The importance of addressing multidrug resistance and not assuming single-drug resistance in case-control studies

Erika M C D'Agata, Maria Adriana Cataldo, Roberto Cauda, Evelina Tacconelli

Research output: Contribution to journalArticle

Abstract

BACKGROUND. Case-control studies analyzing antibiotic exposure as a risk factor for antimicrobial resistance usually assume single-drug resistance in the bacteria under study, even though resistance to multiple antimicrobials may be present. Since antibiotic selection pressures differ depending on the susceptibility profile of the antimicrobial-resistant bacteria, an accurate assessment of whether exposure to an individual antimicrobial is a risk factor for the emergence of resistance should distinguish between single-drug-resistant and multidrug-resistant bacteria. OBJECTIVE. To determine whether the exposures to individual antibiotics that were identified as independent risk factors in case-control studies differed depending on whether single-drug-resistant or multidrug-resistant bacteria were evaluated. DESIGN. Two retrospective case-control studies were performed with data on patients harboring Pseudomonas aeruginosa strains resistant only to ciprofloxacin (CRPA) and patients harboring P. aeruginosa strains resistant to ciprofloxacin and other antibiotics (multidrug-resistant P. aeruginosa [MDR-PA]). These 2 groups were compared with patients not harboring P. aeruginosa. SETTING. Two tertiary care hospitals. RESULTS. A total of 41 patients harboring CRPA and 151 patients harboring MDR-PA were identified and matched to 192 control subjects. By conditional logistic regression, independent risk factors associated with presence of CRPA were nonambulatory status (OR, 5.6 [95% confidence interval {CI}, 1.4-23]; P = .02) and prior ciprofloxacin exposure (OR, 5.0 [95% CI, 1.2-21]; P = .03). Independent risk factors for presence of MDR-PA were a Charlson score greater than 2 (OR, 3.3 [95% CI 1.8-6.0]; P <.001) and exposure to quinolones (OR, 2.8 [95% CI, 1.2-5.0]; P = .001), third- and fourth-generation cephalosporins (OR, 3.5 [95% CI, 1.7-7.1]; P <.001), imipenem (OR, 3.8 [95% CI, 1.2-12.1]; P = .02), and/or aminoglycosides (OR, 2.3 [95% CI, 1.04-5.1]; P = .04). CONCLUSION. There were substantial differences in exposure to individual antimicrobials between patients harboring CRPA and patients harboring MDR-PA. Future case-control studies addressing risk factors for single-drug-resistant bacteria should consider the complete susceptibility profile of the bacteria under investigation.

Original languageEnglish
Pages (from-to)670-674
Number of pages5
JournalInfection Control and Hospital Epidemiology
Volume27
Issue number7
DOIs
Publication statusPublished - Jul 2006

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Multiple Drug Resistance
Drug Resistance
Pseudomonas aeruginosa
Case-Control Studies
Confidence Intervals
Bacteria
Ciprofloxacin
Anti-Bacterial Agents
Pharmaceutical Preparations
Imipenem
Quinolones
Aminoglycosides
Tertiary Healthcare
Cephalosporins
Tertiary Care Centers
Logistic Models
Pressure

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology

Cite this

The importance of addressing multidrug resistance and not assuming single-drug resistance in case-control studies. / D&apos;Agata, Erika M C; Cataldo, Maria Adriana; Cauda, Roberto; Tacconelli, Evelina.

In: Infection Control and Hospital Epidemiology, Vol. 27, No. 7, 07.2006, p. 670-674.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND. Case-control studies analyzing antibiotic exposure as a risk factor for antimicrobial resistance usually assume single-drug resistance in the bacteria under study, even though resistance to multiple antimicrobials may be present. Since antibiotic selection pressures differ depending on the susceptibility profile of the antimicrobial-resistant bacteria, an accurate assessment of whether exposure to an individual antimicrobial is a risk factor for the emergence of resistance should distinguish between single-drug-resistant and multidrug-resistant bacteria. OBJECTIVE. To determine whether the exposures to individual antibiotics that were identified as independent risk factors in case-control studies differed depending on whether single-drug-resistant or multidrug-resistant bacteria were evaluated. DESIGN. Two retrospective case-control studies were performed with data on patients harboring Pseudomonas aeruginosa strains resistant only to ciprofloxacin (CRPA) and patients harboring P. aeruginosa strains resistant to ciprofloxacin and other antibiotics (multidrug-resistant P. aeruginosa [MDR-PA]). These 2 groups were compared with patients not harboring P. aeruginosa. SETTING. Two tertiary care hospitals. RESULTS. A total of 41 patients harboring CRPA and 151 patients harboring MDR-PA were identified and matched to 192 control subjects. By conditional logistic regression, independent risk factors associated with presence of CRPA were nonambulatory status (OR, 5.6 [95{\%} confidence interval {CI}, 1.4-23]; P = .02) and prior ciprofloxacin exposure (OR, 5.0 [95{\%} CI, 1.2-21]; P = .03). Independent risk factors for presence of MDR-PA were a Charlson score greater than 2 (OR, 3.3 [95{\%} CI 1.8-6.0]; P <.001) and exposure to quinolones (OR, 2.8 [95{\%} CI, 1.2-5.0]; P = .001), third- and fourth-generation cephalosporins (OR, 3.5 [95{\%} CI, 1.7-7.1]; P <.001), imipenem (OR, 3.8 [95{\%} CI, 1.2-12.1]; P = .02), and/or aminoglycosides (OR, 2.3 [95{\%} CI, 1.04-5.1]; P = .04). CONCLUSION. There were substantial differences in exposure to individual antimicrobials between patients harboring CRPA and patients harboring MDR-PA. Future case-control studies addressing risk factors for single-drug-resistant bacteria should consider the complete susceptibility profile of the bacteria under investigation.",
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T1 - The importance of addressing multidrug resistance and not assuming single-drug resistance in case-control studies

