Emergence of quinolone-resistant Escherichia coli bacteremia in neutropenic patients with cancer who have received prophylactic norfloxacin

Clin Infect Dis. 1995 Mar;20(3):557-60; discussion 561-3. doi: 10.1093/clinids/20.3.557.

Abstract

Between January 1988 and December 1992, 35 episodes of Escherichia coli bacteremia were identified in a series of 230 cases of bacteremia in neutropenic patients with cancer. Thirteen episodes (37%) were due to quinolone-resistant strains. Minimal inhibitory concentrations of norfloxacin ranged from 16 micrograms/mL to 128 micrograms/mL, and those of ciprofloxacin from 8 micrograms/mL to 64 micrograms/mL. The incidence of bacteremia due to quinolone-resistant E. coli increased from zero episodes per 1,000 hospital admissions in 1988 to four episodes per 1,000 admissions in 1992 (P = .018). To identify risk factors for quinolone-resistant E. coli bacteremia, we compared episodes of quinolone-resistant and quinolone-susceptible E. coli bacteremia. Among the variables analyzed, prophylaxis with norfloxacin was the only factor significantly associated with the development of quinolone-resistant E. coli bacteremia; 13 of 13 patients with bacteremia due to resistant strains received norfloxacin, whereas only one (5%) of 22 patients with bacteremia due to susceptible strains did (P < .001). According to our data, neutropenic patients with cancer who receive fluoroquinolone prophylaxis may be at risk of developing E. coli bacteremia due to quinolone-resistant strains.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteremia / complications
  • Bacteremia / drug therapy*
  • Bacteremia / epidemiology
  • Bacteremia / microbiology
  • Drug Resistance, Microbial
  • Escherichia coli Infections / complications
  • Escherichia coli Infections / drug therapy*
  • Escherichia coli Infections / epidemiology
  • Escherichia coli Infections / microbiology
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Neoplasms / complications*
  • Neutropenia / drug therapy*
  • Neutropenia / microbiology
  • Norfloxacin / therapeutic use*
  • Retrospective Studies
  • Risk Factors

Substances

  • Norfloxacin