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. 1989 Nov;33(11):1855–1859. doi: 10.1128/aac.33.11.1855

Antimicrobial susceptibility in gram-negative bacteremia: are nosocomial isolates really more resistant?

J E McGowan Jr 1, E C Hall 1, P L Parrott 1
PMCID: PMC172776  PMID: 2610495

Abstract

Bloodstream isolates of gram-negative aerobic bacilli from nosocomial infections are more likely to be resistant to antimicrobial agents than isolates from community-acquired cases are. It is not clear, however, how much this is due to the markedly different distribution of organisms in the two groups. We compared the susceptibilities of organisms of a given species which caused community-acquired bacteremia with the susceptibilities of isolates from nosocomial cases. Nine antimicrobial agents were tested against 1,077 isolates which were obtained during a 4-year nonepidemic period. Marked differences in crude rates of resistance were noted for all isolates from nosocomial cases versus all isolates from cases acquired in the community. When results were adjusted for the different organism distributions in the two groups, statistically significant differences were found for only six drug-organism pairs; in each of these, resistance rates were higher in nosocomial isolates. However, when results were further adjusted for the effect of multiple analyses, no significant differences were seen. The major factor leading to the greater prevalence of antimicrobial resistance in our hospital organisms was the markedly different distribution of organisms in the nosocomial and community-acquired groups. For individual organisms, greater resistance in nosocomial strains was confined to certain drugs. Factors that influence differences in organism distribution may not be solely the result of antimicrobial use.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alford R. H., Hall A. Epidemiology of infections caused by gentamicin-resistant enterobacteriaceae and Pseudomonas aeruginosa over 15 years at the Nashville Veterans Administration Medical Center. Rev Infect Dis. 1987 Nov-Dec;9(6):1079–1086. doi: 10.1093/clinids/9.6.1079. [DOI] [PubMed] [Google Scholar]
  2. Atkinson B. A., Lorian V. Antimicrobial agent susceptibility patterns of bacteria in hospitals from 1971 to 1982. J Clin Microbiol. 1984 Oct;20(4):791–796. doi: 10.1128/jcm.20.4.791-796.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cohen J. Variations in sensitivities to antibiotics. Nosocomial versus community-acquired infections caused by same organism. N Y State J Med. 1976 Mar;76(3):391–393. [PubMed] [Google Scholar]
  4. Ellner P. D., Fink D. J., Neu H. C., Parry M. F. Epidemiologic factors affecting antimicrobial resistance of common bacterial isolates. J Clin Microbiol. 1987 Sep;25(9):1668–1674. doi: 10.1128/jcm.25.9.1668-1674.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Forgacs I. C., Eykyn S. J., Bradley R. D. Serious infection in the intensive therapy unit: a 15-year study of bacteraemia. Q J Med. 1986 Aug;60(232):773–779. [PubMed] [Google Scholar]
  6. Garner J. S., Jarvis W. R., Emori T. G., Horan T. C., Hughes J. M. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988 Jun;16(3):128–140. doi: 10.1016/0196-6553(88)90053-3. [DOI] [PubMed] [Google Scholar]
  7. Gaynes R. P., Cooksey R., Thornsberry C., Swenson J. M., Hughes J. M. Mechanism of aminoglycoside resistance among beta-lactam-resistant Escherichia coli in the United States. Diagn Microbiol Infect Dis. 1987 May;7(1):45–50. doi: 10.1016/0732-8893(87)90068-x. [DOI] [PubMed] [Google Scholar]
  8. Klingman K., Mylotte J. M. Ampicillin and cephalothin susceptibility of community-acquired Enterobacteriaceae. N Y State J Med. 1982 Dec;82(13):1801–1804. [PubMed] [Google Scholar]
  9. Lorian V., Topf B. Microbiology of nosocomial infections. Arch Intern Med. 1972 Jul;130(1):104–110. [PubMed] [Google Scholar]
  10. Lynch J. M., Hodges G. R., Clark G. M., Dworzack D. L. Gram-negative bacteremias. Analysis of factors for clinical assessment of gentamicin resistance. Arch Intern Med. 1981 Apr;141(5):582–586. doi: 10.1001/archinte.141.5.582. [DOI] [PubMed] [Google Scholar]
