title: Optimization of empirical antibiotic selection for suspected Gram-negative bacteraemia in the emergency department.
abstract: A 1-year prospective study of patients with a positive blood culture and admitted through the emergency department (ED), was conducted to detect incidence and risk factors for resistance of Enterobacteriaceae to gentamicin and ciprofloxacin. A total of 245 emergency department-admitted patients had positive blood cultures, of which 131 (54%) grew Enterobacteriaceae. Of these 131 isolates, 32 (24%) were resistant to gentamicin and 37 (28%) to ciprofloxacin. Risk factors, by multivariate analysis, for gentamicin and ciprofloxacin resistance were: male gender (P<0.05 and P<0.01, respectively), nursing home residence (P<0.001), diabetes mellitus (P<0.05) and presence of a foreign body (P<0.05 and P<0.005). An additional risk factor for ciprofloxacin resistance was recent hospitalisation (P<0.05). These data facilitate optimal selection of empirical antibiotic treatment of suspected Gram-negative infections, and may contribute to improved patient outcome and optimal use of antibiotics.
authors.affiliation: Infectious Diseases Unit, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Affiliated with the Ben-Gurion Faculty of Medicine, Be'er-Sheva, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Benenson
authors.forename: Amos M
authors.initials: AM
authors.lastname: Yinnon
authors.forename: Yechiel
authors.initials: Y
authors.lastname: Schlesinger
authors.forename: Bernard
authors.initials: B
authors.lastname: Rudensky
authors.forename: David
authors.initials: D
authors.lastname: Raveh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D002648:Child; D002939:Ciprofloxacin / Q000627:therapeutic use; D048909:Diabetes Complications; D024881:Drug Resistance, Bacterial; D004636:Emergency Service, Hospital; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002939:Ciprofloxacin