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. 2016 Oct 19:5:38.
doi: 10.1186/s13756-016-0135-2. eCollection 2016.

Regional variations in fluoroquinolone non-susceptibility among Escherichia coli bloodstream infections within the Veterans Healthcare Administration

Daniel J Livorsi  1 , Michihiko Goto  1 , Margaret Carrel  2 , Makoto M Jones  3 , Jennifer McDanel  4 , Rajeshwari Nair  5 , Bruce Alexander  6 , Brice Beck  6 , Kelly K Richardson  6 , Eli N Perencevich  5
Affiliations

Regional variations in fluoroquinolone non-susceptibility among Escherichia coli bloodstream infections within the Veterans Healthcare Administration

Daniel J Livorsi et al. Antimicrob Resist Infect Control. .

Abstract

Objectives: We sought to define regional variations in fluoroquinolone non-susceptibility (FQ-NS) among bloodstream isolates of Escherichia coli across the Veterans Health Administration (VHA) in the United States.

Methods: We analyzed a retrospective cohort of patients managed at 136 VHA hospitals who had a blood culture positive for E.coli between 2003 and 2013. Hospitals were classified based on US Census Divisions, and regional variations in FQ-NS were analyzed.

Results: Twenty-four thousand five hundred twenty-three unique E.coli bloodstream infections (BSIs) were identified between 2003 and 2013. 53.9 % of these were community-acquired, 30.7 % were healthcare-associated, and 15.4 % were hospital-onset BSIs. The proportion of E.coli BSIs with FQ-NS significantly varied across US Census Divisions (p < 0.001). During 2003-2013, the proportion of E.coli BSIs with FQ-NS was highest in the West South-Central Division (32.7 %) and lowest in the Mountain Division (20.0 %). Multivariable analysis showed that there were universal secular trends towards higher FQ-NS rates (p < 0.001) with significant variability of slopes across US Census Divisions (p < 0.001).

Conclusion: There has been a universal increase in FQ-NS among E.coli BSIs within VHA, but the rate of increase has significantly varied across Census Divisions. The reasons for this variability are unclear. These findings reinforce the importance of using local data to develop and update local antibiograms and antibiotic-prescribing guidelines.

Keywords: Antimicrobial resistance; Epidemiology; Escherichia coli; Fluoroquinolones.

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Figures

Fig. 1
Fig. 1
Region-specific changes in FQ-NS among E.coli BSIs in the Veterans Health Administration, 2003–2013
Fig. 2
Fig. 2
Secular trends in FQ-NS among E.coli BSIs within 9 Census Divisions of VHA, 2003–2013
See this image and copyright information in PMC

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References

    1. Fasugba O, Gardner A, Mitchell BG, Mnatzaganian G. Ciprofloxacin resistance in community- and hospital-acquired Escherichia coli urinary tract infections: a systematic review and meta-analysis of observational studies. BMC Infect Dis. 2015;15:545. doi: 10.1186/s12879-015-1282-4. - DOI - PMC - PubMed
    1. Zervos MJ, Hershberger E, Nicolau DP, Ritchie DJ, Blackner LK, Coyle EA, Donnelly AJ, Eckel SF, Eng RH, Hiltz A, et al. Relationship between fluoroquinolone use and changes in susceptibility to fluoroquinolones of selected pathogens in 10 United States teaching hospitals, 1991–2000. Clin Infect Dis. 2003;37(12):1643–1648. doi: 10.1086/379709. - DOI - PubMed
    1. Sanchez GV, Master RN, Karlowsky JA, Bordon JM. In vitro antimicrobial resistance of urinary Escherichia coli isolates among U.S. outpatients from 2000 to 2010. Antimicrob Agents Chemother. 2012;56(4):2181–2183. doi: 10.1128/AAC.06060-11. - DOI - PMC - PubMed
    1. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O’Neill PJ, Chow AW, Dellinger EP, Eachempati SR, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(2):133–164. doi: 10.1086/649554. - DOI - PubMed
    1. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103–e120. doi: 10.1093/cid/ciq257. - DOI - PubMed

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