ArticleAntimicrobial agents and chemotherapy2010
Treatment with fluoroquinolones or with beta-lactam-beta-lactamase inhibitor combinations is a risk factor for isolation of extended-spectrum-beta-lactamase-producing Klebsiella species in hospitalized patients.
Article in Antimicrobial agents and chemotherapy, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.
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Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it, 73 citations in OpenAlex.
- Pooled it
- Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis.Antimicrobial agents and chemotherapy · 2010Pooled it
- Risk factors and scoring system for predicting bacterial resistance to cefepime as used empirically in haematology wards.BioMed research international · 2015Trial
- Determinants of levofloxacin prophylaxis failure in high-risk haematology patients: a prospective study integrating resistant colonization and pharmacokinetic/pharmacodynamic target attainment.The Journal of antimicrobial chemotherapy · 2026Article
- A systematic analysis of various clonal lineages of colistin-resistant Klebsiella pneumoniae with mgrB mutations.Molecular biology reports · 2025Review
- Molecular epidemiology of extended-spectrum beta-lactamase-producing-Frontiers in microbiology · 2024Article
- Prevalence and antimicrobial resistance profiles of extended-spectrum beta-lactamase-producingFrontiers in veterinary science · 2023Article
- Insights and genetic features of extended-spectrum beta-lactamase producing Escherichia coli isolates from two hospitals in Ghana.Scientific reports · 2022Article
- Antibiotic Utilization in Deceased Organ Donors.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Temporal trends, risk factors and outcomes of infections due to extended-spectrum β-lactamase producing Enterobacterales in Swiss solid organ transplant recipients between 2012 and 2018.Antimicrobial resistance and infection control · 2021Article
- Decreased Outpatient Fluoroquinolone Prescribing Using a Multimodal Antimicrobial Stewardship Initiative.Open forum infectious diseases · 2020Article
- The relation between prescribing of different antibiotics and rates of mortality with sepsis in US adults.BMC infectious diseases · 2020Article
- Prevalence of Extended-Spectrum β-lactamase and Integron Gene Carriage in Multidrug-ResistantIranian journal of medical sciences · 2020Article
- Bioactive extracts ofSaudi journal of biological sciences · 2019Article
- Distribution and drug resistance of pathogenic bacteria in emergency patients.World journal of clinical cases · 2019Article
- Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states - a statistical analysis.BMC public health · 2019Article
- Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states.International journal of antimicrobial agents · 2019Article
- Review
- Infections Caused by Extended-SpectrumBioMed research international · 2018Article
- Antibiotic Therapy for Acute Watery Diarrhea and Dysentery.Military medicine · 2017Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Antibiotic exposure exerts strong selective pressure and is an important modifiable risk factor for antibiotic resistance. We aimed to identify the role of various antibiotics as risk factors for the isolation of extended-spectrum-beta-lactamase (ESBL)-producing Klebsiella spp. in hospitalized patients at a tertiary-care hospital. A parallel multivariable model was created to compare two groups of cases with either nosocomially acquired ESBL- or non-ESBL-producing Klebsiella spp. to a common control group of hospitalized patients (a case-case-control design). Seventy-eight ESBL cases, 358 non-ESBL cases, and 444 controls were analyzed. Significant factors associated with the isolation of Klebsiella spp. were an age of >65 years, transfer from a health care facility, an intensive care unit (ICU) stay, and the presence of a comorbid malignancy or lung, hepatic, or renal disease. A propensity score was generated from the above, and our ability to discriminate between Klebsiella cases and controls (area under the receiver-operating-characteristic [ROC] curve, 0.78) was good. The ESBL phenotype was tightly linked with fluoroquinolone resistance (95% versus 18%, P < 0.001). Factors associated with isolation of ESBL Klebsiella spp. in a multivariable analysis, adjusting for the propensity score, included exposure to beta-lactam-beta-lactamase inhibitor combinations (odds ratio [OR], 10.17; 95% confidence interval [CI], 1.19 to 86.92) and to fluoroquinolones (OR, 2.86; 95% CI, 1.37 to 5.97). Exposure to broad-spectrum cephalosporins was statistically associated with ESBL Klebsiella spp. only among the subgroup of patients not treated with fluoroquinolones. In our institution, where the ESBL-producing-Klebsiella phenotype is coselected with fluoroquinolone resistance, fluoroquinolone and beta-lactam-beta-lactamase inhibitor combinations, rather than cephalosporins, are the main risk factors for ESBL isolates. Formulary interventions to limit the spread of ESBL-producing isolates should be tailored to each setting.
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