title: The clinical impact of fluoroquinolone resistance in patients with E coli bacteremia.
abstract: BACKGROUND
  There are limited data on fluoroquinolone resistance and its impact on mortality in cases of Escherichia coli bloodstream infection (BSI).
  
  
  OBJECTIVE
  To determine risk factors for in-hospital mortality among patients with E coli BSIs.
  
  
  METHODS
  A retrospective case-control study.
  
  
  METHODS
  A 1250-bed tertiary academic medical center.
  
  
  METHODS
  Patients with fluoroquinolone-resistant E coli BSI from January 1, 2000 through December 31, 2005 with 1:1 matched control patients with fluoroquinolone-sensitive E coli BSI. INDEPENDENT OUTCOME: In-hospital mortality.
  
  
  RESULTS
  A total of 93 cases and 93 control patients were included. Compared with control patients, cases were more likely to be admitted from a long-term care facility (35% vs. 9%; P < .001) and to have a hospital-acquired bacteremia (54% vs. 33%; P = .008). Crude mortality was 26% for cases and 8% for controls (P = .002). On univariate analysis, predictors for in-hospital mortality included female gender, admission from a long-term care facility, APACHE II score >10, Charlson comorbidity score >4, cardiac dysfunction, cirrhosis, renal dysfunction, treatment with corticosteroids, and a fluoroquinolone-resistant E coli bacteremia. On multivariate analysis, independent risk factors for in-hospital mortality were cirrhosis (adjusted odds ratio [aOR], 7.2; confidence interval [CI], 1.7-29.8; P = .007), cardiac dysfunction (aOR, 3.9; CI, 1.6-9.4; P = .003), and infection with a fluoroquinolone-resistant E coli isolate (aOR, 3.9; CI, 1.5-10.2; P = .005).
  
  
  CONCLUSIONS
  After controlling for severity of illness and multiple comorbidities only fluoroquinolone resistance, cirrhosis, and cardiac dysfunction independently predicted mortality in patients with E coli bacteremia.
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri 63110-1093, USA. bcamins@dom.wustl.edu
authors.forename: Bernard C
authors.initials: BC
authors.lastname: Camins
authors.forename: Jonas
authors.initials: J
authors.lastname: Marschall
authors.forename: Shannon R
authors.initials: SR
authors.lastname: DeVader
authors.forename: Dawn E
authors.initials: DE
authors.lastname: Maker
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Hoffman
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
mesh_terms: D000046:Academic Medical Centers; D016022:Case-Control Studies; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology* / Q000627:therapeutic use*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008923:Missouri / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D024841:Fluoroquinolones