title: Previous ciprofloxacin exposure is associated with resistance to beta-lactam antibiotics in subsequent Pseudomonas aeruginosa bacteremic isolates.
abstract: BACKGROUND
  Pseudomonas aeruginosa cross-resistance to ceftazidime, imipenem, meropenem, piperacillin, and fluoroquinoles has been shown in experimental studies, but information regarding its impact in the clinical setting is scarce and inconsistent. The aim of this study was to assess whether previous exposure to ciprofloxacin influences on the sensitivity of those antibiotics in subsequent P aeruginosa bacteremic isolates.
  
  
  METHODS
  Patients with P aeruginosa bacteremia were recorded from a blood culture surveillance program (1997-2007). Demographic characteristics, underlying diseases, setting of the infection, source of infection, previous antibiotic exposure, and antibiotic sensitivity were analyzed.
  
  
  RESULTS
  We studied 572 cases of P aeruginosa bacteremia. There were 327 men (57.2%), and the mean age was 61.2 +/- 18 years. The bacteremia was nosocomial in 62.4% of episodes. Resistance rates of P aeruginosa isolates were 15.5% for ceftazidime, 16.7% for imipenem, 11.2% for meropenem, 12.3% for piperacillin-tazobactam, and 23.1% for ciprofloxacin. Exposure to ciprofloxacin during the previous 30 days was an independent predictor of resistance to ceftazidime (odds ratio [OR], 3; 95% confidence interval [CI]: 1.7-5.3; P < .001), imipenem (OR, 2; 95% CI: 1.1-3.7; P = .02), meropenem (OR, 2.7; 95% CI: 1.4-5.3; P = .004), piperacillin-tazobactam (OR, 2.4; 95% CI: 1.3-4.7; P = .007), ciprofloxacin (OR, 2.9; 95% CI: 1.7-4.9; P < .001), and multidrug resistance (OR, 2.5; 95% CI: 1.2-5.2; P = .02).
  
  
  CONCLUSIONS
  P aeruginosa bacteremic isolates from patients who have been exposed to ciprofloxacin during the 30 days prior to the development of bacteremia have an increased risk of being resistant to ceftazidime, imipenem, meropenem, piperacillin-tazobactam, or ciprofloxacin and to have multidrug resistance.
authors.affiliation: Hospital Universitari de Tarragona Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain. jmld@comt.es
authors.forename: Miguel
authors.initials: M
authors.lastname: López-Dupla
authors.forename: José-Antonio
authors.initials: JA
authors.lastname: Martínez
authors.forename: Francesc
authors.initials: F
authors.lastname: Vidal
authors.forename: Manuel
authors.initials: M
authors.lastname: Almela
authors.forename: Alex
authors.initials: A
authors.lastname: Soriano
authors.forename: Francesco
authors.initials: F
authors.lastname: Marco
authors.forename: Josefina
authors.initials: J
authors.lastname: López
authors.forename: Montserrat
authors.initials: M
authors.lastname: Olona
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D016470:Bacteremia / Q000382:microbiology*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D055815:Young Adult; D018440:beta-Lactam Resistance; D047090:beta-Lactams / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D002939:Ciprofloxacin