Previous ciprofloxacin exposure is associated with resistance to β-lactam antibiotics in subsequent Pseudomonas aeruginosa bacteremic isolates
Previous ciprofloxacin exposure is associated with resistance to β-lactam antibiotics in subsequent Pseudomonas aeruginosa bacteremic isolates
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DOI：
10.1016/j.ajic.2009.02.003
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发表时间：
2009-11-01
影响因子：
4.9
通讯作者：
Mensa, Josep
中科院分区：
文献类型：
--
作者：
Lopez-Dupla, Miguel;Martinez, Jose-Antonio;Mensa, Josep
背景资料：铜绿假单胞菌对头孢他啶、亚胺培南、美罗培南、哌拉西林和氟喹诺酮类药物的交叉耐药已在实验研究中显示，但有关其在临床环境中影响的信息很少且不一致。本研究的目的是评估是否以前暴露于环丙沙星的影响，这些抗生素的敏感性在随后的铜绿假单胞菌菌血症striple.Methods：铜绿假单胞菌菌血症患者记录从血培养监测计划（1997-2007年）。人口学特征，基础疾病，感染的设置，感染源，以前的抗生素暴露，抗生素敏感性进行了分析。有327名男性（57.2%），平均年龄为61.2 ± 18岁。62.4%的病例菌血症发生在医院。铜绿假单胞菌对头孢他啶、亚胺培南、美罗培南、哌拉西林-他唑巴坦和环丙沙星的耐药率分别为15.5%、16.7%、11.2%、12.3%和23.1%。前30天内暴露于环丙沙星是头孢他啶耐药的独立预测因子（比值比[OR]，3; 95%置信区间[CI]：1.7-5.3; P < .001），亚胺培南（OR，2; 95% CI：1.1-3.7; P = .02），美罗培南（OR，2.7; 95% CI：1.4-5.3; P = .004），哌拉西林-他唑巴坦（OR，2.4; 95% CI：1.3-4.7; P = .007），环丙沙星（OR，2.9; 95%CI：1.7-4.9; P < .001），多药耐药（OR，2.5; 95% CI：1.2-5.2; P = .02）。在发生菌血症前30天内暴露于环丙沙星的患者中，铜绿假单胞菌菌血症分离株对环丙沙星耐药的风险增加。头孢他啶、亚胺培南、美罗培南、哌拉西林-他唑巴坦或环丙沙星，并具有多药耐药性。
Background: Pseudomonas aeruginosa cross-resistance to ceftazidime, imipenem, meropenem, piperacillin, and fluoroquinoles has been shown in experimental studies, but information regarding its impact in the clinical setting is scarce and inconsistent. The aim of this study was to assess whether previous exposure to ciprofloxacin influences on the sensitivity of those antibiotics in subsequent P aeruginosa bacteremic isolates.Methods: Patients with P aeruginosa bacteremia were recorded from a blood culture surveillance program (1997-2007). Demographic characteristics, underlying diseases, setting of the infection, source of infection, previous antibiotic exposure, and antibiotic sensitivity were analyzed.Results: We studied 572 cases of P aeruginosa bacteremia. There were 327 men (57.2%), and the mean age was 61.2 +/- 18 years. The bacteremia was nosocomial in 62.4% of episodes. Resistance rates of P aeruginosa isolates were 15.5% for ceftazidime, 16.7% for imipenem, 11.2% for meropenem, 12.3% for piperacillin-tazobactam, and 23.1% for ciprofloxacin. Exposure to ciprofloxacin during the previous 30 days was an independent predictor of resistance to ceftazidime (odds ratio [OR], 3; 95% confidence interval [CI]: 1.7-5.3; P < .001), imipenem (OR, 2; 95% CI: 1.1-3.7; P = .02), meropenem (OR, 2.7; 95% CI: 1.4-5.3; P = .004), piperacillin-tazobactam (OR, 2.4; 95% CI: 1.3-4.7; P = .007), ciprofloxacin (OR, 2.9; 95% CI: 1.7-4.9; P < .001), and multidrug resistance (OR, 2.5; 95% CI: 1.2-5.2; P = .02).Conclusion: P aeruginosa bacteremic isolates from patients who have been exposed to ciprofloxacin during the 30 days prior to the development of bacteremia have an increased risk of being resistant to ceftazidime, imipenem, meropenem, piperacillin-tazobactam, or ciprofloxacin and to have multidrug resistance.