AU - D&apos;Agata, Erika M C

AU - Cataldo, Maria Adriana

AU - Cauda, Roberto

AU - Tacconelli, Evelina

PY - 2006/7

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N2 - BACKGROUND. Case-control studies analyzing antibiotic exposure as a risk factor for antimicrobial resistance usually assume single-drug resistance in the bacteria under study, even though resistance to multiple antimicrobials may be present. Since antibiotic selection pressures differ depending on the susceptibility profile of the antimicrobial-resistant bacteria, an accurate assessment of whether exposure to an individual antimicrobial is a risk factor for the emergence of resistance should distinguish between single-drug-resistant and multidrug-resistant bacteria. OBJECTIVE. To determine whether the exposures to individual antibiotics that were identified as independent risk factors in case-control studies differed depending on whether single-drug-resistant or multidrug-resistant bacteria were evaluated. DESIGN. Two retrospective case-control studies were performed with data on patients harboring Pseudomonas aeruginosa strains resistant only to ciprofloxacin (CRPA) and patients harboring P. aeruginosa strains resistant to ciprofloxacin and other antibiotics (multidrug-resistant P. aeruginosa [MDR-PA]). These 2 groups were compared with patients not harboring P. aeruginosa. SETTING. Two tertiary care hospitals. RESULTS. A total of 41 patients harboring CRPA and 151 patients harboring MDR-PA were identified and matched to 192 control subjects. By conditional logistic regression, independent risk factors associated with presence of CRPA were nonambulatory status (OR, 5.6 [95% confidence interval {CI}, 1.4-23]; P = .02) and prior ciprofloxacin exposure (OR, 5.0 [95% CI, 1.2-21]; P = .03). Independent risk factors for presence of MDR-PA were a Charlson score greater than 2 (OR, 3.3 [95% CI 1.8-6.0]; P <.001) and exposure to quinolones (OR, 2.8 [95% CI, 1.2-5.0]; P = .001), third- and fourth-generation cephalosporins (OR, 3.5 [95% CI, 1.7-7.1]; P <.001), imipenem (OR, 3.8 [95% CI, 1.2-12.1]; P = .02), and/or aminoglycosides (OR, 2.3 [95% CI, 1.04-5.1]; P = .04). CONCLUSION. There were substantial differences in exposure to individual antimicrobials between patients harboring CRPA and patients harboring MDR-PA. Future case-control studies addressing risk factors for single-drug-resistant bacteria should consider the complete susceptibility profile of the bacteria under investigation.

AB - BACKGROUND. Case-control studies analyzing antibiotic exposure as a risk factor for antimicrobial resistance usually assume single-drug resistance in the bacteria under study, even though resistance to multiple antimicrobials may be present. Since antibiotic selection pressures differ depending on the susceptibility profile of the antimicrobial-resistant bacteria, an accurate assessment of whether exposure to an individual antimicrobial is a risk factor for the emergence of resistance should distinguish between single-drug-resistant and multidrug-resistant bacteria. OBJECTIVE. To determine whether the exposures to individual antibiotics that were identified as independent risk factors in case-control studies differed depending on whether single-drug-resistant or multidrug-resistant bacteria were evaluated. DESIGN. Two retrospective case-control studies were performed with data on patients harboring Pseudomonas aeruginosa strains resistant only to ciprofloxacin (CRPA) and patients harboring P. aeruginosa strains resistant to ciprofloxacin and other antibiotics (multidrug-resistant P. aeruginosa [MDR-PA]). These 2 groups were compared with patients not harboring P. aeruginosa. SETTING. Two tertiary care hospitals. RESULTS. A total of 41 patients harboring CRPA and 151 patients harboring MDR-PA were identified and matched to 192 control subjects. By conditional logistic regression, independent risk factors associated with presence of CRPA were nonambulatory status (OR, 5.6 [95% confidence interval {CI}, 1.4-23]; P = .02) and prior ciprofloxacin exposure (OR, 5.0 [95% CI, 1.2-21]; P = .03). Independent risk factors for presence of MDR-PA were a Charlson score greater than 2 (OR, 3.3 [95% CI 1.8-6.0]; P <.001) and exposure to quinolones (OR, 2.8 [95% CI, 1.2-5.0]; P = .001), third- and fourth-generation cephalosporins (OR, 3.5 [95% CI, 1.7-7.1]; P <.001), imipenem (OR, 3.8 [95% CI, 1.2-12.1]; P = .02), and/or aminoglycosides (OR, 2.3 [95% CI, 1.04-5.1]; P = .04). CONCLUSION. There were substantial differences in exposure to individual antimicrobials between patients harboring CRPA and patients harboring MDR-PA. Future case-control studies addressing risk factors for single-drug-resistant bacteria should consider the complete susceptibility profile of the bacteria under investigation.

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