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Gastrointestinal Tract Colonization With Fluoroquinolone-Resistant Escherichia coli in Hospitalized Patients: Changes Over Time in Risk Factors for Resistance

Published online by Cambridge University Press:  02 January 2015

Ebbing Lautenbach ,
Joshua P. Metlay ,
Mark G. Weiner ,
Warren B. Bilker ,
Pam Tolomeo ,
Xiangqun Mao ,
Irving Nachamkin  and
Neil O. Fishman
Ebbing Lautenbach*
Affiliation:
Divisions of Infectious Diseases, Philadelphia, Pennsylvania Department of Medicine, the Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, Philadelphia, Pennsylvania
Joshua P. Metlay
Affiliation:
General Internal Medicine, Philadelphia, Pennsylvania Department of Medicine, the Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, Philadelphia, Pennsylvania University of Pennsylvania School of Medicine, and the Department of Veterans Affairs, Philadelphia, Pennsylvania
Mark G. Weiner
Affiliation:
General Internal Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Department of Medicine, the Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, Philadelphia, Pennsylvania
Pam Tolomeo
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pennsylvania
Xiangqun Mao
Affiliation:
Department of Pathology and Laboratory Medicine, Philadelphia, Pennsylvania
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, Philadelphia, Pennsylvania
Neil O. Fishman
Affiliation:
Divisions of Infectious Diseases, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, Philadelphia, Pennsylvania
*
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021 (ebbing@mail.med.upenn.edu)
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Abstract

Objective.

The prevalence of fluoroquinolone (FQ) resistance in Escherichia coli has increased markedly in recent years. Despite the important role of gastrointestinal tract colonization with FQ-resistant E. coli (FQREC), the prevalence of and risk factors for FQREC colonization among the general hospitalized patient population have not been described, to our knowledge. The objective of this study was to identify the prevalence of and risk factors for FQREC colonization among hospitalized patients.

Design.

Three-year case-control study. Case patients (ie, all subjects with FQREC colonization) were compared with control patients (ie, all subjects without FQREC colonization).

Setting.

Two large medical centers within an academic health system.

Participants.

All patients hospitalized at the 2 study hospitals.

Main Outcome Measure.

Three annual fecal surveillance surveys were conducted. All patients colonized with FQREC (levofloxacin minimum inhibitory concentration, ≥ 8 μg/mL) were identified.

Results.

Of the 774 subjects, 89 (11.5%) were colonized with FQREC. Although there was a significant association between prior FQ use and FQREC colonization on bivariable analysis (odds ratio [OR], 2.02 [95% confidence interval {CI}, 1.14–3.46]; P = .01), there was statistically significant effect modification by year of study (P = .005). In multivariable analyses, after controlling for the hospital and for the duration of hospitalization prior to sampling, the association between FQ use and FQREC colonization was as follows: adjusted OR (aOR), 0.97 (95% CI, 0.29–3.23) in 2002; aOR, 1.41 (95% CI, 0.57–3.50) in 2003; and aOR, 9.87 (95% CI, 3.67–26.55) in 2004.

Conclusions.

The association between prior FQ use and FQREC colonization varied significantly by study year, suggesting that the clinical epidemiology of resistant organisms may change over time. Furthermore, in the context of recent work showing significant changes in FQREC prevalence as well as changes in FQ resistance mechanisms (specifically, efflux overexpression) over the same time period, these results suggest a previously unrecognized complexity in the relationship between the clinical and molecular epidemiology of FQ resistance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 1 , January 2009 , pp. 18 - 24
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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