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.
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.
aVA Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD
bDepartment of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD
cDepartment of Neurology, University of Maryland School of Medicine, Baltimore, MD
dDepartment of Pathology, University of Maryland School of Medicine, Baltimore, MD
eVA Medical Center, Department of Neurology, Georgetown University School of Medicine, Washington, DC
Correspondence to Mary-Claire Roghmann, MD, MS, 100 N Greene St (lower level), Baltimore, MD 21201.
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.
ABSTRACT