Multicenter in vitro comparative study of fluoroquinolones after four years of widespread clinical use

Waites, Ken B.; Rand, Kenneth H.; Jenkins, Stephen G.; Yangco, Bienvenido G.; Brookings, Eneida S.; Gaskins, Darla; Lewis, Julia W.; Halkias, Kalliope D.

doi:10.1016/0732-8893(94)90089-2

Cited by 16 publications

(6 citation statements)

References 13 publications

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“…The exception to this finding is the abated activity that levofloxacin and ciprofloxacin demonstrated against Providencia spp. Although the reason for the reduced activity against this particular group of organisms is unknown, it has been reported in other studies and may be related to intrinsic permeability or mutational idiosyncrasies in this genus (3,6,19,23,28,29,30).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Current Activities of Fluoroquinolones against Gram-Negative Bacilli Using Centralized In Vitro Testing and Electronic Surveillance

Sahm

Critchley

Kelly

et al. 2001

Antimicrob Agents Chemother

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Given the propensity for Enterobacteriaceae and clinically significant nonfermentative gram-negative bacilli to acquire antimicrobial resistance, consistent surveillance of the activities of agents commonly prescribed to treat infections arising from these organisms is imperative. This study determined the activities of two fluoroquinolones, levofloxacin and ciprofloxacin, and seven comparative agents against recent clinical isolates of Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia using two surveillance strategies: 1) centralized in vitro susceptibility testing of isolates collected from 27 hospital laboratories across the United States and 2) analysis of data from The Surveillance Network Database-USA, an electronic surveillance network comprising more than 200 laboratories nationwide. Regardless of the surveillance method, Enterobacteriaceae, P. aeruginosa, and A. baumannii demonstrated similar rates of susceptibility to levofloxacin and ciprofloxacin. Susceptibilities to the fluoroquinolones approached or exceeded 90% for all Enterobacteriaceae except Providencia spp. (<65%). Approximately 70% of P. aeruginosa and 50% of A. baumanii isolates were susceptible to both fluoroquinolones. Among S. maltophilia isolates, 50% more isolates were susceptible to levofloxacin than to ciprofloxacin. Overall, the rate of ceftazidime nonsusceptibility among Enterobacteriaceae was 8.7%, with fluoroquinolone resistance rates notably higher among ceftazidime-nonsusceptible isolates than ceftazidime-susceptible ones. Multidrug-resistant isolates were present among all species tested but were most prevalent for Klebsiella pneumoniae and Enterobacter cloacae. No gram-negative isolates resistant only to a fluoroquinolone were encountered, regardless of species. Thus, while levofloxacin and ciprofloxacin have maintained potent activity against Enterobacteriaceae, the potential for fluoroquinolone resistance, the apparent association between fluoroquinolone and cephalosporin resistance, and the presence of multidrug resistance in every species examined emphasize the need to maintain active surveillance of resistance patterns among gram-negative bacilli.The potent activity of fluoroquinolones (FQs) against a myriad of gram-negative and gram-positive bacterial pathogens has fostered a decade of frequent and continued clinical use. Recently, levofloxacin has broadened the range of indications for FQs to include community-acquired respiratory tract infections attributable to penicillin-resistant Streptococcus pneumoniae. In spite of their success, concern remains regarding the development and increasing prevalence of resistance to FQs among human pathogens and colonizing bacterial species (12,23,24,25).A decline in the activity of FQs would be especially problematic in view of the ability of gram-negative bacilli to acquire resistance to all other classes of antimicrobials (4,5,10,11,14,15,17,20,22,29,30). This ability underscores the need to closely monitor FQ activity in the Uni...

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Section: Discussionmentioning

confidence: 99%

Evaluation of Current Activities of Fluoroquinolones against Gram-Negative Bacilli Using Centralized In Vitro Testing and Electronic Surveillance

Sahm

Critchley

Kelly

et al. 2001

Antimicrob Agents Chemother

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“…In contrast, resistance to all other agents except vancomycin and ceftriaxone exceeded 10%, and in the case of macrolides, resistance was greater than 20%. While it is difficult to estimate the extent to which fluoroquinolone resistance will increase, the potential of pneumococci to acquire resistance to fluoroquinolones (4,11,25) dictates that timely surveillance be continued. Currently, however, fluoroquinolone resistance in the United States does not appear to be due to clonal distribution of strains and is not associated with the most prevalent MDR phenotypes (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Need for Annual Surveillance of Antimicrobial Resistance in Streptococcus pneumoniae in the United States: 2-Year Longitudinal Analysis

