The Clinical Impact of Fluoroquinolone Resistance in Patients With E coli Bacteremia

BACKGROUND: There are limited data on fluoroquinolone resistance and its impact on mortality in cases of Escherichia coli bloodstream infection (BSI). OBJECTIVE: To determine risk factors for in-hospital mortality among patients with E coli BSIs. DESIGN: A retrospective case-control study. SETTING: A 1250-bed tertiary academic medical center. PATIENTS: Patients with fluoroquinolone-resistant E coli BSI from January 1, 2000 through December 31, 2005 with 1:1 matched control patients with fluoroquinolone-sensitive E coli BSI. INDEPENDENT OUTCOME: In-hospital mortality. RESULTS: A total of 93 cases and 93 control patients were included. Compared with control patients, cases were more likely to be admitted from a long-term care facility (35% vs. 9%; P < .001) and to have a hospital-acquired bacteremia (54% vs. 33%; P = .008). Crude mortality was 26% for cases and 8% for controls (P = .002). On univariate analysis, predictors for in-hospital mortality included female gender, admission from a long-term care facility, APACHE II score > 10, Charlson comorbidity score > 4, cardiac dysfunction, cirrhosis, renal dysfunction, treatment with corticosteroids, and a fluoroquinolone-resistant E coli bacteremia. On multivariate analysis, independent risk factors for in-hospital mortality were cirrhosis (adjusted odds ratio [aOR], 7.2; confidence interval [Cl], 1.7-29.8; P = .007), cardiac dysfunction (aOR, 3.9; Cl, 1.6-9.4; P = .003), and infection with a fluoroquinolone-resistant E coli isolate (aOR, 3.9; Cl, 1.5-10.2; P = .005). CONCLUSIONS: After controlling for severity of illness and multiple comorbidities only fluoroquinolone resistance, cirrhosis, and cardiac dysfunction independently predicted mortality in patients with E coli bacteremia. Journal of Hospital Medicine 2011;6:344-349. (C) 2011 Society of Hospital Medicine