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Epidemiology of ciprofloxacin resistance among patients with methicillin-resistant Staphylococcus aureus
1Microbiology Section, Department of Veterans Affairs Medical Center, East Orange, New Jersey 07019.
Abstract:
During the first twelve months after ciprofloxacin was introduced for clinical use at our institution, 65 new patients were found to be either infected or colonized by methicillin-resistant Staphylococcus aureus (MRSA) which were also ciprofloxacin resistant (CR-MRSA). Only 18 of these patients (28%) had been previously exposed to this antibiotic. Nine (50%) of the 18 patients had received ciprofloxacin for treatment for a pathogen other than MRSA. Although the initial cases of colonization or infection with CR-MRSA can be directly related to ciprofloxacin use, many of the subsequent cases of colonization and infection were not the consequence of ciprofloxacin therapy but rather hospital transmission of existing CR-MRSA.
Insights
Ciprofloxacin use led to resistant MRSA infections. However, hospital transmission, not just antibiotic exposure, drove most later CR-MRSA cases.
Area of Science:
- Infectious Diseases
- Antimicrobial Resistance
- Clinical Microbiology
Background:
- Ciprofloxacin is a widely used antibiotic.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a significant healthcare-associated pathogen.
- The emergence of antibiotic resistance in MRSA strains is a growing concern.
Purpose of the Study:
- To investigate the incidence of ciprofloxacin-resistant MRSA (CR-MRSA) infections and colonizations.
- To determine the association between prior ciprofloxacin exposure and CR-MRSA acquisition.
- To differentiate between direct antibiotic selection and hospital transmission as drivers of CR-MRSA spread.
Main Methods:
- Retrospective analysis of patient data over twelve months following ciprofloxacin introduction.
- Identification of patients infected or colonized with MRSA exhibiting ciprofloxacin resistance.
- Review of patient antibiotic exposure history, specifically to ciprofloxacin.
Main Results:
- Sixty-five new cases of CR-MRSA infection or colonization were identified within the first year.
- Only 28% of these patients had prior exposure to ciprofloxacin.
- A significant proportion of CR-MRSA cases were attributed to hospital transmission rather than direct ciprofloxacin selective pressure.
Conclusions:
- While initial CR-MRSA cases may be linked to ciprofloxacin use, hospital transmission plays a crucial role in subsequent spread.
- This highlights the importance of infection control measures to prevent the dissemination of resistant pathogens.
- Understanding transmission dynamics is vital for managing antibiotic resistance in clinical settings.