Affiliation:
1. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts
Abstract
ABSTRACT
Ampicillin-sulbactam resistance in
Escherichia coli
is an emerging problem. This study determined risk factors for the recovery of ampicillin-sulbactam-resistant
E. coli
in hospitalized patients. A case-control design was used to compare two groups of case patients with control patients. The first group of case patients consisted of patients from whom nosocomially acquired ampicillin-sulbactam-resistant
E. coli
strains were isolated, and the second group of case patients consisted of patients from whom ampicillin-sulbactam-susceptible
E. coli
strains were isolated. Control patients were a random selection among 5% of all patients admitted during the same time period. Risk factors analyzed included antimicrobial drug exposure, comorbid conditions, and demographics. Univariate and multivariate analyses were performed. Ampicillin-sulbactam-resistant
E. coli
strains were isolated from 175 patients, and ampicillin-sulbactam-susceptible
E. coli
strains were isolated from 577 patients. Nine hundred thirty-four control patients were selected. Exposure to penicillin antibiotics as a class and to ampicillin and ampicillin-sulbactam individually were the only significant, independent risk factors associated with the isolation of ampicillin-sulbactam-resistant
E. coli
(odds ratio [OR] = 2.32 [
P
< 0.001], OR = 3.04 [
P
= 0.02], and OR = 1.72 [
P
= 0.04], respectively), but they were not associated with the isolation of ampicillin-sulbactam-susceptible
E. coli
. Interestingly, exposure to piperacillin-tazobactam tended to protect against the isolation of
E. coli
strains resistant to ampicillin-sulbactam, but this did not reach statistical significance (OR = 0.13;
P
= 0.11).
Publisher
American Society for Microbiology
Subject
Infectious Diseases,Pharmacology (medical),Pharmacology
Cited by
50 articles.
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