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Impact of Antibiotic Use during Hospitalization on the Development of Gastrointestinal Colonization with Escherichia coli with Reduced Fluoroquinolone Susceptibility

Published online by Cambridge University Press:  02 January 2015

Jennifer H. Han ,
Warren B. Bilker ,
Irving Nachamkin ,
Pam Tolomeo ,
Xiangqun Mao ,
Neil O. Fishman  and
Ebbing Lautenbach
Jennifer H. Han*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Pam Tolomeo
Affiliation:
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
Xiangqun Mao
Affiliation:
Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Neil O. Fishman
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Ebbing Lautenbach
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
*
Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3rd Floor, Silverstein Building, Suite E, Philadelphia, PA 19104 ([email protected])
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Abstract

Objective.

Infections due to fluoroquinolone-resistant Escherichia coli (FQREC) are associated with significant morbidity and mortality. Fluoroquinolone resistance likely arises at the level of gastrointestinal colonization. The objective of this study was to identify risk factors for the development of FQREC gastrointestinal tract colonization in hospitalized patients, including the impact of antibiotics prescribed during hospitalization.

Design.

A prospective cohort study was conducted from 2002 to 2004 within a university health system.

Methods.

Hospitalized patients initially colonized with fluoroquinolone-susceptible E. coli were followed up with serial fecal sampling for new FQREC colonization or until hospital discharge or death. A Cox proportional hazards regression model was developed to identify risk factors for new FQREC colonization, with antibiotic exposure modeled as time-varying covariates.

Results.

Of 395 subjects, 73 (18.5%) became newly colonized with FQREC. Length of stay before sampling (hazard ratio [HR], 1.02 [95% confidence interval (CI), 1.1–1.03]; P = .003) and malignancy (HR, 0.37 [95% CI, 0.21–0.67]; P = .001) were significantly associated with the development of FQREC colonization. In addition, receipt of a first-generation cephalosporin (HR, 1.19 [95% CI, 1.10–1.29]; P<.001) or cefepime (HR, 1.05 [95% CI, 1.00–1.10]; P = .048) during hospitalization increased the risk of new FQREC colonization.

Conclusions.

The acquisition of FQREC in the hospital setting is complex, and antimicrobial stewardship programs should take into account patterns of antibiotic use in implementing strategies to reduce the development of new FQREC colonization. Future studies are needed to identify risk factors for infection in hospitalized patients newly colonized with FQREC.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 10 , October 2013 , pp. 1070 - 1076
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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