Emergence of Quinolone-Resistant Escherichia coli Bacteremia in Neutropenic Patients with Cancer Who Have Received Prophylactic Norfloxacin

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.

Infections Caused By Escherichia Coli Resistant to Norfloxacin in Hospitalized Cirrhotic Patients

“…[19][20][21][22][23][24][25][26][27][28] These studies showed changes in the bacteria responsible for the infections, because cirrhotic patients submitted to prophylaxis with norfloxacin were infected almost exclusively by gram-positive cocci and gram-negative bacilli were rarely observed because of the apparent absence of resistance to quinolones by these bacteria. [19][20][21][22][23][24]29 However, recent studies have shown an increasing incidence in the resistance of gram-negative bacilli to quinolones in the general population, [30][31][32] as well as in neutropenic [33][34] and cirrhotic 23,35,36 patients submitted to prophylaxis with these antibiotics. This is thought to be a result of the current widespread use of quinolones in these populations.…”

“…This is thought to be a result of the current widespread use of quinolones in these populations. 23,30,31,34 The development of bacterial resistance is perhaps at present the most worrisome concern regards antibiotic prophylaxis in cirrhotic patients, because it might decrease the effectiveness of this method of prophylaxis. 11,37 In addition, bacteria resistant to prophylactic antibiotics could cause more severe infections in patients on prophylaxis than the infections developed by patients without prophylaxis.…”

A randomized comparison of empiric or pre-emptive antibiotic therapy after hematopoietic stem cell transplantation

“…5 Prophylaxis with oral levofloxacin decreased bloodstream infections (BSIs) in one randomized placebocontrolled study, although patients were exclusively undergoing autologous transplantation, and most were receiving therapy for solid tumours rather than leukaemia or lymphoma. 7 The use of prophylactic oral fluoroquinolones remains controversial [8][9][10][11] and the effects of oral antibiotics used prophylactically may not equate to intravenous agents. 12 We and others have hypothesized that pre-emptive intravenous antibiotic therapy, that is, antibiotics commenced at onset of neutropenia or on day of transplant (also referred to as prophylactic antibiotics in some recent publications), would reduce the incidence of fever and bacterial infection during the acute phase of transplantation.…”

Aumento da freqüência de resistência à norfloxacina e ciprofloxacina em bactérias isoladas em uroculturas

“…A introdução de fluoroquinolonas, grupo ao qual pertencem a norfloxacina e ciprofloxacina, na década de 80, significou, sem dúvi-da, um avanço no tratamento de infecções por bactérias multirresistentes, particularmente infecções do trato urinário (ITU) [2][3][4] , visto que diversas cepas de bactérias resistentes a múltiplos antimicrobianos mostraram-se sensíveis a esse novo grupo de medicamentos 5,6 . Trabalhos mais recentes, no entanto, têm alertado para um aumento da freqüência de bactérias resistentes às quinolonas [7][8][9][10] . Esse problema tem sido observado principalmente em pacientes com septicemias graves causadas por bactérias provenientes do trato urinário [8][9][10] .…”

“…Trabalhos mais recentes, no entanto, têm alertado para um aumento da freqüência de bactérias resistentes às quinolonas [7][8][9][10] . Esse problema tem sido observado principalmente em pacientes com septicemias graves causadas por bactérias provenientes do trato urinário [8][9][10] . O presente estudo foi realizado com o objetivo básico de avaliar possíveis modificações, ao longo dos anos, na sensibilidade à norfloxacina e ciprofloxacina de bactérias isoladas de uroculturas provenientes de pacientes ambulatoriais e hospitalizados de um Hospital Universitário localizado em Salvador, BA.…”