Optimization of empirical antibiotic selection for suspected Gram-negative bacteraemia in the emergency department

Int J Antimicrob Agents. 2005 May;25(5):398-403. doi: 10.1016/j.ijantimicag.2005.01.019.

Abstract

A 1-year prospective study of patients with a positive blood culture and admitted through the emergency department (ED), was conducted to detect incidence and risk factors for resistance of Enterobacteriaceae to gentamicin and ciprofloxacin. A total of 245 emergency department-admitted patients had positive blood cultures, of which 131 (54%) grew Enterobacteriaceae. Of these 131 isolates, 32 (24%) were resistant to gentamicin and 37 (28%) to ciprofloxacin. Risk factors, by multivariate analysis, for gentamicin and ciprofloxacin resistance were: male gender (P<0.05 and P<0.01, respectively), nursing home residence (P<0.001), diabetes mellitus (P<0.05) and presence of a foreign body (P<0.05 and P<0.005). An additional risk factor for ciprofloxacin resistance was recent hospitalisation (P<0.05). These data facilitate optimal selection of empirical antibiotic treatment of suspected Gram-negative infections, and may contribute to improved patient outcome and optimal use of antibiotics.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteremia / drug therapy*
  • Child
  • Ciprofloxacin / therapeutic use
  • Diabetes Complications
  • Drug Resistance, Bacterial
  • Emergency Service, Hospital*
  • Enterobacteriaceae / drug effects
  • Enterobacteriaceae / isolation & purification
  • Enterobacteriaceae Infections / drug therapy*
  • Enterobacteriaceae Infections / etiology
  • Enterobacteriaceae Infections / microbiology
  • Female
  • Gentamicins / therapeutic use*
  • Humans
  • Infant
  • Male
  • Prospective Studies
  • Risk Factors

Substances

  • Anti-Bacterial Agents
  • Gentamicins
  • Ciprofloxacin