The Close Relationship between Ciprofloxacin Resistance and Extended-Spectrum beta-Lactamase Production:Analysis of 154 Consecutive Nosocomially-Acquired Klebsiella pneumoniae Bacteremia.
- Author:
Miyoung KIM
1
;
Eun Ju CHOO
;
Yee Gyung KWAK
;
Moon Hee SONG
;
Seong Su NAH
;
Taejun SONG
;
Sung Hye KIM
;
Jae Bum JUN
;
Sang Ho CHOI
;
Jin Yong JEONG
;
Nam Joong KIM
;
Yang Soo KIM
;
Jun Hee WOO
;
Jiso RYU
Author Information
1. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea. yskim@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Beta lactamase;
Bacteremia;
Ciprofloxacin;
Klebsiella pneumoniae
- MeSH:
Anti-Bacterial Agents;
Bacteremia*;
beta-Lactamases*;
Ciprofloxacin*;
Epidemiology;
Hematologic Neoplasms;
Humans;
Klebsiella pneumoniae*;
Klebsiella*;
Male;
Metronidazole;
Odds Ratio;
Pneumonia;
Risk Factors
- From:
Infection and Chemotherapy
2004;36(5):265-270
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Strains of ciprofloxacin-resistant Klebsiella pneumoniae have emerged worldwide. We investigated the epidemiology of ciprofloxacin resistance and its relationship to ESBL production in nosocomial K. pneumoniae bacteremia. MATERIALS AND METHODS: Using the computerized database of clinical microbiology, we identified all patients whose blood culture had yielded K. pneumoniae between January 2001 and December 2002 at a 2200-bed university-affiliated tertiary-care hospital. During the study period, total of 392 episodes of K. pneumoniae bacteremia were documented of which 163 episodes were acquired nosocomially. 9 cases of recurrent episodes were excluded. RESULTS: The resistance rates to ciprofloxacin was 28.6% (44/154). ESBL-production was significantly more common in ciprofloxacin-resistant isolates than in ciprofloxacin-susceptible isolates (95.9% [42/44] vs. 24.5% [27/110], P<0.001). In univariate analysis, following factors were significantly associated with resistance to ciprofloxacin: older age, male sex, ICU admission at the time of bacteremia, prior use of antibiotics within 1 month before bacteremia, solid tumor, hematological malignancy, or biliary disease as underlying disease, and ESBL-production. The prior use of 3rd- generation cephalosprins, metronidazole, fluroquinolone, or carbapenem were also risk factors. Independent risk factors for ciprofloxacin resistance were older age (adjusted odds ratio [AOR]; 1.04, 95% confidence interval [CI]; 1.01-1.06) and ESBL production (AOR; 81.35, 95% CI; 17.76-372.53). CONCLUSION: The close relationship between ciprofloxacin resistance and ESBL production was documented in nosocomial K. pneumoniae bacteremia. Further epidemiological and molecular studies to determine factors and mechanisms involved in the relationship are needed.
