This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Schwaber, M. J.
Right arrow Articles by Carmeli, Y.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Schwaber, M. J.
Right arrow Articles by Carmeli, Y.

 Previous Article  |  Next Article 

Antimicrobial Agents and Chemotherapy, June 2003, p. 1882-1886, Vol. 47, No. 6
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.6.1882-1886.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Treatment with a Broad-Spectrum Cephalosporin versus Piperacillin-Tazobactam and the Risk for Isolation of Broad-Spectrum Cephalosporin-Resistant Enterobacter Species

Mitchell J. Schwaber,1,2* Camilla S. Graham,1 Bruce E. Sands,3 Howard S. Gold,1 and Yehuda Carmeli1,2

Division of Infectious Diseases and Department of Medicine, Beth Israel Deaconess Medical Center,1 Division of Gastroenterology and Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts,3 Unit of Epidemiology, Tel-Aviv Sourasky Medical Center, Tel Aviv 64239, Israel2

Received 9 December 2002/ Returned for modification 14 January 2003/ Accepted 24 March 2003

Receipt of a broad-spectrum cephalosporin is a strong risk factor for isolation of broad-spectrum cephalosporin-resistant Enterobacter species, and yet the risk from other broad-spectrum ß-lactams hydrolyzed by group 1 ß-lactamases has not been well characterized. We compared the risk conferred by broad-spectrum cephalosporins to that conferred by piperacillin-tazobactam, alone or in combination with an aminoglycoside or a fluoroquinolone. A retrospective cohort was monitored from treatment onset until a broad-spectrum cephalosporin-resistant Enterobacter strain was isolated or the patient was discharged. There were 447 patients in the piperacillin-tazobactam group and 2,341 patients in the broad-spectrum cephalosporin group. Groups were similar in age (mean, 62.5 years). The piperacillin-tazobactam group had a smaller percentage of men (32% versus 44%, P < 0.001) and a lower rate of intensive care unit stay (25% versus 38%, P < 0.001) but a higher rate of surgery (41% versus 26%, P < 0.001). Groups differed in the distribution of comorbidities. Resistant Enterobacter strains were isolated from 62 patients, 2% in each group (hazard ratio [RR] = 1.02 [P = 0.95]). In multivariable analysis, risk was similar among treatment groups (RR = 0.71 [P = 0.32]). Intensive care unit stay and surgery were associated with increased risk (RR = 4.53 [P < 0.001] and RR = 1.97 [P = 0.015], respectively), fluoroquinolones were protective (RR = 0.24 [P = 0.003]), and aminoglycosides did not affect risk (RR = 0.98 [P = 0.95]). The protective effect of fluoroquinolones against isolation of broad-spectrum cephalosporin-resistant Enterobacter spp. and the equivalence in risk associated with piperacillin-tazobactam and broad-spectrum cephalosporins may have important clinical and epidemiologic implications.

* Corresponding author. Mailing address: Unit of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel-Aviv 64239, Israel. Phone: (011) 972-5-673-8066. Fax: (011) 972-3-697-4996. E-mail: mschwabe{at}caregroup.harvard.edu.

Antimicrobial Agents and Chemotherapy, June 2003, p. 1882-1886, Vol. 47, No. 6
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.6.1882-1886.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Baughman, R. P. (2009). The Use of Carbapenems in the Treatment of Serious Infections. J Intensive Care Med 24: 230-241 [Abstract]  
  • Marchaim, D., Navon-Venezia, S., Schwaber, M. J., Carmeli, Y. (2008). Isolation of Imipenem-Resistant Enterobacter Species: Emergence of KPC-2 Carbapenemase, Molecular Characterization, Epidemiology, and Outcomes. Antimicrob. Agents Chemother. 52: 1413-1418 [Abstract] [Full Text]  
  • Schlesinger, J., Navon-Venezia, S., Chmelnitsky, I., Hammer-Munz, O., Leavitt, A., Gold, H. S., Schwaber, M. J., Carmeli, Y. (2005). Extended-Spectrum Beta-Lactamases among Enterobacter Isolates Obtained in Tel Aviv, Israel. Antimicrob. Agents Chemother. 49: 1150-1156 [Abstract] [Full Text]  


Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»