Details:

Alternative Title:
Ann Clin Microbiol Antimicrob
Publisher's site:
http://dx.doi.org/10.1186/s12941-017-0202-4
Personal Author:
Rattanaumpawan, Pinyo ; Nachamkin, Irving ; Bilker, Warren B. ; Roy, Jason A. ; Metlay, Joshua P. ; ... More +
Rattanaumpawan, Pinyo ; Nachamkin, Irving ; Bilker, Warren B. ; Roy, Jason A. ; Metlay, Joshua P. ; Zaoutis, Theoklis E. ; Lautenbach, Ebbing Less -
Corporate Authors:
on behalf of the CDC prevention epicenters program
Description:
Background

Suboptimal clinical response to fluoroquinolone (FQ) therapy has been clearly documented in patients with Salmonella typhi infection with reduced FQ susceptibility. However, the clinical impact of reduced FQ susceptibility on other infections including E. coli urinary tract infections (UTIs) has never been evaluated.

Methods

We conducted a retrospective cohort study of female patients with fluoroquinolone susceptible E. coli (FQSEC) UTIs who received FQ therapy at outpatient services within University of Pennsylvania Health System, Philadelphia. Exposed patients were those with high MIC-FQSEC UTIs (the levofloxacin MIC > 0.12 but ≤ 2 mg/L) while unexposed patients were those with low MIC-FQSEC UTIs (the levofloxacin MIC ≤ 0.12 mg/L). The primary treatment outcome was treatment failure within 10 weeks after initiation of FQ therapy.

Results

From May 2008 to April 2011, we enrolled 29 exposed patients and 246 unexposed patients. Two patients in each group experienced treatment failure; exposed vs. unexposed (6.9 vs. 0.8%; p = 0.06). Risk difference and risk ratio (RR) for treatment failure were 0.06 [95% CI −0.03–0.15; exact-p = 0.06] and 8.48 [95% CI 1.24–57.97; exact-p = 0.06], respectively. After adjusting for underlying cerebrovascular disease, the RR was 7.12 (95% CI 1.20–42.10; MH-p = 0.04).

Conclusion

Our study demonstrated the negative impact of reduced FQ susceptibility on the treatment response to FQ therapy in FQSEC UTIs. This negative impact may be more intensified in other serious infections. Future studies in other clinical situations should be conducted to fill the gap of knowledge.


Subject:
[+]
Academic Medical Centers
Adolescent
Adult
Aged
Aged, 80 And Over
Anti-Bacterial Agents
Cohort Studies
Escherichia Coli
Escherichia Coli Infections
Female
Fluoroquinolone Resistance
Fluoroquinolones
Humans
Microbial Sensitivity Tests
Middle Aged
Outpatients
Philadelphia
Retrospective Studies
Short Report
Treatment Failure
Urinary Tract Infection
Urinary Tract Infections
Young Adult

Source:
Ann Clin Microbiol Antimicrob. 16.
Pubmed ID:
28390438
Pubmed Central ID:
PMC5385084
Document Type:
Journal Article
Funding:
K24 AI080942/AI/NIAID NIH HHS/United States ; R21 AI103497/AI/NIAID NIH HHS/United States ; U54 CK000163/CK/NCEZID CDC HHS/United States
K24 AI080942/AI/NIAID NIH HHS/United States ; R21 AI103497/AI/NIAID NIH HHS/United States ; U54 CK000163/CK/NCEZID CDC HHS/United States Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:d9010ef6bbe13e507ac2761664551edf1577fe475cc59e3c5187229ac59d6368
File Type:

Supporting Files

• 12941_2017_Article_202.nxml

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