Risk Factors for Fluoroquinolone Resistance in Nosocomial Urinary Tract Infections caused by Gram-Negative Bacilli 3.5.10

Risk Factors for Fluoroquinolone Resistance in Nosocomial Urinary Tract Infections Caused by Gram-Negative Bacilli Pinyo Rattanaumpawan, MD; Pam Tolomeo, MPH; Warren B. Bilker, PhD; Ebbing Lautenbach, MD, MPH, MSCE; University of Pennsylvania School of Medicine Pinyo Rattanaumpawan, MD 108 Blockley Hall, 423 Guardian Drive Philadelphia, PA 19104-6021 USA (267)-746-9084; pinyo@mail.med.upenn.edu ,[object Object],[object Object],[object Object],[object Object],[object Object],BACKGROUND & OBJECTIVE Background: The prevalence of urinary tract infections (UTIs) caused by fluoroquinolone-resistant gram-negative bacilli (FQR-GNB) has increased in recent years. Although many studies have explored risk factors for FQ-resistance, the majority have focused only on UTIs caused by E. coli and/or failed to distinguish colonization and infection. Objectives: To identify risk factors FQ-resistance among nosocomial UTIs caused by GNB. Methods: We conducted a case-control study of hospitalized patients with nosocomial GNB UTIs at 2 medical centers within the University of Pennsylvania Health System. Of subjects in whom GNB were isolated on urine culture, only those who met CDC criteria for nosocomial UTI were eligible for the study. Of these eligible subjects, all patients with urinary pathogens demonstrating a levofloxacin-MIC of ≥ 8 ug/mL were selected as cases. Among all subjects with FQ-susceptible gram-negative bacilli (FQS-GNB), controls were frequency matched to cases by month of isolation and species of infecting organism. . Results: A total of 251 cases with FQR-GNB and 263 controls with FQS-GNB UTIs were included from January 1, 2003 – March 31, 2005. Among 251 cases, major causative pathogens were E. coli (51.0%),, P. aeruginosa (21.5%) , Klebsiella spp. (9.2%). Independent risk factors for FQ-resistance identified via multiple logistic regression analyses are noted in the table 2. Conclusion: Not only FQ use, but also cotrimoxazole and metronidazole use should be optimized in an effort to reduce the emergence of FQ resistance among GNB uropathogens. Residence in a long term care facility and prior hospitalization were also risk factors, suggesting FQ resistance may be spreading across healthcare facilities. ABSTRACT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],RESULTS ,[object Object],[object Object],ACKNOWLEDGEMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],METHODS ,[object Object],[object Object],CONCLUSIONS Table 2. Risk factors for FQ-resistance (Multivariable analysis) Risk factors Unadjusted OR [95% CI] Adjusted OR [95% CI] P-value Month of isolation * * 0.966 Species of infecting organism * * 0.738 LOS prior to UTI (days) 1.03 (1.01-1.04) 1.01 [0.99-1.02] 0.258 Male sex 1.86 (1.26-2.74) 2.03 [1.21-3.39 ] 0.007 African American 1.31 (0.91-1.91) 1.80 [1.10-2.94] 0.03 Having chronic respiratory diseases 3.32 (1.74-6.63) 22.58 [1.18-5.62] 0.01 Residence of a LTCF 4.09 (1.98-9.07) 4.41 [1.79-10.88 ] 0.002 Previous hospitalization within 2 wks 2.28 (1.55-3.38) 2.19 [1.31-3.64 ] 0.003 Medicine services 2.34 (1.62-3.40) 2.72 [1.63-4.54 ] <0.001 Recent antibiotic exposure Fluoroquinolones 26.98 (11.50-76.72) 15.73 [6.15-40.26] <0.001 Cotrimoxazole 3.23 (1.69-6.45) 2.49 [1.07-5.79] 0.008 Metronidazole 3.18 (2.02-5.06) 2.89 [1.48-5.65] 0.001 Cefazolin 0.31 (0.19-0.50) 0.53 [0.29-0.97] 0.03 ,[object Object],Table 1. Baseline characteristic and Recent antibiotic exposure of cases and controls Variables Cases (n=251) ( %) Controls (n=263) (%) P-value Median age (range), years 69 (21-95) 68 (23-91) 0.225 Median LOS prior UTI (range), days 8 (2-120) 5 (2-68) <0.001 Male sex 101 (40.2) 70 (26.6) 0.001 African American 106 (42.2) 94 (35.7) 0.131 Residence of a long term care facility (LTCF) 38 (15.1) 11 (4.2) <0.001 Previous hospitalization within 2 wks 110 (43.8) 67 (25.5) <0.001 Medicine services 141 (56.2) 93 (35.4) <0.001 Underlying diseases 194 (56.9) 147 (43.1) <0.001 ,[object Object],11 (4.4) 5 (1.9) 0.105 ,[object Object],88 (35.1) 59 (22.4) 0.002 ,[object Object],75 (29.9) 58 (22.1) 0.043 ,[object Object],42 (16.7) 15 (5.7) <0.001 ,[object Object],18 (7.2) 6 (2.3) 0.009 ,[object Object],23 (9.2) 18 (6.8) 0.332 ,[object Object],40 (15.9) 44 (16.7) 0.808 ,[object Object],11 (4.4) 3 (1.1) 0.024 ,[object Object],36 (14.3) 13 (4.9) <0.001 ,[object Object],9 (3.6) 3 (1.1) 0.067* ,[object Object],172 (68.5) 150 (57.0) 0.007 ,[object Object],9 (4.8) 2 (0.8) 0.031* Recent antibiotic exposure 188 (74.9) 142 (54.0) <0.001 ,[object Object],32 (12.7) 15 (5.7) 0.006 ,[object Object],6 (2.4) 3 (1.1) 0.280* ,[object Object],35 (13.9) 24 (9.1) 0.087 ,[object Object],60 (23.9) 95 (36.1) 0.003 ,[object Object],30 (12.0) 80 (30.4) <0.001 ,[object Object],32 (12.7) 23 (8.7) 0.142 ,[object Object],97 (38.6) 6 (2.3) <0.001 ,[object Object],11 (4.4) 2 (0.8) 0.009* ,[object Object],14 (5.6) 14 (5.3) 0.898 ,[object Object],[object Object],17 (6.8) 8 (3.0) 0.049 ,[object Object],41 (16.3) 15 (5.7) <0.001 ,[object Object],86 (34.3) 37 (14.1) <0.001 ,[object Object],79 (31.5) 37 (14.1) <0.001 Categorical variables were compared by using Chi-square test or fisher’s exact test* when appropriate. Continuous variables were compared by using Wilcoxon Rank Sum test.

Risk Factors for Fluoroquinolone Resistance in Nosocomial Urinary Tract Infections caused by Gram-Negative Bacilli 3.5.10

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Risk Factors for Fluoroquinolone Resistance in Nosocomial Urinary Tract Infections caused by Gram-Negative Bacilli 3.5.10