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Fluoroquinolones could increase risk for MDR gram-negative bacilli colonization

Issue: November 2014

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PHILADELPHIA — The use of fluoroquinolones to treat deployment-related injuries was associated with multidrug-resistant gram-negative bacilli colonization, according to data presented at IDWeek 2014.

“One of the big things we think of is antibiotic stewardship, and patients who really need antibiotics choosing wisely,” Laura Gilbert, MD, of the Walter Reed National Military Medical Center in Bethesda, Md., told Infectious Disease News. “We saw patients who had received lots of blood transfusions or whose infections were at higher risk of receiving a lot of antibiotics, especially fluoroquinolones, and we found that a lot of fluoroquinolones can cause resistance to the MDR gram-negatives.”

Laura Gilbert

Gilbert and colleagues examined the registry data of 2,079 deployment-injured patients admitted to US hospitals participating in the Trauma Infectious Diseases Outcome Study. Among patients with MDR gram-negative bacilli (n=289), 74% were colonized with Escherichia coli, 15% Acinetobacter baumannii, 10% Klebsiella pneumoniae, 1% Enterobacter cloacae and fewer than 1% with Citrobacter species.

Factors associated with MDR gram-negative bacilli colonization included injury from April to September (OR=1.8; 95%, 1.4-2.4), massive blood transfusion (OR=2.7; 95% CI, 1.7-4.2), fluoroquinolone use post-injury (OR=1.8; 95% CI, 1.4-2.5) and infection prior to arrival in US (OR=1.7; 95% CI, 1.1-2.6). Factors that were not associated included branch of service, country of injury, mechanism of injury, ICU admission, injury severity score, indwelling orthopedic hardware and use of cefazolin or carbapenem.

“Although several factors are associated with higher rates of MDR gram-negative bacilli colonization post-deployment-related injury, fluoroquinolone use is the only modifiable one,” the authors wrote. “This finding proves further support for current guidelines which do not recommend routine fluoroquinolone use for post-injury prophylaxis.” — by Dave Muoio

For more information:

Gilbert L. Abstract 325. Presented at: IDWeek 2014; Oct. 8-12, 2014; Philadelphia.

Disclosure: The researchers report no relevant financial disclosures.