High Rate of Coadministration of Di- or Tri-valent Cation-Containing Compounds With Oral Fluoroquinolones: Risk Factors and Potential Implications

2005 ◽  
Vol 26 (1) ◽  
pp. 93-99 ◽  
Author(s):  
Todd D. Barton ◽  
Neil O. Fishman ◽  
Mark G. Weiner ◽  
Lori A. LaRosa ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Medical Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
High Rate ◽  
Fluoroquinolone Resistance ◽  
Bacterial Development ◽  
Tertiary Care Medical Center ◽  
Control Study

AbstractBackground:The characteristics of fluoroquinolone use that increase the risk of selecting for fluoroquinolone resistance remain unclear. Exposure to subtherapeutic levels of fluoroquinolone promotes bacterial development of fluoroquinolone resistance. Oral fluoroquinolone absorption is significantly impaired by coadministration with many common di- or tri-valent cation-containing compounds (DTCCs), and this interaction has been associated with therapeutic failure. However, the prevalence of, and risk factors for, in-hospital coadministration of oral fluoroquinolones with DTCCs is unknown.Design:Case-control study.Setting:A 625-bed, tertiary-care medical center.Patients:All inpatients who were dispensed oral levofloxacin from July 1, 1999, to June 30, 2001, were included. Coadministration was defined by documented administration of any DTCC within 2 hours of levofloxacin. Complete coadministration was defined as coadministration complicating every dose of a course of levofloxacin.Results:A subset of 3,227 (41.0%) of 7,871 doses of levofloxacin that occurred during the same calendar day as any DTCC was selected for further review. Overall, 1,904 (77.1%) of 2,470 doses of oral levofloxacin reviewed were complicated by coadministration with at least one DTCC. On multivariable analysis, an increased number of prescribed medications was significantly associated with complete coadministration (per increase of one medication: OR, 1.05; CI95, 1.01–1.10; P = .036), whereas patient location in an ICU was protective (OR, 0.51; CI95, 0.30–0.87; P = .013). If our prevalence results are extrapolated to all patients receiving oral levofloxacin at our hospital, approximately one in three doses was complicated by coadministration.Conclusion:Coadministration of fluoroquinolones with DTCCs is extremely common and significantly associated with polypharmacy.

scholarly journals Risk Factors for Resistance to β-Lactam/β-Lactamase Inhibitors and Ertapenem in Bacteroides Bacteremia

2015 ◽  
Vol 59 (8) ◽  
pp. 5049-5051 ◽  
Author(s):  
Janessa M. Smith ◽  
Edina Avdic ◽  
Pranita D. Tamma ◽  
Long Zhang ◽  
Karen C. Carroll ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Medical Center ◽  
Tertiary Care ◽  
Case Control ◽  
Retrospective Case ◽  
Content Type ◽  
Development Of Resistance ◽  
Tertiary Care Medical Center ◽  
Control Study

ABSTRACTThe objective of this study was to determine risk factors for the development of resistance to β-lactams/β-lactamase inhibitors (βL/βLIs) and ertapenem amongBacteroidesspecies bacteremia. We conducted a retrospective case-control study of 101 adult patients withBacteroidesspecies bacteremia at a 1,051-bed tertiary care medical center. The duration of exposure to βL/βLIs (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.08 to 2.31) was the only independent risk factor for resistance.

Extended-Spectrum β-Lactamase–ProducingEscherichia coliandKlebsiellaSpecies: Risk Factors for Colonization and Impact of Antimicrobial Formulary Interventions on Colonization Prevalence

2002 ◽  
Vol 23 (5) ◽  
pp. 254-260 ◽  
Author(s):  
Gregory Bisson ◽  
Neil O. Fishman ◽  
Jean Baldus Patel ◽  
Paul H. Edelstein ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Tertiary Care ◽  
Healthcare Facility ◽  
System A ◽  
Extended Spectrum ◽  
Tertiary Care Medical Center ◽  
Duration Of Hospitalization ◽  
Third Generation Cephalosporins ◽  
Control Study

