Antimicrobial resistance among Gram-negative bacilli causing infections in intensive care unit patients in the United States between 1993 and 2004.
During the 12-year period from 1993 to 2004, antimicrobial susceptibility profiles of 74,394 gram-negative bacillus isolates recovered from intensive care unit (ICU) patients in United States hospitals were determined by participating hospitals and collected in a central location. MICs for 12 different agents were determined using a standardized broth microdilution method. The 11 organisms most frequently isolated were Pseudomonas aeruginosa (22.2%), Escherichia coli (18.8%), Klebsiella pneumoniae (14.2%), Enterobacter cloacae (9.1%), Acinetobacter spp. (6.2%), Serratia marcescens (5.5%), Enterobacter aerogenes (4.4%), Stenotrophomonas maltophilia (4.3%), Proteus mirabilis (4.0%), Klebsiella oxytoca (2.7%), and Citrobacter freundii (2.0%). Specimen sources included the lower respiratory tract (52.1%), urine (17.3%), and blood (14.2%). Rates of resistance to many of the antibiotics tested remained stable during the 12-year study period. Carbapenems were the most active drugs tested against most of the bacterial species. E. coli and P. mirabilis remained susceptible to most of the drugs tested. Mean rates of resistance to 9 of the 12 drugs tested increased with Acinetobacter spp. Rates of resistance to ciprofloxacin increased over the study period for most species. Ceftazidime was the only agent to which a number of species (Acinetobacter spp., C. freundii, E. aerogenes, K. pneumoniae, P. aeruginosa, and S. marcescens) became more susceptible. The prevalence of multidrug resistance, defined as resistance to at least one extended-spectrum cephalosporin, one aminoglycoside, and ciprofloxacin, increased substantially among ICU isolates of Acinetobacter spp., P. aeruginosa, K. pneumoniae, and E. cloacae.
Lockhart
Shawn R
SR
Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242-1009, USA. shawn-lockhart@uiowa.edu
Abramson
Murray A
MA
Beekmann
Susan E
SE
Gallagher
Gale
G
Riedel
Stefan
S
Diekema
Daniel J
DJ
Quinn
John P
JP
Doern
Gary V
GV
D003428:Cross Infection / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D024841:Fluoroquinolones / Q000494:pharmacology; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology*; D006801:Humans; D007362:Intensive Care Units; D008826:Microbial Sensitivity Tests; D013997:Time Factors; D014481:United States
D024841:Fluoroquinolones
Antimicrob Agents Chemother. 2003 May;47(5):1672-80
12709339
Crit Care Med. 2003 Apr;31(4):1035-41
12682469
Am J Infect Control. 2003 Dec;31(8):481-98
14647111
Am J Med. 1991 Sep 16;91(3B):185S-191S
1928163
Arch Intern Med. 1992 Mar;152(3):554-7
1546918
Clin Infect Dis. 1996 Oct;23(4):779-84
8909844
Antimicrob Agents Chemother. 1998 Jul;42(7):1762-70
9661018
Chest. 1999 Feb;115(2):462-74
10027448
Clin Infect Dis. 1999 Sep;29(3):595-607
10530454
Infect Control Hosp Epidemiol. 2004 Oct;25(10):842-6
15518026
Eur J Clin Microbiol Infect Dis. 2005 Feb;24(2):111-8
15714332
Clin Infect Dis. 2005 Jun 15;40(12):1792-8
15909268
Clin Infect Dis. 2005 Sep 15;41(6):848-54
16107985
Surg Infect (Larchmt). 2002 Fall;3(3):259-67
12542927
Clin Infect Dis. 2006 Jan 15;42 Suppl 2:S82-9
16355321
Diagn Microbiol Infect Dis. 2005 Dec;53(4):265-71
16360550
Antimicrob Agents Chemother. 2006 Feb;50(2):498-504
16436702
Clin Infect Dis. 2006 Sep 1;43 Suppl 2:S43-8
16894514
Diagn Microbiol Infect Dis. 2007 Feb;57(2):207-15
16949243
Chest. 2000 Jul;118(1):146-55
10893372
J Antimicrob Chemother. 2000 Aug;46(2):223-8
10933644
Clin Infect Dis. 2000 Sep;31(3):690-7
11017817
Microb Drug Resist. 2000 Winter;6(4):297-303
11272258
Clin Infect Dis. 2001 May 15;32 Suppl 2:S146-55
11320454
Clin Infect Dis. 2001 Oct 15;33(8):1288-94
11565067
Pharmacotherapy. 2002 Jan;22(1):81-7
11794434
Emerg Infect Dis. 2002 May;8(5):473-8
11996681
Emerg Infect Dis. 2002 Jul;8(7):697-701
12095437
JAMA. 2003 Feb 19;289(7):885-8
12588273
Infect Control Hosp Epidemiol. 2003 Aug;24(8):607-12
12940583