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JAC Advance Access published online on December 1, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh510
© 2004 by The British Society for Antimicrobial Chemotherapy
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Received July 26, 2004
Revised October 3, 2004
Accepted October 23, 2004

Original article

Fluoroquinolone consumption and resistance in haematology-oncology patients: ecological analysis in two university hospitals 1999-2002

Winfried V. Kern 1*, Michaela Steib-Bauert 1, Katja de With 1, Stefan Reuter 2, Hartmut Bertz 3, Uwe Frank 4, and Heike von Baum 5

1 Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital, Hugstetter Strasse 55, D-79106 Freiburg, Germany
2 Section of Infectious Diseases and Clinical Immunology, University Hospital and Medical Center, Ulm, Germany; Department of Haematology-Oncology, University Hospital and Medical Center, Ulm, Germany
3 Department of Haematology-Oncology, University Hospital, Hugstetter Strasse 55, D-79106 Freiburg, Germany
4 Institute of Environmental Medicine and Hospital Epidemiology, University Hospital, Hugstetter Strasse 55, D-79106 Freiburg, Germany
5 Section of Hospital Hygiene, Department of Medical Microbiology and Hygiene, University of Ulm, Ulm, Germany

* To whom correspondence should be addressed.
Winfried V. Kern, E-mail: info{at}if-freiburg.de


  Abstract

Objectives: To compare rates of in vitro fluoroquinolone resistance of bacterial isolates obtained from inpatients of two haematology-oncology services with high and low fluoroquinolone consumption.

Methods: Two hospitals with consistently high (A) and low (B) fluoroquinolone use in their haematology-oncology services between the years 1999 and 2002 were identified in a hospital antibiotic use surveillance project. Rates of in vitro resistance to fluoroquinolones in inpatients of the services were determined for Escherichia coli and coagulase-negative staphylococcal bloodstream isolates, and also for Pseudomonas aeruginosa and Staphylococcus aureus isolates from any site.

Results: Fluoroquinolone resistance of E. coli was significantly higher in hospital A than in hospital B, but there was no such correlation between fluoroquinolone use and resistance rates for P. aeruginosa and staphylococci.

Conclusion: The impact of antibiotic consumption on the prevalence of resistance may differ widely between different pathogens. Interventions using ecological analyses of the relationship between hospital antibiotic use and resistance need to consider pathogen-specific dynamics in the emergence and control of bacterial resistance.

Keywords: antibiotic use; Escherichia coli; fluoroquinolone resistance; antibiotic policy; drug utilization; febrile neutropenia; resistance epidemiology; staphylococci.
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