  11. Magnussen C. R., Jacobson M. T. Longitudinal analysis of endemic gentamicin- and tobramycin-resistant gram-negative bacilli in a community hospital. Infect Control. 1984 Feb;5(2):88–92. doi: 10.1017/s0195941700059014. [DOI] [PubMed] [Google Scholar]
  12. McCue J. D. Cefoxitin resistance in community-acquired gram-negative bacillary bacteremia. Associated clinical risk factors. Arch Intern Med. 1985 May;145(5):834–836. [PubMed] [Google Scholar]
  13. McGowan J. E., Jr Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis. 1983 Nov-Dec;5(6):1033–1048. doi: 10.1093/clinids/5.6.1033. [DOI] [PubMed] [Google Scholar]
  14. McGowan J. E., Jr Changing etiology of nosocomial bacteremia and fungemia and other hospital-acquired infections. Rev Infect Dis. 1985 Jul-Aug;7 (Suppl 3):S357–S370. doi: 10.1093/clinids/7.supplement_3.s357. [DOI] [PubMed] [Google Scholar]
  15. McGowan J. E., Jr, Garner C., Wilcox C., Finland M. Antibiotic susceptibility of gram-negative bacilli isolated from blood cultures. Results of tests with 35 agents and strains from 169 patients at Boston City Hospital during 1972. Am J Med. 1974 Aug;57(2):225–238. doi: 10.1016/0002-9343(74)90447-1. [DOI] [PubMed] [Google Scholar]
  16. McGowan J. E., Jr Is antimicrobial resistance in hospital microorganisms related to antibiotic use? Bull N Y Acad Med. 1987 Apr;63(3):253–268. [PMC free article] [PubMed] [Google Scholar]
  17. McGowan J. E., Jr, Parrott P. L., Duty V. P. Nosocomial bacteremia. Potential for prevention of procedure-related cases. JAMA. 1977 Jun 20;237(25):2727–2729. doi: 10.1001/jama.237.25.2727. [DOI] [PubMed] [Google Scholar]
  18. Murthy S. K., Baltch A. L., Smith R. P., Desjardin E. K., Hammer M. C., Conroy J. V., Michelsen P. B. Oropharyngeal and fecal carriage of Pseudomonas aeruginosa in hospital patients. J Clin Microbiol. 1989 Jan;27(1):35–40. doi: 10.1128/jcm.27.1.35-40.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. O'Brien P. C., Shampo M. A. Statistical considerations for performing multiple tests in a single experiment. 1. Introduction. Mayo Clin Proc. 1988 Aug;63(8):813–815. doi: 10.1016/s0025-6196(12)62362-3. [DOI] [PubMed] [Google Scholar]
  20. O'Brien T. F., Acar J. F., Medeiros A. A., Norton R. A., Goldstein F., Kent R. L. International comparison of prevalence of resistance to antibiotics. JAMA. 1978 Apr 14;239(15):1518–1523. [PubMed] [Google Scholar]
  21. Rhame F. S. Surveillance objectives: descriptive epidemiology. Infect Control. 1987 Nov;8(11):454–458. doi: 10.1017/s0195941700069770. [DOI] [PubMed] [Google Scholar]
  22. Rubinstein E., Mark Z., Keren G., Alkan M., Berger S., Bogokowski B. Comparative activity of ofloxacin with reference to bacterial strains isolated in in-patients and out-patients. Infection. 1986;14 (Suppl 1):S20–S25. doi: 10.1007/BF01645193. [DOI] [PubMed] [Google Scholar]
  23. Schaberg D. R., Haley R. W., Highsmith A. K., Anderson R. L., McGowan J. E., Jr Nosocomial bacteriuria: a prospective study of case clustering and antimicrobial resistance. Ann Intern Med. 1980 Sep;93(3):420–424. doi: 10.7326/0003-4819-93-3-420. [DOI] [PubMed] [Google Scholar]
  24. Siegman-Igra Y., Schwartz D., Gonen I., Konforti N. Bacteremic infections in granulopenic patients in Israel. Isr J Med Sci. 1987 Dec;23(12):1214–1218. [PubMed] [Google Scholar]
  25. Smith D. G., Clemens J., Crede W., Harvey M., Gracely E. J. Impact of multiple comparisons in randomized clinical trials. Am J Med. 1987 Sep;83(3):545–550. doi: 10.1016/0002-9343(87)90768-6. [DOI] [PubMed] [Google Scholar]
  26. Warren J. W. Providencia stuartii: a common cause of antibiotic-resistant bacteriuria in patients with long-term indwelling catheters. Rev Infect Dis. 1986 Jan-Feb;8(1):61–67. doi: 10.1093/clinids/8.1.61. [DOI] [PubMed] [Google Scholar]
  27. Weinstein R. A. Resistant bacteria and infection control in the nursing home and hospital. Bull N Y Acad Med. 1987 Apr;63(3):337–344. [PMC free article] [PubMed] [Google Scholar]

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