title: Correlation between levofloxacin consumption and the incidence of nosocomial infections due to fluoroquinolone-resistant Escherichia coli.
abstract: OBJECTIVE
  The relationship between fluoroquinolone resistance in Escherichia coli isolates causing nosocomial infection and hospital antibiotic consumption were investigated. Restriction of levofloxacin use was implemented to control the incidence of fluoroquinolone-resistant E coli in the hospital.
  
  
  METHODS
  The study was conducted from January 2004 to December 2010. Antimicrobial agent consumption was obtained from the pharmacy computer system and presented as the defined daily doses per 1000 patient-days every 6 months. The incidence of fluoroquinolone-resistant E coli isolates causing nosocomial infections was obtained from the Department of Infection Control every 6 months. An antimicrobial stewardship program, restricting levofloxacain use, was implemented in July 2007.
  
  
  RESULTS
  The incidence of fluoroquinolone-resistant E coli causing nosocomial infections was significantly correlated with fluoroquinolone usage (p = 0.005), but not with the use of third- or fourth-generation cephalosporins, piperacillin-tazobactam, or carbapenems. Parenteral (p = 0.002), oral (p = 0.018), and total levofloxacin (p = 0.001) use were significantly correlated with the extent of fluoroquinolone resistance. With a reduction of levofloxacin use, a decrease of the incidence of fluoroquinolone resistance in E coli isolates was observed.
  
  
  CONCLUSIONS
  There is a significant correlation between levofloxacin use and the incidence of nosocomial fluoroquinolone-resistant E coli isolates. The incidence of fluoroquinolone-resistant E coli could be reduced by limiting levofloxacin consumption.
authors.affiliation: Division of Infection Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Hui-Hsiu
authors.initials: HH
authors.lastname: Wu
authors.affiliation: Division of Infection Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Infection Control, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Hsin-Yi
authors.initials: HY
authors.lastname: Liu
authors.affiliation: Division of Infection Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Infection Control, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.affiliation: Division of Infection Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Infection Control, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: yuarn438@yahoo.com.tw.
authors.forename: Yuarn-Jang
authors.initials: YJ
authors.lastname: Lee
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use*; D008826:Microbial Sensitivity Tests; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D000077725:Piperacillin, Tazobactam Drug Combination; D064704:Levofloxacin; D010397:Penicillanic Acid; D010878:Piperacillin