Fluoroquinolone-resistant Pseudomonas aeruginosa:: Assessment of risk factors and clinical impact

被引:77
作者
Gasink, Leanne B.
Fishman, Neil O.
Weiner, Mark G.
Nachamkin, Irving
Bilker, Warren B.
Lautenbach, Ebbing
机构
[1] Univ Penn, Sch Med, Div Infect Dis, Philadelphia, PA 19104 USA
[2] Univ Penn, Sch Med, Div Gen Internal Med, Dept Med, Philadelphia, PA 19104 USA
[3] Univ Penn, Sch Med, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA
[4] Univ Penn, Sch Med, Dept Pathol & Lab Med, Philadelphia, PA 19104 USA
[5] Univ Penn, Sch Med, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA
[6] Univ Penn, Sch Med, Ctr Educ & Res Therapeut, Philadelphia, PA 19104 USA
基金
美国国家卫生研究院; 美国医疗保健研究与质量局;
关键词
fluoroquinolones; Pseudomonas aeruginosa; resistance;
D O I
10.1016/j.amjmed.2005.11.029
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
PURPOSE: Pseudomonas aeruginosa infections have been associated with considerable morbidity and mortality. Fluoroquinolones (FQ) are the only oral therapy available for P. aeruginosa infections, but resistance is increasingly prevalent. METHODS: We examined annual trends in FQ-resistant P. aeruginosa (FQRPA) from 1991 to 2000. Subsequently, inpatients with a clinical culture positive for P. aeruginosa between January 1, 1999 and December 31, 2000 were included in a case control study to identify risk factors for FQ resistance and a cohort study to examine the impact of FQ resistance on outcomes in P. aeruginosa. RESULTS: Annual prevalence of FQRPA increased from 15% in 1991 to 41% in 2000 (P < 0.001 trend). Between 1999 and 2000, 332 P. aeruginosa isolates were FQ resistant and 540 were FQ susceptible. Prior FQ use was the only independent risk factor for FQRPA (adjusted OR = 3.43; 95% confidence interval [CI] 2.37, 4.96). Subjects with FQRPA had greater median hospital charges ($62,325 vs $48,734) ( P =.007) and higher mortality (47.5% vs 35.5%) (P =.004). However, in a multivariate model, only imipenem resistance of the isolate was significantly associated with mortality. FQ resistance was not an independent risk factor. CONCLUSIONS: FQRPA has increased significantly and is associated with prior FQ use. Limiting FQ use may curb the emergence of resistance among P. aeruginosa. FQRPA is associated with increased hospital charges, but other resistance patterns may have a more significant impact on mortality. (c) 2006 Elsevier Inc. All rights reserved.
引用
收藏
页码:526.e19 / 526.e25
页数:7
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