title: Risk factors for coexistence of fluoroquinolone resistance and ESBL production among Enterobacteriaceae in a Greek university hospital.
abstract: The purpose of this study was to identify risk factors for fluoroquinolone resistance (QR) among ESBL- producing Enterobacteriaceae causing nosocomial infections. The study was conducted in Laikon General Hospital in Athens, Greece, during the period January 2004 - January 2005. Epidemiological and clinical data were collected from the medical charts of the patients diagnosed with nosocomial infections due to an ESBL-producing Enterobacteriaceae. QR was 60% among the 84 ESBL-producing Enterobacteriaceae isolates. Infection from QR-ESBL bacteria was associated with increased hospital stay (p=0.028); QRESBL bacteria were isolated later during hospitalization than fluoroquinolone susceptible (QS)-ESBL (p=0.089); factors associated with QR were immune-deficiency (p=0.047), previous use of carbapenems (p=0.08) and fluoroquinolones (p=0.067), and admission to the Transplantation Unit (p=0.047). In addition, QR-ESBL bacteria were more likely to be resistant to co-trimoxazole (p<0.001), gentamicin (p=0.054) and tobramycin (p=0.004). Logistic regression analysis indicated that admission to the transplantation unit was an independent risk factor for infection due to a QR-ESBL isolate. Results of this study question ciprofloxacin's usefulness as a valid alternative to carbapenems in our hospital for the treatment of infections due to ESBL-producing bacteria. In addition strategies for addressing the QR-ESBL situation should focus on limiting fluoroquinolone and carbapenem consumption and emphasize on barrier precautions in patients with longer hospitalization, immunosuppression, or admission to the transplantation unit.
authors.affiliation: Department of Microbiology, Laikon General Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Katsandri
authors.forename: A
authors.initials: A
authors.lastname: Avlamis
authors.forename: A
authors.initials: A
authors.lastname: Vasilakopoulou
authors.forename: V
authors.initials: V
authors.lastname: Mela
authors.forename: C
authors.initials: C
authors.lastname: Kosmidis
authors.forename: J
authors.initials: J
authors.lastname: Papaparaskevas
authors.forename: G L
authors.initials: GL
authors.lastname: Petrikkos
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000201:enzymology / Q000302:isolation & purification*; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology*; D006115:Greece / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D001618:beta-Lactamases