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Antimicrobial Agents and Chemotherapy, April 2000, p. 1004-1009, Vol. 44, No. 4
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Risk Factors for Recovery of Ampicillin-Sulbactam-Resistant Escherichia coli in Hospitalized Patients

Keith S. Kaye,* Anthony D. Harris, Howard Gold, and Yehuda Carmeli

Division of Infectious Diseases, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts

Received 2 August 1999/Returned for modification 9 December 1999/Accepted 13 January 2000

Ampicillin-sulbactam resistance in Escherichia coli is an emerging problem. This study determined risk factors for the recovery of ampicillin-sulbactam-resistant E. coli in hospitalized patients. A case-control design was used to compare two groups of case patients with control patients. The first group of case patients consisted of patients from whom nosocomially acquired ampicillin-sulbactam-resistant E. coli strains were isolated, and the second group of case patients consisted of patients from whom ampicillin-sulbactam-susceptible E. coli strains were isolated. Control patients were a random selection among 5% of all patients admitted during the same time period. Risk factors analyzed included antimicrobial drug exposure, comorbid conditions, and demographics. Univariate and multivariate analyses were performed. Ampicillin-sulbactam-resistant E. coli strains were isolated from 175 patients, and ampicillin-sulbactam-susceptible E. coli strains were isolated from 577 patients. Nine hundred thirty-four control patients were selected. Exposure to penicillin antibiotics as a class and to ampicillin and ampicillin-sulbactam individually were the only significant, independent risk factors associated with the isolation of ampicillin-sulbactam-resistant E. coli (odds ratio [OR] = 2.32 [P < 0.001], OR = 3.04 [P = 0.02], and OR = 1.72 [P = 0.04], respectively), but they were not associated with the isolation of ampicillin-sulbactam-susceptible E. coli. Interestingly, exposure to piperacillin-tazobactam tended to protect against the isolation of E. coli strains resistant to ampicillin-sulbactam, but this did not reach statistical significance (OR = 0.13; P = 0.11).

* Corresponding author. Mailing address: Division of Infectious Diseases, Beth Israel Deaconess Medical Center East Campus, 330 Brookline Ave., SL-435, Boston, MA 02215. Phone: (617) 667-2249. Fax: (617) 667-7251. E-mail: kkaye{at}caregroup.harvard.edu.

Antimicrobial Agents and Chemotherapy, April 2000, p. 1004-1009, Vol. 44, No. 4
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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