title: Risk factors associated with resistance to ciprofloxacin in clinical bacterial isolates from intensive care unit patients.
abstract: OBJECTIVE
  To determine risk factors and outcomes associated with ciprofloxacin resistance in clinical bacterial isolates from intensive care unit (ICU) patients.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Twenty-bed medical-surgical ICU in a Canadian tertiary care teaching hospital.
  
  
  METHODS
  All patients admitted to the ICU with a stay of at least 72 hours between January 1 and December 31, 2003.
  
  
  METHODS
  Prospective surveillance to determine patient comorbidities, use of medical devices, nosocomial infections, use of antimicrobials, and outcomes. Characteristics of patients with a ciprofloxacin-resistant gram-negative bacterial organism were compared with characteristics of patients without these pathogens.
  
  
  RESULTS
  Ciprofloxacin-resistant organisms were recovered from 20 (6%) of 338 ICU patients, representing 38 (21%) of 178 nonduplicate isolates of gram-negative bacilli. Forty-nine percent of Pseudomonas aeruginosa isolates and 29% of Escherichia coli isolates were resistant to ciprofloxacin. In a multivariate analysis, independent risk factors associated with the recovery of a ciprofloxacin-resistant organism included duration of prior treatment with ciprofloxacin (relative risk [RR], 1.15 per day [95% confidence interval {CI}, 1.08-1.23]; P<.001), duration of prior treatment with levofloxacin (RR, 1.39 per day [95% CI, 1.01-1.91]; P=.04), and length of hospital stay prior to ICU admission (RR, 1.02 per day [95% CI, 1.01-1.03]; P=.005). Neither ICU mortality (15% of patients with a ciprofloxacin-resistant isolate vs 23% of patients with a ciprofloxacin-susceptible isolate; P=.58) nor in-hospital mortality (30% vs 34%; P=.81) were statistically significantly associated with ciprofloxacin resistance.
  
  
  CONCLUSIONS
  ICU patients are at risk of developing infections due to ciprofloxacin-resistant organisms. Variables associated with ciprofloxacin resistance include prior use of fluoroquinolones and duration of hospitalization prior to ICU admission. Recognition of these risk factors may influence antibiotic treatment decisions.
authors.affiliation: Department of Critical Care, Sunnybrook Health Sciences Centre, B121-2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Levin
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fowler
authors.forename: Cameron
authors.initials: C
authors.lastname: Guest
authors.forename: William J
authors.initials: WJ
authors.lastname: Sibbald
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Simor
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000494:pharmacology*; D002170:Canada; D002939:Ciprofloxacin / Q000494:pharmacology*; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D012307:Risk Factors
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin