Susceptibility to fluoroquinolones among commonly isolated Gram-negative bacilli in 2000: TRUST and TSN data for the United States

Karlowsky, James A.; Kelly, Laurie J.; Thornsberry, Clyde; Jones, Mark; Evangelista, Alan T.; Critchley, Ian A.; Sahm, Daniel F.

doi:10.1016/s0924-8579(01)00466-6

Cited by 80 publications

(62 citation statements)

References 27 publications

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“…Although large differences were seen between susceptibility to fluoroquinolones, both inpatient status and age appeared to be confounding factors in the effect of sex on fluoroquinolone resistance. The absence of a sex effect contradicts the findings of others (16,17,19), but few of these studies adjusted both for inpatient status and age and other studies have demonstrated no association with sex (12,20).…”

Section: Discussioncontrasting

confidence: 60%

Analysis of 1560 Inpatient and Outpatient Escherichia coli Isolates from across Canada—Results from the CANWARD 2007 Study

Lagacé-Wiens

DeCorby

Baudry

et al. 2009

Canadian Journal of Infectious Diseases and Medical Microbiolog

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OBJeCtIveS: Escherichia coli was the most common pathogen isolated in the Canadian Ward Surveillance Study (CANWARD 2007) and remains one of the most common pathogens isolated in all health care settings. An in-depth analysis of all E coli isolates was performed to determine the distribution and demographics associated with resistance to antimicrobials, presence of extended-spectrum beta-lactamases (ESBLs) and multidrug resistance (MDR; concurrent resistance to agents from three or more different antimicrobial classes). MethODS:The CANWARD 2007 study characterized pathogens isolated from inpatient (surgical and medical wards, and intensive care units) and outpatient (emergency departments and clinics) areas of 12 Canadian hospitals between January and December 2007. E coli susceptibility to 12 antimicrobials was determined, ESBL production was determined, and a multivariate nominal logistic regression model was designed to determine if sex, isolation from a sterile site, inpatient versus outpatient status, and age were significantly associated with susceptibility to the tested antimicrobials, MDR or ESBL production. ReSuLtS: In total, 1702 E coli isolates, representing 21.6% of all isolates collected in the CANWARD 2007 study, were investigated. Of these, 1560 isolates fell within the primary objective of the study and were included in the present analysis. Susceptibilities were greater than 90% for meropenem (100%), ertapenem (100%), tigecycline (99.9%), piperacillin-tazobactam (97.9%), cefepime (97.9%), ceftriaxone (95.4%), nitrofurantoin (95.2%), cefoxitin (94.8%), amoxicillinclavulanate (92.9%) and gentamicin (91.4%). Cefazolin (89.4%), the fluoroquinolones (ciprofloxacin, 79.4%; levofloxacin, 79.9%) and trimethoprim-sulfamethoxazole (75.7%) were less active agents. In the multivariate model, invasive isolates were significantly associated with lower susceptibility rates for trimethoprim-sulfamethoxazole. Increasing age was associated with lower susceptibility to fluoroquinolones, ceftriaxone, cefepime, gentamicin and nitrofurantoin, as well as ESBL production. Sex was not associated with resistance to any antimicrobial or to ESBL production. Inpatient status was associated with higher resistance rates to amoxicillin-clavulanate, cefazolin, fluoroquinolones and trimethoprim-sulfamethoxazole. Isolation of an ESBL producer was only found to be independently associated with age, being more common in older patients. MDR was not found to be associated with any variable measured when ESBL producers were excluded from analysis. CONCLuSIONS: E coli antimicrobial susceptibility varies according to patient factors. Age and inpatient status were the most important determinants in the present analysis and should be considered when prescribing empirical antimicrobial therapy. Fluoroquinolones and sulfonamides should be used cautiously and in consideration of local resistance patterns for infections caused by E coli, due to lower susceptibility rates. Independent factors associated with antimicrobial resistance were age...

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Section: Discussioncontrasting

confidence: 60%

Analysis of 1560 Inpatient and Outpatient Escherichia coli Isolates from across Canada—Results from the CANWARD 2007 Study

Lagacé-Wiens

DeCorby

Baudry

et al. 2009

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…Presented in Table 1 are rates of P. aeruginosa resistance to several antipseudomonal drugs (54,95,99,100,178,211,212). This summary is not meant to be inclusive of all of the published literature, but rather highlights data reported for isolates from several U.S. surveillance studies since January 2000.…”

Section: Antibacterial Resistance Trendsmentioning

confidence: 99%

Antibacterial-ResistantPseudomonas aeruginosa: Clinical Impact and Complex Regulation of Chromosomally Encoded Resistance Mechanisms