Objective:The incidence of extended-spectrum β-lactamase (ESβL)–mediated resistance has increased markedly during the past decade. Risk factors for colonization with ESβL-producingEscherichia coliand Klebsiella species(ESβL-EK) remain unclear, as do methods to control their further emergence.Design:Case–control study.Setting:Two hospitals within a large academic health system: a 725-bed academic tertiary-care medical center and a 344-bed urban community hospital.Patients:Thirteen patients with ESβL-EK fecal colonization were compared with 46 randomly selected noncolonized controls.Results:Duration of hospitalization was the only independent risk factor for ESβL-EK colonization (odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). Of note, 8 (62%) of the patients had been admitted from another healthcare facility. In addition, there was evidence for dissemination of a singleK. oxytocaclone. Finally, the prevalence of ESβL-EK colonization decreased from 7.9% to 5.7% following restriction of third-generation cephalosporins (P= .51).Conclusions:ESβL-EK colonization was associated only with duration of hospitalization and there was no significant reduction following antimicrobial formulary interventions. The evidence for nosocomial spread and the high percentage of patients with ESβL-EK admitted from other sites suggest that greater emphasis must be placed on controlling the spread of such organisms within and between institutions.

Chloramphenicol Resistance in Vancomycin-Resistant Enterococcal Bacteremia: Impact of Prior Fluoroquinolone Use?

2004 ◽  
Vol 25 (2) ◽  
pp. 138-145 ◽  
Author(s):  
Carolyn V. Gould ◽  
Neil O. Fishman ◽  
Irving Nachamkin ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Medical Center ◽  
Tertiary Care ◽  
Case Control ◽  
Close Monitoring ◽  
Chi Square ◽  
Chloramphenicol Resistance ◽  
Vancomycin Resistant ◽  
Control Study

AbstractObjective:The prevalence of vancomycin-resistant enterococci (VRE) has increased markedly during the past decade. Few data exist regarding the epidemiology of resistance of VRE to chloramphenicol, one of the few therapeutic options.Design:Survey and case-control study.Setting:A 725-bed, tertiary-care academie medical center and a 344-bed urban community hospital.Patients:Hospitalized patients with blood cultures demonstrating VRE.Methods:We examined the trends in the prevalence of chloramphenicol resistance in VRE blood isolates at our institution from 1991 through 2002 and conducted a case-control study to identify risk factors for chloramphenicol resistance among these isolates.Results:From 1991 through 2002, the annual prevalence of chloramphenicol-resistant VRE increased from 0% to 12% (P < .001, chi-square test for trend). Twenty-two case-patients with chloramphenicol-resistant VRE bloodstream isolates were compared with 79 randomly selected control-patients with chloramphenicol-susceptible VRE. Independent risk factors for chloramphenicol-resistant VRE were prior chloramphenicol use (odds ratio [OR], 10.9; 95% confidence interval [CI95], 1.72-68.91; P = .01) and prior fluoroquinolone use (OR, 4.74; CI95, 1.15-19.42; P = .03). Chloramphenicol-resistant VRE isolates were more likely to be susceptible to beta-lactams and resistant to tetracycline than were chloramphenicol-susceptible VRE isolates.Conclusions:Significant increases in the prevalence of chloramphenicol-resistant VRE may limit the future utility of chloramphenicol in the treatment of VRE infections, and close monitoring of susceptibility trends should continue. The association between fluoroquinolone use and chloramphenicol-resistant VRE, reflecting possible co-selection of resistance, suggests that recent dramatic increases in fluoroquinolone use may have broader implications than previously recognized.

scholarly journals Independent risk factors for surgical site infection after cesarean delivery in a rural tertiary care medical center

2016 ◽  
Vol 31 (1) ◽  
pp. 120-126 ◽  
Author(s):  
Manuel C. Vallejo ◽  
Ahmed F. Attaallah ◽  
Robert E. Shapiro ◽  
Osama M. Elzamzamy ◽  
Michael G. Mueller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Cesarean Delivery ◽  
Medical Center ◽  
Tertiary Care ◽  
Site Infection ◽  
Tertiary Care Medical Center ◽  
Independent Risk Factors

Risk Factors for Inpatient Hypoglycemia in a Tertiary Care Medical Center

2011 ◽  
pp. P3-450-P3-450
Author(s):  
Jeremy R Grogg ◽  
Pooja Singal ◽  
Abhilasha Jarori ◽  
James P Walsh
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Tertiary Care ◽  
Tertiary Care Medical Center

Imipenem Resistance Among Pseudomonas aeruginosa Isolates Risk Factors for Infection and Impact of Resistance on Clinical and Economic Outcomes

