title: Risk factors for efflux pump overexpression in fluoroquinolone-resistant Escherichia coli.
abstract: BACKGROUND
  We conducted a case-control study to identify risk factors for efflux overexpression, an important mechanism of fluoroquinolone resistance, among patients with fluoroquinolone-resistant Escherichia coli (FQREC) gastrointestinal tract colonization.
  
  
  METHODS
  Three annual fecal surveillance surveys were performed hospital-wide, and all patients colonized with FQREC (levofloxacin minimum inhibitory concentration, ≥8 μg/mL) were included in the study. Cases and controls were defined on the basis of overexpression of the AcrAB efflux pump, as measured by the organic solvent tolerance (OST) assay. A multivariable logistic regression model was developed to identify risk factors for OST positivity among patients with FQREC colonization.
  
  
  RESULTS
  Eighty-nine patients were colonized with FQREC: 44 (49.4%) and 45 (50.6%) patients had isolates that were OST-positive and OST-negative, respectively. On multivariable analyses, location on the surgical service was significantly associated with recovery of an OST-positive isolate (odds ratio, 7.36; 95% confidence interval, 1.82-29.7; P = .005). Furthermore, patients who had received a first-generation cephalosporin in the 30 days prior to sampling were less likely to have an OST-positive isolate (odds ratio, 0.20; 95% confidence interval, .04-.94; P = .04).
  
  
  CONCLUSIONS
  Among phenotypically identical FQREC isolates, different factors may drive the emergence of different resistance mechanisms. Further studies are needed to elucidate the relationship between antimicrobial use and specific resistance mechanisms.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. jennifer.han@uphs.upenn.edu
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Han
authors.forename: Irving
authors.initials: I
authors.lastname: Nachamkin
authors.forename: Pam
authors.initials: P
authors.lastname: Tolomeo
authors.forename: Xiangqun
authors.initials: X
authors.lastname: Mao
authors.forename: Warren B
authors.initials: WB
authors.lastname: Bilker
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000235:genetics / Q000378:metabolism; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D024841:Fluoroquinolones / Q000494:pharmacology*; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000382:microbiology; D015964:Gene Expression Regulation, Bacterial; D006801:Humans; D026901:Membrane Transport Proteins / Q000235:genetics / Q000378:metabolism*; D010414:Pennsylvania / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D026901:Membrane Transport Proteins