2009

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SUMMARY Treatment of infectious diseases becomes more challenging with each passing year. This is especially true for infections caused by the opportunistic pathogen Pseudomonas aeruginosa, with its ability to rapidly develop resistance to multiple classes of antibiotics. Although the import of resistance mechanisms on mobile genetic elements is always a concern, the most difficult challenge we face with P. aeruginosa is its ability to rapidly develop resistance during the course of treating an infection. The chromosomally encoded AmpC cephalosporinase, the outer membrane porin OprD, and the multidrug efflux pumps are particularly relevant to this therapeutic challenge. The discussion presented in this review highlights the clinical significance of these chromosomally encoded resistance mechanisms, as well as the complex mechanisms/pathways by which P. aeruginosa regulates their expression. Although a great deal of knowledge has been gained toward understanding the regulation of AmpC, OprD, and efflux pumps in P. aeruginosa, it is clear that we have much to learn about how this resourceful pathogen coregulates different resistance mechanisms to overcome the antibacterial challenges it faces.

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“…Although several surveillance studies have reported on the relative in vitro activities of various antimicrobial agents (4,6,7,13,16), an extensive comparative statistical analysis of resistance to antimicrobial agents relative to factors associated with resistance has not been performed. Such analysis is important to more completely elucidate the status of antimicrobial resistance among P. aeruginosa isolates and to attempt to understand and predict the direction and chronology of future resistance trends.…”

mentioning

confidence: 99%

Factors Associated with Relative Rates of Antibiotic Resistance in Pseudomonas aeruginosa Isolates Tested in Clinical Laboratories in the United States from 1999 to 2002

Flamm

Weaver

Thornsberry

et al. 2004

Antimicrob Agents Chemother

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111

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For the period from 1999 to 2002 in the United States, the in vitro susceptibilities of 52,637 Pseudomonas aeruginosa isolates to 10 antimicrobial agents were evaluated. The isolates were from 29 laboratories, 11 of which participated in The Surveillance Network for four consecutive years. Isolates were collected from adult patients (>18 years of age) in intensive care units (ICU), non-ICU inpatients, nursing home patients, and outpatients; data were analyzed to evaluate factors, such as year of isolation, patient age group, isolate specimen source, and patient type (hospitalized patients [ICU, non-ICU, or nursing home] or outpatients). Rates of resistance for the 4-year period were highest for isolates from patients in ICU and 18-to 39-year-old patients and for isolates from the lower respiratory tract. Resistance decreased with age. Resistance was lowest in isolates from outpatients, in isolates from >70-year-old patients, and from specimens from the upper respiratory tract. Multidrug resistance (MDR) (resistance to three or more antimicrobial agents) accounted for 24.9% of all isolates. The MDR rate was highest in isolates from patients in nursing homes (29.9%) and ICU (29.5%).Infection with Pseudomonas aeruginosa is a serious problem affecting hospitalized patients, particularly those who are critically ill and immunocompromised, such as patients with cystic fibrosis, neutropenia, iatrogenic immunosuppression, or disrupted anatomical barriers (3,8). P. aeruginosa only occasionally causes serious infections in otherwise healthy persons and is infrequently identified as normal microbial flora in healthy individuals (8). Rates of colonization with P. aeruginosa increase in hospitalized patients, particularly in those who have been hospitalized for extended periods of time and/or have received broad-spectrum antimicrobial therapy or cancer chemotherapy. These increasing resistance rates have greatly limited the number of therapeutic choices (9, 10, 11).P. aeruginosa is a common human saprophyte that is able to adapt to a multitude of physical and nutritional environments and survive in large numbers in close proximity to its host. For these reasons, it is found in a broad range of infections. Infections caused by P. aeruginosa range from superficial skin infections to more serious infections, such as meningitis, endocarditis, and osteomyelitis, to fulminant sepsis (15). Antimicrobial resistance among clinical isolates of P. aeruginosa may complicate the treatment of infections and can adversely affect clinical outcomes and patient treatment costs (1, 5). New antimicrobial agents with activity against P. aeruginosa will not be available in the near future, making ongoing surveillance of the activities of currently available agents of critical importance.Although several surveillance studies have reported on the relative in vitro activities of various antimicrobial agents (4, 6, 7, 13, 16), an extensive comparative statistical analysis of resistance to antimicrobial agents relative to factors associated with resis...

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Susceptibility to fluoroquinolones among commonly isolated Gram-negative bacilli in 2000: TRUST and TSN data for the United States

Cited by 80 publications

References 27 publications

Analysis of 1560 Inpatient and Outpatient Escherichia coli Isolates from across Canada—Results from the CANWARD 2007 Study

Analysis of 1560 Inpatient and Outpatient Escherichia coli Isolates from across Canada—Results from the CANWARD 2007 Study

Antibacterial-ResistantPseudomonas aeruginosa: Clinical Impact and Complex Regulation of Chromosomally Encoded Resistance Mechanisms

Factors Associated with Relative Rates of Antibiotic Resistance in Pseudomonas aeruginosa Isolates Tested in Clinical Laboratories in the United States from 1999 to 2002

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