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Previous ciprofloxacin exposure is associated with resistance to β-lactam antibiotics in subsequent Pseudomonas aeruginosa bacteremic isolates

https://doi.org/10.1016/j.ajic.2009.02.003Get rights and content

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.

Section snippets

Design and setting

This was a case-control study. Patients were collected through a blood culture surveillance program between 1997 and 2007. The main characteristics of our database and cohorts studied have been reported elsewhere.22, 23, 24, 25 Patients aged over 14 years with P aeruginosa bacteremia were included. Patients with more than 1 episode of P aeruginosa bacteremia were included only once, and the episode included was the first one. The study was conducted at the Hospital Clínic Universitari in

Characteristics of the patients studied

The study group was made of 572 patients with P aeruginosa bacteremia. The main demographic and clinical characteristics are shown in Table 1. An underlying condition was present in 84%, and half of patients had ultimately or rapidly fatal diseases. Previous antibiotic therapy is showed in Table 1. Ciprofloxacin was the only fluoroquinolone given previously. P aeruginosa isolates showed resistance to ceftazidime in 87 of 563 tested (15.5%), imipenem in 94 of 562 (16.7%), meropenem in 63 of 563

Discussion

This study shows that exposure to ciprofloxacin within the previous 30 days is associated with an increased risk of resistance to ceftazidime, imipenem, meropenem, piperacillin-tazobactam, or ciprofloxacin or were multidrug resistant in isolates of subsequent P aeruginosa bacteremia. We also confirm a predisposition to a greater resistance to imipenem18, 21, 30 and ciprofloxacin31, 32 if these antibiotics have been used previously. However, previous therapy with ceftazidime, meropenem, or

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    Supported in part by a grant from the Fundación Máximo Soriano Jiménez.

    Conflicts of interest: None to report.

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    Copyright © 2009 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.