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Antimicrobial Agents and Chemotherapy, September 2003, p. 2882-2887, Vol. 47, No. 9
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.9.2882-2887.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Epidemiological Risk Factors for Isolation of Ceftriaxone-Resistant versus -Susceptible Citrobacter freundii in Hospitalized Patients

Peter W. Kim,1,2* Anthony D. Harris,1,2 Mary-Claire Roghmann,1,2 J. Glenn Morris Jr.,1 Arjun Strinivasan,3 and Eli N. Perencevich1,2

Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine,1 Division of Healthcare Outcomes Research, Veterans Affairs Maryland Healthcare System,2 Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland 212013

Received 7 January 2003/ Returned for modification 27 May 2003/ Accepted 23 June 2003

Antimicrobial resistance is an emerging problem among nosocomial bacteria. Risk factors for the recovery of ceftriaxone-resistant (CRCF) or -susceptible (CSCF) Citrobacter freundii in clinical cultures from hospitalized patients were determined by using a case-case-control study design. CRCF was isolated from 43 patients (case group 1) and CSCF was isolated from 87 patients (case group 2) over a 3-year period. Risk factors for CRCF were exposure to imipenem (odds ratio [OR], 7.5; 95% confidence interval [CI], 1.2 to 45.4), broad-spectrum cephalosporins (OR, 6.9; 95% CI, 1.8 to 26.7), vancomycin (OR, 3.0; 95% CI, 1.2 to 7.4), or piperacillin-tazobactam (OR, 2.6; 95% CI, 1.1 to 6.2), as well as hospital length of stay >=1 week (OR, 3.6; 95% CI, 1.3 to 10.2) and intensive care unit (ICU) stay (OR, 2.6; 95% CI, 1.1 to 6.2). Risk factors for CSCF were peripheral vascular disease (OR, 23.2; 95% CI, 4.3 to 124.6), AIDS (OR, 9.5; 95% CI, 1.6 to 55.5), cerebrovascular disease (OR, 4.2; 95% CI, 1.6 to 10.8), and ICU stay (OR, 3.1; 95% CI, 1.8 to 5.4).

* Corresponding author. Mailing address: VA Maryland Health Care System, 100 North Greene St., Room 5D150(BT111), Baltimore, MD 21201. Phone: (410) 706-0063. Fax: (410) 706-0098. E-mail: pkim{at}medicine.umaryland.edu.

Antimicrobial Agents and Chemotherapy, September 2003, p. 2882-2887, Vol. 47, No. 9
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.9.2882-2887.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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