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Gentamicin treatment associated with later nosocomial gentamicin-resistant Serratia marcescens infections
Abstract:
During a hospital epidemic of infections with gentamicin-resistant Serratia marcescens (GRS), we studied the relation between receiving antibiotics and acquiring GRS. In a five-month period, 22 patients acquired GRS, whereas 18 patients acquired gentamicin-sensitive Serratia (GSS). When compared with patients with nosocomial GSS infection, patients with nosocomial GRS had been in the hospital (p = 0.04) and the intensive care unit (p = 0.003) longer before infection and more had received gentamicin (p = 0.001) or ampicillin (p = 0.02) before infection. To control for the influence of underlying disease, we matched all 12 ICU patients with GRS infection and 12 patients without GRS infection for underlying illness and duration of intensive care. Use of any antibiotic (p = 0.04), or a combination of gentamicin plus ampicillin or cephalosporin (p = 0.047) was more common among patients with GRS infection. The hospital had not significantly increased the use of aminoglycosides from the previous year. We conclude that for the individual patient antimicrobial therapy, especially with gentamicin or ampicillin, creates a risk for later infection by GRS that is independent of the severity of the underlying illness.
Insights
Antibiotic use, particularly gentamicin or ampicillin, increases the risk of acquiring gentamicin-resistant Serratia marcescens (GRS) hospital infections. This risk is independent of underlying illness severity.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Resistance
Background:
- A hospital experienced an epidemic of gentamicin-resistant Serratia marcescens (GRS) infections.
- Understanding risk factors for acquiring GRS is crucial for infection control.
Purpose of the Study:
- To investigate the relationship between antibiotic administration and the acquisition of GRS infections in a hospital setting.
Main Methods:
- A comparative study was conducted over five months, analyzing patients with GRS versus gentamicin-sensitive Serratia (GSS) infections.
- Matched case-control analysis was performed on intensive care unit (ICU) patients to control for underlying disease and ICU stay duration.
Main Results:
- Patients with nosocomial GRS had longer hospital and ICU stays and received more gentamicin or ampicillin prior to infection compared to GSS patients.
- In a matched analysis, antibiotic use, especially gentamicin/ampicillin or cephalosporin combinations, was more frequent in GRS-infected patients.
- No significant increase in overall aminoglycoside use was noted compared to the previous year.
Conclusions:
- Antimicrobial therapy, specifically with gentamicin and ampicillin, independently elevates an individual patient's risk of developing GRS infections.
- This finding highlights the importance of judicious antibiotic use in preventing the spread of resistant pathogens within hospitals.