title: First-generation fluoroquinolone use and subsequent emergence of multiple drug-resistant bacteria in the intensive care unit.
abstract: OBJECTIVE
  The objective of this study was to determine the relationship between fluoroquinolone (FQ) use and subsequent emergence of multiple drug-resistant bacteria (MRB) in the intensive care unit (ICU).
  
  
  METHODS
  The authors conducted a prospective observational cohort study and a case control study.
  
  
  METHODS
  The study was conducted in a 30-bed ICU.
  
  
  METHODS
  All immunocompetent patients hospitalized for >48 hrs who did not receive antibiotics before ICU admission were eligible during a 15-month period. Routine MRB screening was performed at ICU admission and weekly thereafter. This screening included tracheal aspirate and nasal, anal, and axilla swabs. Univariate and multivariate analyses were used to determine risk factors for MRB emergence in the ICU. In addition, a case control study was performed to determine whether FQ use is associated with subsequent emergence of MRB.
  
  
  RESULTS
  Two hundred thirty-nine patients were included; 108 ICU-acquired MRB were isolated in 77 patients. FQ use and longer duration of antibiotic treatment were identified as independent risk factors for MRB occurrence (odds ratio [95% confidence interval [CI] = 3.3 [1.7-6.5], 1.1 [1.0-1.2]; p < .001; respectively). One hundred thirty-five (56%) patients received FQ; matching was successful for 72 (53%) of them. Number of MRB (40 vs. 15 per 1,000 ICU days; p = .019) and percentage of patients with MRB (40% vs. 22%; OR [95% CI] = 1.5 [1.0-2.4]; p = .028) were significantly higher in cases than in controls. Although methicillin-resistant Staphylococcus aureus (26% vs. 12%; OR [95% CI] = 1.6 [.6-2.9]; p = .028) and extending-spectrum beta-lactamase-producing Gram-negative bacilli (11% vs. 1%; OR [95% CI] = 4.7 [0.7-30.2]; p = .017) rates were higher in cases than in controls, ceftazidime or imipenem-resistant Pseudomonas aeruginosa (15% vs. 8%), Acinetobacter baumannii (1% vs. 5%), and Stenotrophomonas maltophilia (2% vs. 1%) rates were similar (p > .05) in case and control patients.
  
  
  CONCLUSIONS
  FQ use and longer duration of antibiotic treatment are independently associated with MRB emergence. Reducing antimicrobial treatment duration and restricting FQ use could be suggested to control MRB spread in the ICU.
authors.affiliation: Intensive Care Unit, Calmette Hospital, Regional University Centre, Lille, France.
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir
authors.forename: Christophe
authors.initials: C
authors.lastname: Di Pompeo
authors.forename: Stéphane
authors.initials: S
authors.lastname: Soubrier
authors.forename: Pierre
authors.initials: P
authors.lastname: Delour
authors.forename: Hélène
authors.initials: H
authors.lastname: Lenci
authors.forename: Micheline
authors.initials: M
authors.lastname: Roussel-Delvallez
authors.forename: Thierry
authors.initials: T
authors.lastname: Onimus
authors.forename: Fabienne
authors.initials: F
authors.lastname: Saulnier
authors.forename: Daniel
authors.initials: D
authors.lastname: Mathieu
authors.forename: Alain
authors.initials: A
authors.lastname: Durocher
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015331:Cohort Studies; D003428:Cross Infection / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012121:Respiration, Artificial; D012307:Risk Factors; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones