TY - JOUR
T1 - High admission prevalence of fluoroquinolone resistance in third-generation cephalosporin-resistant Enterobacteriaceae in German university hospitals
AU - On behalf of the DZIF-ATHOS Study Group
AU - Rohde, Anna M.
AU - Wiese-Posselt, Miriam
AU - Zweigner, Janine
AU - Schwab, Frank
AU - Mischnik, Alexander
AU - Seifert, Harald
AU - Gastmeier, Petra
AU - Kern, Winfried V.
AU - Armean, Sabina
AU - Behnke, Michael
AU - Busch, Dirk
AU - Feihl, Susanne
AU - Först, Gesche
AU - Foschi, Federico
AU - Gillis, Meyke
AU - Hamprecht, Axel
AU - Hansen, Dorothea
AU - Häcker, Georg
AU - Heim, Markus
AU - Hug, Martin
AU - Kaier, Klaus
AU - Knobloch, Johannes
AU - Kola, Axel
AU - Küpper, M. Fabian
AU - Langebartels, Georg
AU - Liekweg, Andrea
AU - Lipp, Hans Peter
AU - Nordmann, Mathias
AU - Obermann, Birgit
AU - Peña-Diaz, Luis Alberto
AU - Peter, Silke
AU - Querbach, Christiane
AU - Rupp, Jan
AU - Schneider, Christian
AU - Schröder, Christin
AU - Schröder, Wiebke
AU - Spohn, Katrin
AU - Steib-Bauert, Michaela
AU - Tacconelli, Evelina
AU - Vehreschild, Jörg J.
AU - vor dem Esche, Ulrich
AU - Willmann, Mathias
N1 - Funding Information:
This work was supported by the German Center for Infection Research (grant number TTU 08.801). Microbiology data (species identification and in vitro susceptibility testing) were generated as part of routine diagnostics.
Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Objectives: Fluoroquinolone resistance (FQR) in third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE) presents serious limitations to antibiotic therapy. The aim of this study was to investigate whether the FQR proportion among 3GCRE differs between community-acquired (CA) and hospital-acquired (HA) isolates. Methods: In a prospective observational study covering 2014 and 2015, we monitored the occurrence of 3GCRE in adult hospitalized patients in six German university hospitals. 3GCRE clinical isolates were subdivided into CA and HA. Multivariable analysis identified factors associated with in vitro non-susceptibility to ciprofloxacin. Results: The dataset included 5721 3GCRE isolates of which 52.9% were HA and 52.7% exhibited FQR. Interestingly, the FQR proportion was higher in CA 3GCRE than in HA 3GCRE (overall, 60.1% versus 46.2%, respectively, P < 0.001). Multivariable analysis adjusting for age confirmed community acquisition as a risk factor for FQR [adjusted rate ratio (aRR) 1.33, 95% CI 1.17-1.53]. Escherichia coli and Klebsiella spp. were associated with a much higher FQR proportion than other Enterobacteriaceae species (aRR 8.14, 95% CI 6.86-9.65 and aRR 7.62 with 95%CI 6.74-8.61, respectively). Conclusions: The high FQR proportion observed among CA 3GCRE, particularly in E. coli and Klebsiella spp., indicates that selection pressure in the outpatient setting needs to be addressed with antibiotic stewardship and other interventions in order to limit further spread of MDR.
AB - Objectives: Fluoroquinolone resistance (FQR) in third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE) presents serious limitations to antibiotic therapy. The aim of this study was to investigate whether the FQR proportion among 3GCRE differs between community-acquired (CA) and hospital-acquired (HA) isolates. Methods: In a prospective observational study covering 2014 and 2015, we monitored the occurrence of 3GCRE in adult hospitalized patients in six German university hospitals. 3GCRE clinical isolates were subdivided into CA and HA. Multivariable analysis identified factors associated with in vitro non-susceptibility to ciprofloxacin. Results: The dataset included 5721 3GCRE isolates of which 52.9% were HA and 52.7% exhibited FQR. Interestingly, the FQR proportion was higher in CA 3GCRE than in HA 3GCRE (overall, 60.1% versus 46.2%, respectively, P < 0.001). Multivariable analysis adjusting for age confirmed community acquisition as a risk factor for FQR [adjusted rate ratio (aRR) 1.33, 95% CI 1.17-1.53]. Escherichia coli and Klebsiella spp. were associated with a much higher FQR proportion than other Enterobacteriaceae species (aRR 8.14, 95% CI 6.86-9.65 and aRR 7.62 with 95%CI 6.74-8.61, respectively). Conclusions: The high FQR proportion observed among CA 3GCRE, particularly in E. coli and Klebsiella spp., indicates that selection pressure in the outpatient setting needs to be addressed with antibiotic stewardship and other interventions in order to limit further spread of MDR.
UR - http://www.scopus.com/inward/record.url?scp=85048102126&partnerID=8YFLogxK
U2 - 10.1093/jac/dky040
DO - 10.1093/jac/dky040
M3 - Journal articles
C2 - 29490046
AN - SCOPUS:85048102126
SN - 0305-7453
VL - 73
SP - 1688
EP - 1691
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
IS - 6
ER -
