Incidence and Risk Factors for Nosocomial Infections Caused by Fluoroquinolone-Resistant Escherichia coli


The aim of the retrospective case-control study presented here was to elucidate the incidence, risk factors, and outcomes of nosocomial infections caused by quinolone-resistant Escherichia coli (QREC). During the 3-year period studied, 51 nosocomial QREC infections were found, and the characteristics of these cases were compared with those of 102 control patients with quinolone-susceptible nosocomial infections. In the multivariate analysis, risk factors were identified as prior quinolone therapy (odds ratio [OR], 18.49; 95% confidence interval [CI], 5.53–61.82; P value <0.001), urinary tract abnormalities (OR, 6.69; 95% CI, 1.68–26.63; P=0.007), and prior therapy with other antimicrobial agents (OR, 3.57; 95% CI, 1.38–9.27; P=0.009). No difference in mortality or in length of hospital stay was found. Prudent use of quinolones, especially in patients with urinary tract abnormalities, is probably the best way to avoid an increase in the incidence of QREC infections, but further studies on interventions with restricted use of quinolones are necessary to demonstrate the effectiveness and safety of this strategy.

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  1. 1.

    Ena J, Lopez-Perezagua MM, Martinez-Peinado C, Cia-Barrio MA, Ruiz-Lopez I (1998) Emergence of ciprofloxacin resistance in Escherichia coli isolates after widespread use of fluoroquinolones. Diagn Microbiol Infect Dis 30:103–107

  2. 2.

    Pena C, Albareda JM, Pallares R, Pujol M, Tubau F, Ariza J (1995) Relationship between quinolone use and emergence of ciprofloxacin-resistant Escherichia coli in bloodstream infections. Antimicrob Agents Chemother 39:520–524

  3. 3.

    Kahlmeter G (2003) An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO-SENS project. J Antimicrob Chemother 51:69–76

  4. 4.

    Garau J, Xercavins M, Rodriguez-Carballeira M, Gomez-Vera JR, Coll I, Vidal D, Llovet T, Ruiz-Bremon A (1999) Emergence and dissemination of fluoroquinolone-resistant Escherichia coli in the community. Antimicrob Agents Chemother 43:2736–2741

  5. 5.

    Cheong H, Yoo C, Sohn J, Kim W, Kim M, Park S (2001) Bacteremia due to quinolone-resistant Escherichia coli in a teaching hospital in South Korea. Clin Infect Dis 33:48–53

  6. 6.

    Ena J, Amador C, Martinez C, Ortiz de la Tabla V (1995) Risk factors for acquisition of urinary tract infections caused by ciprofloxacin resistant Escherichia coli. J Urol 153:117–120

  7. 7.

    Lautenbach E, Fishman NO, Bilker WB, Castiglioni A, Metlay JP, Edelstein PH, Strom BL (2002) Risk factors for fluoroquinolone resistance in nosocomial Escherichia coli and Klebsiella pneumoniae infections. Arch Intern Med 162:2469–2477

  8. 8.

    McDonald LC, Chen F-J, Lo H-J,Yin H-J, Lu P-L, Huang C-H, Chen P, Lauderdale T-L, Ho M (2001) Emergence of reduced susceptibility and resistance to fluoroquinolones in Escherichia coli in Taiwan and contributions of distinct selective pressures. Antimicrob Agents Chemother 45:3084–3091

  9. 9.

    Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140

  10. 10.

    National Committee for Clinical Microbiology Standards (1997) Performance standards for antimicrobial disk suspectibility tests. Approved standard M2-A6. NCCLS, Villanova PA

  11. 11.

    Aparicio JR, Such J, Pascual S, et al. (1999) Development of quinolone-resistant strains of Escherichia coli in stools of patients with cirrhosis undergoing norfloxacin prophylaxis: clinical consequences. J Hepatol 31:277–283

  12. 12.

    Horcajada JP, Vila J, Moreno-Martinez A, et al (2002) Molecular epidemiology and evolution of resistance to quinolones in Escherichia coli after prolonged administration of ciprofloxacin in patients with prostatitis. J Antimicrob Chemother 49:55–59

  13. 13.

    Vila J, Simon K, Ruiz J, et al. (2002) Are quinolone-resistant uropathogenic Escherichia coli less virulent? J Infect Dis 186:1039–1042

  14. 14.

    Harris AD, Samore MH, Lipsitch M, et al. (2002) Control-group selection importance in studies of antimicrobial resistance: examples applied to Pseudomonas aeruginosa, enterococci and Escherichia coli. Clin Infect Dis 34:1558–1563

  15. 15.

    Lee Y-E, Cesario T, McCauley V, et al. (1998) Low-level colonization and infection with ciprofloxacin-resistant gram-negative bacilli in a skilled nursing facility. Am J Infect Control 26:552–557

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Correspondence to K. Huotari.

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Huotari, K., Tarkka, E., Valtonen, V. et al. Incidence and Risk Factors for Nosocomial Infections Caused by Fluoroquinolone-Resistant Escherichia coli . Eur J Clin Microbiol Infect Dis 22, 492–495 (2003) doi:10.1007/s10096-003-0975-6

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  • Antimicrobial Agent
  • Fluoroquinolones
  • Quinolone
  • Nosocomial Infection
  • Norfloxacin