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Clinical Epidemiology of Ciprofloxacin Resistance and Its Relationship to Broad-Spectrum Cephalosporin Resistance in Bloodstream Infections Caused by Enterobacter Species

Published online by Cambridge University Press:  21 June 2016

Cheol-In Kang
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Sung-Han Kim
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Wan Beom Park
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Ki-Deok Lee
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Hong-Bin Kim
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Eui-Chong Kim
Affiliation:
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
Myoung-don Oh
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
Kang-Won Choe
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Corresponding
E-mail address:

Abstract

Objectives:

To evaluate the clinical features of ciprofloxacin-resistant Enterobacter bacteremia and to examine the risk factors for ciprofloxacin resistance in Enterobacter species isolates causing bacteremia.

Design:

A case-control study.

Setting:

A 1,500-bed, tertiary-care university hospital and referral center.

Patients:

All patients older than 16 years with Enterobacter species isolated from blood were enrolled. The medical records of 183 patients with clinically significant Enterobacter bacteremia from January 1998 to December 2002 were identified. We compared patients with bacteremia caused by ciprofloxacin-susceptible isolates with patients with bacteremia caused by ciprofloxacin-resistant isolates.

Results:

Twenty-three (12.6%) of the patients had bacteremia caused by isolates resistant to ciprofloxacin. There were no significant differences in age, gender, underlying diseases, primary site of infection, or Acute Physiology and Chronic Health Evaluation II score between the ciprofloxacin-resistant and the ciprofloxacin-susceptible groups. Broad-spectrum cephalosporin resistance, defined as resistance to cefotaxime or ceftazidime in vitro, was detected in 21 (91.3%) of 23 ciprofloxacin-resistant isolates compared with 65 (40.6%) of 160 ciprofloxacin-susceptible isolates (P < .001). Multivariate analysis revealed that independent risk factors for ciprofloxacin resistance were the prior receipt of fluoroquinolones (P < .001) and broad-spectrum cephalosporin resistance (P < .001).

Conclusions:

In Enterobacter species isolates causing bacteremia, ciprofloxacin resistance was closely associated with the prior receipt of fluoroquinolones and broad-spectrum cephalosporin resistance. The close relationship between ciprofloxacin resistance and broad-spectrum cephalosporin resistance is particularly troublesome because it severely restricts the therapeutic options for Enterobacter species infection.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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