title: Risk factors for fluoroquinolone resistance in Gram-negative bacilli causing healthcare-acquired urinary tract infections.
abstract: The prevalence of urinary tract infections caused by fluoroquinolone-resistant Gram-negative bacilli (FQ-resistant GNB-UTIs) has been increasing. Previous studies that explored risk factors for FQ resistance have focused only on UTIs caused by Escherichia coli and/or failed to distinguish colonisation from infection. We conducted a case-control study at two medical centres within the University of Pennsylvania Health System to identify risk factors for FQ resistance among healthcare-acquired GNB-UTIs. Subjects with positive urine cultures for GNB and who met Centers for Disease Control and Prevention criteria for healthcare-acquired UTI were eligible. Cases were subjects with FQ-resistant GNB-UTI and controls were subjects with FQ-susceptible GNB-UTI matched to cases by month of isolation and species of infecting organism. In total, 251 cases and 263 controls were included from 1 January 2003 to 31 March 2005. Independent risk factors (adjusted odds ratio; 95% confidence interval) for FQ resistance included male sex (2.03; 1.21-3.39; P=0.007), African-American race (1.80; 1.10-2.94; P=0.020), chronic respiratory disease (2.58; 1.18-5.62; P=0.017), residence in a long term care facility (4.41; 1.79-10.88; P=0.001), hospitalisation within the past two weeks (2.19; 1.31-3.64; P=0.003), hospitalisation under a medical service (2.72; 1.63-4.54; P<0.001), recent FQ exposure (15.73; 6.15-40.26; P<0.001), recent cotrimoxazole exposure (2.49; 1.07-5.79; P=0.033), and recent metronidazole exposure (2.89; 1.48-5.65; P=0.002).
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
authors.forename: P
authors.initials: P
authors.lastname: Rattanaumpawan
authors.forename: P
authors.initials: P
authors.lastname: Tolomeo
authors.forename: W B
authors.initials: WB
authors.lastname: Bilker
authors.forename: N O
authors.initials: NO
authors.lastname: Fishman
authors.forename: E
authors.initials: E
authors.lastname: Lautenbach
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D003428:Cross Infection / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology*; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D015995:Prevalence; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones