Fluoroquinolone use is not associated with the cha

Authors: Kathryn J Eagye David P Nicolau

Publish Date: 2011/03/22

Volume: 28, Issue: 4, Pages: 326-333

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Abstract

Evidence suggests use of fluoroquinolones is associated with carbapenem resistance in Pseudomonas aeruginosa and fluoroquinolone use has been identified as a risk factor for clinical acquisition of imipenemresistant P aeruginosa in singlecenter studies Imipenem susceptibility and fluoroquinolone use was evaluated within 25 hospitals over 9 yearsUse density ratios UDR for fluoroquinolones ciprofloxacin gatifloxacin levofloxacin and moxifloxacin and for three other antibiotic classes carbapenems ertapenem doripenem imipenem and meropenem other antipseudomonal betalactams cefepime ceftazidime and piperacillin/tazobactam and aminoglycosides gentamicin and tobramycin were derived from drug purchase data for up to 9 years ending in 2008 Susceptibility data were obtained from hospital antibiograms in corresponding years A mixed model repeated measures ANOVA Analysis of Variance explored associations between 9year repeated imipenem susceptibility and fluoroquinolone UDR in each year while controlling for other drug classes teaching status and number of bedsAll sites had 7 years of data n=22 had 8 years n=18 had 9 years Teaching hospitals were 36 of the cohort median number of beds was 714 for teaching hospitals and 381 for nonteaching hospitals Fluoroquinolone use declined from year Y 1–5 such use then rose over Y69 which was heavily influenced by ciprofloxacin/moxifloxacin mean fluoroquinolone UDR from Y19 was 3038 1865 1568 1744 1691 2750 5042 4770 and 4233 Mean imipenem susceptibility was Y19 852 828 827 822 828 824 823 817 and 806 this change across time was not significant P=046 Change in 9year imipenem susceptibility was not associated with fluoroquinolone UDR P=017 nor with any other drug class P040 for each Results were not different when considering only sites with top 25 fluoroquinolone UDR during Y7–9Singlecenter studies of fluoroquinolone use have reported changes in P aeruginosa susceptibility to carbapenems Our study finds no such association while controlling for other drug classes As such resistance development in individual patients versus institutions warrants further research

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