In:
Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 18, No. 12 ( 1997-12), p. 809-813
Abstract:
To determine the relation between prior exposure to specific antimicrobials and acquisition of gram-negative bacilli resistant to multiple ß-lactam and aminoglycoside antibiotics among long-term-care patients. Design: Case-control study. Cases were patients from whom multiply resistant Enterobacteriaceae or Pseudomonas aeruginosa were isolated; controls were patients from whom nonresistant bacteria of the same species were isolated. Prospectively defined risk factors included underlying illness, activity level, presence of decu-bitus ulcers, presence of indwelling devices, and prior exposure to specific antimicrobial agents. Resistant and control isolates of P aeruginosa were compared using pulsed-field gel electrophoresis (PFGE) of genomic DNA after digestion with XbaI . Setting: 390-bed long-term Veterans' Affairs facility. Results: We identified 35 patients with multiply resistant Enterobacteriaceae and 24 patients with multiply resistant P aeruginosa . Of the resistant Enterobacteriaceae , 87% of isolates were resistant to piperacillin, 55% to ceftazidime, and 90% to gentamicin. Acquisition of multiply resistant Enterobacteriaceae was associated with presence of decubitus ulcers (odds ratio [OR], 12.2; 95% confidence interval [CI 95 ], 3.3-44.2; P =.0002) and prior receipt of ampicillm (OR, 13.7; CI 95 , 2.2-84; P =.005). Of resistant isolates of P aeruginosa , 88% were resistant to piperacillin, 25% to ceftazidime, 42% to imipenem, and 67% to ciprofloxacin. Isolation of a multiply resistant P aeruginosa was associated with total days of antimicrobial exposure (OR, 1.07; CI 95 , 1.01-1.12; P =.011) and not with prior receipt of any individual agent. Eleven multiply resistant isolates shared a common PFGE pattern. Conclusions: In our long-term-care facility, acquisition of multiply resistant Enterobacteriaceae was associated with the presence of decubitus ulcers and prior exposure to ampicillin. Acquisition of resistant P aeruginosa was associated with total antibiotic exposure. Molecular typing of P aeruginosa isolates implicated patient-to-patient transmission of a limited number of resistant strains.
Type of Medium:
Online Resource
ISSN:
0899-823X
,
1559-6834
DOI:
10.1017/S0195941700086513
Language:
English
Publisher:
Cambridge University Press (CUP)
Publication Date:
1997
detail.hit.zdb_id:
2106319-9
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