title: Prevalence and natural history of colonization with fluoroquinolone-resistant gram-negative bacilli in community-dwelling people with spinal cord dysfunction.
abstract: OBJECTIVE
  To estimate the prevalence of colonization with fluoroquinolone-resistant gram-negative bacilli (GNB) and to assess risk factors for and define the natural history of colonization.
  
  
  METHODS
  Cross-sectional study with follow-up of up to 1 year.
  
  
  METHODS
  Multiple outpatient sites.
  
  
  METHODS
  Eighty-four community-dwelling adults with spinal cord dysfunction.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Colonization of perineum with fluoroquinolone-resistant GNB.
  
  
  RESULTS
  Overall, 24% of this community-dwelling cohort was colonized with fluoroquinolone-resistant GNB with resistance to both levofloxacin and gatifloxacin. The use of any antibiotic in the last 90 days was most strongly associated with an increased risk of colonization with fluoroquinolone-resistant GNB (relative risk, 2.3; 95% confidence interval, 1.1-4.8; P=.05). Incontinence was significantly more common among those with fluoroquinolone-resistant GNB colonization. Among the participants with incontinence (n=42), the use of intermittent catheterization (vs suprapubic, urethral, or condom catheters or overflow incontinence) was significantly protective. Colonization was not associated with an increase in urinary tract infection and was often transient.
  
  
  CONCLUSIONS
  Fluoroquinolone resistance among GNB colonizing community-dwelling people with spinal cord dysfunction is common. Colonization is more common among those receiving antibiotics and less common among those continent of urine. Among those with incontinence, those using intermittent catheterization have less colonization.
authors.affiliation: VA Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD, USA. mroghman@epi.umaryland.edu
authors.forename: Mary-Claire
authors.initials: MC
authors.lastname: Roghmann
authors.forename: Mitchell T
authors.initials: MT
authors.lastname: Wallin
authors.forename: Peter H
authors.initials: PH
authors.lastname: Gorman
authors.forename: Judith A
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002353:Carrier State / Q000382:microbiology; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology*; D000077734:Gatifloxacin; D006088:Gram-Negative Aerobic Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000494:pharmacology*; D010502:Perineum / Q000382:microbiology; D015995:Prevalence; D011446:Prospective Studies; D013118:Spinal Cord Diseases / Q000382:microbiology*; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000453:epidemiology / Q000382:microbiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D064704:Levofloxacin; D015242:Ofloxacin; D000077734:Gatifloxacin