Archives of Physical Medicine and Rehabilitation
Volume 87, Issue 10 , Pages 1305-1309, October 2006

Prevalence and Natural History of Colonization With Fluoroquinolone-Resistant Gram-Negative Bacilli in Community-Dwelling People With Spinal Cord Dysfunction

Presented in part to the 44th Interscience Conference on Antimicrobial Agents and Chemotherapy, November 2, 2004, Washington, DC, and the American Spinal Injury Association and International Spinal Cord Society, June 27, 2006, Boston, MA.

  • Mary-Claire Roghmann, MD

      Affiliations

    • VA Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD
    • Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD
    • Corresponding Author InformationCorrespondence to Mary-Claire Roghmann, MD, MS, 100 N Greene St (lower level), Baltimore, MD 21201.
    • ,
  • Mitchell T. Wallin, MD

      Affiliations

    • VA Medical Center, Department of Neurology, Georgetown University School of Medicine, Washington, DC
    • ,
  • Peter H. Gorman, MD

      Affiliations

    • VA Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD
    • Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
    • ,
  • Judith A. Johnson, PhD

      Affiliations

    • VA Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD
    • Department of Pathology, University of Maryland School of Medicine, Baltimore, MD

Abstract 

Roghmann M-C, Wallin MT, Gorman PH, Johnson JA. Prevalence and natural history of colonization with fluoroquinolone-resistant gram-negative bacilli in community-dwelling people with spinal cord dysfunction.

Objectives

To estimate the prevalence of colonization with fluoroquinolone-resistant gram-negative bacilli (GNB) and to assess risk factors for and define the natural history of colonization.

Design

Cross-sectional study with follow-up of up to 1 year.

Setting

Multiple outpatient sites.

Participants

Eighty-four community-dwelling adults with spinal cord dysfunction.

Interventions

Not applicable.

Main Outcome Measure

Colonization of perineum with fluoroquinolone-resistant GNB.

Results

Overall, 24% of this community-dwelling cohort was colonized with fluoroquinolone-resistant GNB with resistance to both levofloxacin and gatifloxacin. The use of any antibiotic in the last 90 days was most strongly associated with an increased risk of colonization with fluoroquinolone-resistant GNB (relative risk, 2.3; 95% confidence interval, 1.1−4.8; P=.05). Incontinence was significantly more common among those with fluoroquinolone-resistant GNB colonization. Among the participants with incontinence (n=42), the use of intermittent catheterization (vs suprapubic, urethral, or condom catheters or overflow incontinence) was significantly protective. Colonization was not associated with an increase in urinary tract infection and was often transient.

Conclusions

Fluoroquinolone resistance among GNB colonizing community-dwelling people with spinal cord dysfunction is common. Colonization is more common among those receiving antibiotics and less common among those continent of urine. Among those with incontinence, those using intermittent catheterization have less colonization.

Key Words: Antibiotic resistance, Anti-infective agents, fluoroquinolone, Cross-sectional study, Multiple sclerosis, Rehabilitation, Spinal cord injuries, Urinary tract infections

 

 Supported by a VA Merit Review Grant Clinical Science Research and Development, the University of Maryland School of Medicine General Clinical Research Center (grant no. M01-RR-16500), and a Merck Medical School grant.No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.Reprints are not available from the author.

PII: S0003-9993(06)00846-X

doi:10.1016/j.apmr.2006.07.260

Archives of Physical Medicine and Rehabilitation
Volume 87, Issue 10 , Pages 1305-1309, October 2006

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