Sahm

Karlowsky

Kelly

et al. 2001

Antimicrob Agents Chemother

115

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Although changing patterns in antimicrobial resistance in Streptococcus pneumoniae have prompted several surveillance initiatives in recent years, the frequency with which these studies are needed has not been addressed. To approach this issue, the extent to which resistance patterns change over a 1-year period was examined. In this study we analyzed S. pneumoniae antimicrobial susceptibility results produced in our laboratory with isolates obtained over 2 consecutive years (1997-1998 and 1998-1999) from the same 96 institutions distributed throughout the United States. Comparison of results revealed increases in resistant percentages for all antimicrobial agents studied except vancomycin. For four of the agents tested (penicillin, cefuroxime, trimethoprim-sulfamethoxazole, and levofloxacin), the increases were statistically significant (P < 0.05). Resistance to the fluoroquinolone remained low in both years (0.1 and 0.6%, respectively); in contrast, resistance to macrolides was consistently greater than 20%, and resistance to trimethoprim-sulfamethoxazole increased from 13.3 to 27.3%. Multidrug resistance, concurrent resistance to three or more antimicrobials of different chemical classes, also increased significantly between years, from 5.9 to 11%. The most prevalent phenotype was resistance to penicillin, azithromycin (representative macrolide), and trimethoprim-sulfamethoxazole. Multidrug-resistant phenotypes that included fluoroquinolone resistance were uncommon; however, two phenotypes that included fluoroquinolone resistance not found in 1997-1998 were encountered in 1998-1999. This longitudinal surveillance study of resistance in S. pneumoniae revealed that significant changes do occur in just a single year and supports the need for surveillance at least on an annual basis, if not continuously.Resistance to ␤-lactams, macrolides, and trimethoprim-sulfamethoxazole (SXT) continues to increase among clinical isolates of Streptococcus pneumoniae. This trend, coupled with the potential for increasing resistance to fluoroquinolones, has prompted several surveillance studies in recent years (4-6, 10, 17, 22, 23). Although evolving patterns in antimicrobial resistance suggest clearly an exigency for such surveillance initiatives, the frequency with which studies are needed has not been addressed.The decision to expend resources to perform resistance surveillance must be based on a careful assessment of how frequently the data and information are needed. One approach to making this determination involves establishing the extent to which resistance rates and patterns change over a given time period. Among the surveillance reports published in recent years, there are substantial differences among institutions, geographic regions, and countries represented; the number of institutions involved; and the time periods during which the isolates were obtained (5,6,10,17,21,22). These differences make analysis of resistance change over time difficult, and only rarely have studies addressed the extent of changes in resista...

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“…resistentes à norfloxacina e ciprofloxacina, desde a época em que foram introduzidas, é consistente com o que tem sido descrito em diversos tipos de infecção 21,22 , incluindo ITU 23,24 . É importante observar que existem indicações que essas cepas de Staphylococcus resistentes à norfloxacina e ciprofloxacina são mais freqüentemente resistentes a diversos outros antimicrobianos 21 .…”

Section: Discussionunclassified

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

Lopes¹,

Salgado²,

Martinelli³

et al. 1998

Rev. Assoc. Med. Bras.

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INTRODUÇÃOAs bactérias resistentes à múltiplos antimicrobianos representam um desafio no tratamento de infecções 1 . 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) 2-4 , 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] . 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. MÉTODOSFoi feito um levantamento de todas as uroculturas positivas (≥10 5 unidades formadoras de colônias por mL de urina, UFC/mL) para as espé-cies bacterianas mais freqüentemente isoladas (Escherichia coli, Klebsiella spp. Staphylococcus spp., Proteus spp. e Enterobacter spp.) no período 1983-1994 e que foram testadas para a sensibilidade à norfloxacina ou ciprofoxacina no laboratório de bacteriologia da Disciplina de Nefrologia, Universidade Federal da Bahia. Esse laboratório recebe material proveniente tanto de pacientes ambulatoriais quanto hospitalizados.Procedimentos microbiológicos -O jato médio da urina de cada paciente foi coletado em recipientes esterilizados no próprio laboratório. Após recebimento da amostra, realizava-se a semeadura direta da urina em meios de ágar sangue e McConkey com alça de platina calibrada (0,01mL), fazendo-se, no dia seguinte (18 a 24 horas), a contagem, na placa de ágar sangue, das colônias bacterianas surgidas [11][12][13] . Em adição procedeu-se, nas fases iniciais do estudo (1983)(1984)(1985)(1986)), a diluição (1/1.000) da urina em solução salina fisiológica estéril, seguida

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Multicenter in vitro comparative study of fluoroquinolones after four years of widespread clinical use

Cited by 16 publications

References 13 publications

Evaluation of Current Activities of Fluoroquinolones against Gram-Negative Bacilli Using Centralized In Vitro Testing and Electronic Surveillance

Evaluation of Current Activities of Fluoroquinolones against Gram-Negative Bacilli Using Centralized In Vitro Testing and Electronic Surveillance

Need for Annual Surveillance of Antimicrobial Resistance in Streptococcus pneumoniae in the United States: 2-Year Longitudinal Analysis

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

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