A Clinical Prediction Rule for Fluoroquinolone Resistance in Healthcare-Acquired Gram-Negative Urinary Tract Infection

Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6021, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 11/2011; 32(11):1124-6. DOI: 10.1086/662379
Source: PubMed


Data from a case-control study were used to derive and internally validate a prediction rule for identifying fluoroquinolone resistance in healthcare-acquired gram-negative urinary tract infection. This prediction rule has an excellent sensitivity and specificity (C-statistic, 0.816). External validation is necessary before implementing this rule to optimize empirical antibiotic use in clinical practice.

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Available from: Pam Tolomeo, Mar 31, 2014
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    ABSTRACT: Introduction: This review summarizes data on the fluoroquinolone resistance epidemiology published in the previous 5 years. Materials and methods: The data reviewed are stratified according to the different prescription patterns by either primary- or tertiary-care givers and by indication. Global surveillance studies demonstrate that fluoroquinoloneresistance rates increased in the past several years in almost all bacterial species except Staphylococcus pneumoniae and Haemophilus influenzae causing community-acquired respiratory tract infections (CARTIs), as well as Enterobacteriaceae causing community-acquired urinary tract infections. Geographically and quantitatively varying fluoroquinolone resistance rates were recorded among Gram-positive and Gram-negative pathogens causing healthcare-associated respiratory tract infections. One- to two-thirds of Enterobacteriaceae producing extendedspectrum b-lactamases (ESBLs) were fluoroquinolone resistant too, thus, limiting the fluoroquinolone use in the treatment of community- as well as healthcare-acquired urinary tract and intra-abdominal infections. The remaining ESBL-producing or plasmid-mediated quinolone resistance mechanisms harboring Enterobacteriaceae were low-level quinolone resistant. Furthermore, 10-30 % of H. influenzae and S. pneumoniae causing CARTIs harbored first-step quinolone resistance determining region (QRDR) mutations. These mutants pass susceptibility testing unnoticed and are primed to acquire high-level fluoroquinolone regulatory authorities, and the pharmaceutical industry have diverse interests, which, however, are not addressed by different designs of a surveillance study. Tools should be developed to provide customer-specific datasets. Conclusion: Consequently, most surveillance studies suffer from well recognized but uncorrected biases or inaccuracies. Nevertheless, they provide important information that allows the identification of trends in pathogen incidence and antimicrobial resistance.
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