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Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use

Melinda M Neuhauser1, Robert A Weinstein, Robert Rydman

  • 1Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, Tex, USA.

JAMA
|February 18, 2003
PubMed
Abstract

Insights

Antimicrobial resistance increased in US intensive care units. Ciprofloxacin resistance rose significantly with greater fluoroquinolone use, necessitating more judicious prescribing.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Pharmacology

Background:

  • Previous studies indicated rising antimicrobial resistance in US intensive care units (ICUs) during the early 1990s.
  • Gram-negative aerobic bacteria are common causes of infections in ICUs.

Purpose of the Study:

  • To evaluate national trends in antimicrobial resistance among gram-negative aerobic isolates from ICU patients.
  • To correlate these resistance patterns with national antimicrobial usage, specifically fluoroquinolones.

Main Methods:

  • Analysis of antibiotic susceptibility data for 35,790 gram-negative aerobic isolates from US ICUs (1994-2000).
  • Data collected from multiple institutions across 43 states and the District of Columbia.
  • Correlation of isolate susceptibility with national fluoroquinolone consumption data.

Main Results:

  • Overall susceptibility to most tested antimicrobial agents decreased by 6% or less.
  • Ciprofloxacin susceptibility declined from 86% in 1994 to 76% in 2000.
  • Increased national fluoroquinolone use was significantly associated with decreased ciprofloxacin susceptibility.

Conclusions:

  • The study confirms a rise in ciprofloxacin resistance among gram-negative bacilli.
  • This increase in resistance coincided with elevated fluoroquinolone consumption.
  • Judicious use of fluoroquinolones is recommended to mitigate further resistance development.

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