Lautenbach Ebbing, Fishman Neil O, Bilker Warren B, Castiglioni Analia, Metlay Joshua P, Edelstein Paul H, Strom Brian L
Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
Arch Intern Med. 2002 Nov 25;162(21):2469-77. doi: 10.1001/archinte.162.21.2469.
The incidence of fluoroquinolone (FQ) resistance has increased markedly in recent years. Even in the common nosocomial pathogens Escherichia coli and Klebsiella pneumoniae, in which the emergence of FQ resistance was believed to be unlikely, increasing resistance to these agents has been noted. Risk factors for FQ resistance in these pathogens remain unknown. Although FQs are important components of the present antimicrobial arsenal, their continued usefulness is threatened by rising FQ resistance.
To identify risk factors for nosocomial FQ resistance.
A case-control study of hospitalized patients with infections due to FQ-resistant and FQ-susceptible E coli and K pneumoniae occurring between January 1, 1998, and June 30, 1999.
We included 123 patients with nosocomial FQ-resistant infections and 70 randomly selected patients with nosocomial FQ-susceptible infections. Independent risk factors (adjusted odds ratio [95% confidence interval]) for FQ resistance were (1) recent FQ use (5.25 [1.81-15.26]); (2) residence in a long-term care facility (3.65 [1.64-8.15]); (3) recent aminoglycoside use (8.86 [1.71-45.99]); and (4) older age (1.03 [1.01-1.06]).
Recent FQ use, residence in a long-term care facility, recent aminoglycoside use, and older age were all noted to be independent risk factors for FQ resistance among patients with nosocomial E coli and K pneumoniae infections. Efforts should be directed at recognition and modification of these risk factors to curb the rise in FQ resistance and preserve the utility of these agents in the treatment of common nosocomial gram-negative infections.
近年来，氟喹诺酮（FQ）耐药率显著上升。即使在常见的医院病原体大肠杆菌和肺炎克雷伯菌中，原本认为不太可能出现FQ耐药，但对这些药物的耐药性仍在增加。这些病原体中FQ耐药的危险因素尚不清楚。尽管FQ是目前抗菌药物库的重要组成部分，但不断上升的FQ耐药性威胁着它们的持续有效性。
确定医院获得性FQ耐药的危险因素。
对1998年1月1日至1999年6月30日期间因FQ耐药和FQ敏感的大肠杆菌及肺炎克雷伯菌感染而住院的患者进行病例对照研究。
我们纳入了123例医院获得性FQ耐药感染患者和70例随机选择的医院获得性FQ敏感感染患者。FQ耐药的独立危险因素（调整后的优势比[95%置信区间]）为：（1）近期使用FQ（5.25[1.81 - 15.26]）；（2）居住在长期护理机构（3.65[1.64 - 8.15]）；（3）近期使用氨基糖苷类药物（8.86[1.71 - 45.99]）；（4）年龄较大（1.03[1.01 - 1.06]）。
近期使用FQ、居住在长期护理机构、近期使用氨基糖苷类药物和年龄较大均被认为是医院获得性大肠杆菌和肺炎克雷伯菌感染患者中FQ耐药的独立危险因素。应努力识别和改变这些危险因素，以遏制FQ耐药性的上升，并保持这些药物在治疗常见医院获得性革兰氏阴性感染中的效用。
