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Quinolone resistance inPseudomonas aeruginosa andStaphylococcus aureus. Development during therapy and clinical significance

Chinolonresistenz beiPseudomonas aeruginosa undStaphylococcus aureus: Entwicklung während der Therapie und klinische Bedeutung

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Summary

This review focuses on published information on the experimental as well as clinical data on the emergence of quinolone resistant isolates. In the course of clinical use of fluoroquinolones, only a sporadic emergence of quinolone resistance has been noted. The resistant organisms emerged particularly in certain clinical settings where large numbers of organisms frequently causing chronic infections are present and/or in loci where quinolone concentrations may not be optimal. In terms of occurrence in individuals, quinolone resistance has emerged most frequently in hospitalized and nursing-home patients with identifiable risk factors. Epidemiological studies revealed that in nearly all the cases studied one or one predominating quinolone resistant clone was selected that was horizontally transmitted. Thus, the emergence of quinolone resistance is not due to an independent selection of resistant strains in a number of patients, but to the clonal spread of one strain once it has acquired quinolone resistance. Therefore, the rate of quinolone resistance is very likely to be lower than reported.

Zusammenfassung

Die publizierten präklinischen sowie klinischen Daten zur Chinolonresistenz sind synoptisch dargestellt. Im Verlauf der klinischen Anwendung von Fluorochinolonen wurde bislang nur sporadisch das Auftreten Chinolon-resistenter Stämme beobachtet. Diese resistenten Stämme traten vor allem unter solchen klinischen Bedingungen auf, unter denen entweder hohe Bakterienzellzahlen chronische Infektionen verursachen und/oder in solchen Infektlokalisationen, in denen die Chinolonkonzentrationen nicht optimal sein können. Bezogen auf die individuelle Wahrscheinlichkeit des Auftretens Chinolon-resistenter Stämme treten diese vorrangig in hospitalisierten Patienten oder Pflegeheimbewohnern mit identifizierbaren Risikofaktoren auf. Epidemiologische Studien ergaben, daß in nahezu allen untersuchten Fällen ein oder ein vorherrschender Chinolon-resistenter Klon selektiert worden war, der sich anschließend horizontal ausbreitete. Somit ist das Auftreten einer Chinolonresistenz nicht auf eine unabhängige Selektion einer Vielzahl resistenter Stämme in entsprechend vielen Patienten zurück-zuführen, sondern vielmehr auf eine klonale Ausbreitung eines einzigen Stammes sobald dieser eine Chinolonresistenz erworben hat. Folglich ist die Rate der Chinolonresistenz sehr wahrscheinlich geringer als publiziert.

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Dalhoff, A. Quinolone resistance inPseudomonas aeruginosa andStaphylococcus aureus. Development during therapy and clinical significance. Infection 22 (Suppl 2), S111–S121 (1994). https://doi.org/10.1007/BF01793575

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