2006 ◽  
Vol 27 (9) ◽  
pp. 893-900 ◽  
Author(s):  
Ebbing Lautenbach ◽  
Mark G. Weiner ◽  
Irving Nachamkin ◽  
Warren B. Bilker ◽  
Angela Sheridan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Medical Center ◽  
Tertiary Care ◽  
Economic Outcomes ◽  
Control Group ◽  
Case Group ◽  
Tertiary Care Medical Center ◽  
Imipenem Resistance ◽  
The Impact

Objectives.To identify risk factors for infection with imipenem-resistant Pseudomonas aeruginosa and determine the impact of imipenem resistance on clinical and economic outcomes among patients infected with P. aeruginosa.Designs.An ecologic study, a case-control study, and a retrospective cohort study.Setting.A 625-bed tertiary care medical center.Patients.All patients who had an inpatient clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000.Results.From 1991 through 2000, the annual prevalence of imipenem resistance among P. aeruginosa isolates increased significantly (P<.001 by the χ2 test for trend). Among 879 patients infected with P. aeruginosa during 1999-2000, a total of 142 had imipenem-resistant P. aeruginosa infection (the case group), whereas 737 had imipenem-susceptible P. aeruginosa infection (the control group). The only independent risk factor for imipenem-resistant P. aeruginosa infection was prior fluoroquinolone use (adjusted odds ratio, 2.52 [95% confidence interval {CI}, 1.61-3.92]; P<.001). Compared with patients infected with imipenem-susceptible P. aeruginosa, patients infected with imipenem-resistant P. aeruginosa had longer subsequent hospitalization durations (15.5 days vs 9 days; P = .02) and greater hospital costs ($81,330 vs $48,381; P<.001). The mortality rate among patients infected with imipenem-resistant P. aeruginosa was 31.1%, compared with 16.7% for patients infected with imipenem-susceptible P. aeruginosa (relative risk, 1.86 [95% CI, 1.38-2.51]; P<.001). In multivariable analyses, there remained an independent association between infection with imipenem-resistant P. aeruginosa and mortality.Conclusions.The prevalence of imipenem resistance among P. aeruginosa strains has increased markedly in recent years and has had a significant impact on both clinical and economic outcomes. Our results suggest that curtailing use of other antibiotics (particularly fluoroquinolones) may be important in attempts to curb further emergence of imipenem resistance.

scholarly journals PGI1 PREVALENCE AND RISK FACTORS FOR DIARRHEA AT A LARGE TERTIARY CARE MEDICAL CENTER

2005 ◽  
Vol 8 (3) ◽  
pp. 369-370
Author(s):  
S Kachroo ◽  
N Kumar ◽  
G Graham ◽  
L Gerard ◽  
T Dao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Tertiary Care ◽  
Tertiary Care Medical Center ◽  
Large Tertiary Care

Risk factors for sporadicVibrio parahaemolyticusgastroenteritis in east China: a matched case-control study

2014 ◽  
Vol 143 (5) ◽  
pp. 1020-1028 ◽  
Author(s):  
W. X. YAN ◽  
Y. DAI ◽  
Y. J. ZHOU ◽  
H. LIU ◽  
S. G. DUAN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Multivariable Analysis ◽  
Antibiotic Use ◽  
Population Based ◽  
Case Control ◽  
Population Attributable Fractions ◽  
Attributable Fractions ◽  
Matched Case ◽  
Control Study

SUMMARYTo determine risk factors for sporadicVibrio parahaemolyticusgastroenteritis, we conducted a population-based case-control study in sentinel hospital surveillance areas of Shanghai and Jiangsu province, China. Seventy-one patients with diarrhoea and confirmedV. parahaemolyticusinfections were enrolled, and they were matched with 142 controls for gender, age and residential area. From the multivariable analysis,V. parahaemolyticusinfections were associated with antibiotics taken during the 4 weeks prior to illness [odds ratio (OR) 8·1, 95% confidence interval (CI) 1·2–56·4)], frequent eating out (OR 3·3, 95% CI 1·1–10·1), and shellfish consumption (OR 3·2, 95% CI 1·0–9·9), with population-attributable fractions of 0·09, 0·25, and 0·14, respectively. Protective factors included keeping the aquatic products refrigerated (OR 0·4, 95% CI 0·1–0·9) and pork consumption (OR 0·2, 95% CI 0·1–0·8). Further study of the association ofV. parahaemolyticusgastroenteritis with prior antibiotic use and shellfish consumption is needed.

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