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Risk factors for ciprofloxacin resistance in bloodstream infections due to extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae



Risk factors for ciprofloxacin resistance in bloodstream infections due to extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 43: 365



Background: The bloodstream infections due to extended spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK) are increasingly being recognized. Although ciprofloxacin is effective against ESBL-EK, the ciprofloxacin resistance rate has also increased markedly in recent years. The current study was conducted to identify risk factors for ciprofloxacin resistance in bloodstream infections due to ESBL-EK. Methods: ESBL production was evaluated in stored K. pneumoniae and E. coli blood isolates from Jan. 1998 to Dec. 2002 by NCCLS guidelines and/or double-disk synergy test. 133 patients with ESBL-EK bacteremia were analyzed retrospectively. Antimicrobial susceptibility was evaluated by disk diffusion test. Results: Of 133 patients with ESBL-EK bacteremia, 80 (60.2%) were resistant to ciprofloxacin. There was no significant difference in age, sex, and APACHE II score between ciprofloxacin resistant group (CIP-R) and susceptible group (CIP-S). The most common primary site of infection in CIP-R was pancreaticobiliary tract infection (46/80, 57.5%) and that in CIP-S was unknown primary site (23/53=43.4%). Independent risk factors for ciprofloxacin resistance were prior use of ciprofloxacin (OR, 5.53; 95% CI, 1.56-25.42, P=0.032), indwelling urinary catheter (OR, 3.68; 95% CI, 1.27-10.67, P=0.017), and invasive procedure within 72 hours before bacteremia (OR, 4.03; 95% CI, 1.44-11.25, P=0.008). The 30-day mortality rate of CIP-R was similar to CIP-S (26.3% vs. 24.5%, respectively, P=0.824). Conclusions: Risk factors for ciprofloxacin resistance in bloodstream infections due to ESBL-EK were prior use of ciprofloxacin, indwelling urinary catheter, and invasive procedure within 72 hours before bacteremia.

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