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Prior antimicrobial therapy and resistance of Enterobacter Citrobacter and Serratia to third generation
1Office of Infection Control, Calgary General Hospital, Alberta.
Abstract:
During a 6-month period all inpatients from whom Enterobacter, Citrobacter or Serratia. had been isolated were reviewed and information on selected variables recorded. Two groups, one including 19 patients with organisms resistant to third generation cephalosporins and the other 111 patients with susceptible organisms were compared. In the initial analysis, the mean number of antimicrobials received in the prior 2 months was the variable most strongly associated with isolation of resistant organisms (2.6 +/- 1.5 vs 1.5 +/- 1.6; P = 0.002). When patients who had received no antimicrobials were omitted from the analysis, the mean number of antimicrobials was similar (2.6 +/- 1.5 vs 2.3 +/- 1.5; P = 0.19). Comparisons of antimicrobials received in the prior 2 months showed only cefoxitin (9/70 vs 7/19; P = 0.016) and cefotaxime (4/70 vs 5/19; P = 0.008) to be associated with isolation of resistant organisms. These data suggest that, at our institution, antimicrobial therapy with an extended spectrum cephalosporin is an important risk factor for subsequent acquisition of an organism resistant to third generation cephalosporins.
Insights
Extended spectrum cephalosporin use is linked to resistant Enterobacteriaceae infections. This study found that prior antimicrobial therapy, particularly with extended spectrum cephalosporins, increases the risk of acquiring third-generation cephalosporin-resistant organisms.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Enterobacter, Citrobacter, and Serratia are common Gram-negative pathogens.
- Rising antimicrobial resistance poses a significant public health threat.
- Third-generation cephalosporins are crucial antibiotics for treating serious infections.
Purpose of the Study:
- To identify risk factors associated with third-generation cephalosporin resistance in Enterobacteriaceae.
- To investigate the impact of prior antimicrobial exposure on the isolation of resistant organisms.
Main Methods:
- Retrospective review of 130 inpatients over 6 months.
- Comparison of patients with resistant versus susceptible Enterobacteriaceae isolates.
- Analysis of antimicrobial use within the 2 months prior to organism isolation.
Main Results:
- Prior antimicrobial exposure was strongly associated with resistant organism isolation (2.6 vs 1.5 antimicrobials; P = 0.002).
- This association diminished when patients with no prior antimicrobial use were excluded (P = 0.19).
- Specific cephalosporins, cefoxitin and cefotaxime, were significantly associated with resistant isolates.
Conclusions:
- Antimicrobial therapy with extended spectrum cephalosporins is a key risk factor for acquiring third-generation cephalosporin-resistant Enterobacteriaceae.
- Understanding these risk factors is crucial for infection control and antimicrobial stewardship.
- Further research is needed to explore broader implications and interventions.