801:Humans; D008826:Microbial Sensitivity Tests; D013030:Spain / Q000453:epidemiology
chemical_list: D002511:Cephalosporins; D002443:Ceftriaxone; D002439:Cefotaxime