title: Increasing Rates of Fluoroquinolone Resistance inEscherichia coliIsolated From the Blood and Urine of Patients with Hematologic Malignancies and Stem Cell Transplant Recipients.
abstract: Fluoroquinolone (FQ) antibiotics have been shown to reduce mortality and the number of febrile episodes when used as prophylaxis during neutropenia. Prior studies suggest that prophylaxis may result in increasing rates of FQ resistance. Fluoroquinolone non-susceptibility trends inEscherichia coliisolated from blood and urine cultures were evaluated over a 16-year period during which prophylaxis was initiated in patients with hematologic malignancies and stem cell transplants. Non-susceptibility rates increased after the introduction of prophylaxis, with yearly non-susceptibility rates rising from 30%-33% to 40%-88% in blood isolates. The high rates of non-susceptibility now observed raise concerns about the continued efficacy of FQ prophylaxis. This concern exists particularly in those patients undergoing stem cell transplants where the total FQ non-susceptibility rates over the study period were 82.3%. Further evaluation of the effect of FQ prophylaxis on antibiotic resistance and its efficacy in the setting of increased rates of resistance is warranted.
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Hauck
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC.
authors.forename: Pearlie P
authors.initials: PP
authors.lastname: Chong
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Miller
authors.affiliation: Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Jamieson
authors.affiliation: Biostatistics Department, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Fine
authors.affiliation: Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Foster
authors.affiliation: Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Shea
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC.
authors.forename: David
authors.initials: D
authors.lastname: van Duin
keywords: Escherichia coli; Fluoroquinolone resistance; hematologic malignancy; stem cell transplant