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Determinanten van ciprofloxacineresistentie

机译：环丙沙星耐药性的决定因素

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Abstract Determinants of ciprofloxacin resistance. Identifying patients at risk on the basis of patient and disease characteristics Objective Primary objective was to identify patient and disease characteristics associated with ciprofloxacin resistance in a university hospital. Secondary objective was to explore the quality of microbial diagnostics in clinical practice. Design Retrospective nested case control study. Methods Subsequent individual culture results were linked for 551 internal medicine patients using ciprofloxacin. Cases were patients with a pathogen resistance shift from sensitive before start of ciprofloxacin to resistant after start. Controls were patients with persistent ciprofloxacin sensitive pathogens. Patient (e.g. age, co-morbidity, prior extramural ciprofloxacin use) and disease characteristics (e.g. fever, CRP level) as determinants for ciprofloxacin resistance were assessed. Results Nearly 80% of the patients were excluded. A shift in resistance was not detectable because there were no culture results after start of ciprofloxacin or because no pathogens were cultured. Of the evaluable patients, 19 were classified as cases and 81 as controls. No patient or disease characteristics were associated with ciprofloxacin resistance although elevated serum creatinin (>130mumol/L) and CRP (>100 mg/L) levels were more common among the cases. Community patient data of prior ciprofloxacin use and ciprofloxacin resistant pathogens were poorly documented in the hospital files, hindering assessment of these determinants. Conclusion It is possible to analyse the occurrence of ciprofloxacin resistance and its determinants on a patient level. Due to the nature of routine culture data collection (e.g. no cultures are taken once a patient improves on initiated therapy) this study is limited by the low number of assessable patients. A prospective study with surveillance cultures and a more thorough community patient data collection needs to be conducted to address this limitation.
机译：摘要环丙沙星耐药性的决定因素。根据患者和疾病特征识别有风险的患者目的主要目的是在大学医院中识别与环丙沙星耐药相关的患者和疾病特征。次要目标是探索临床实践中微生物诊断的质量。设计回顾性嵌套病例对照研究。方法采用环丙沙星将551名内科患者随后的个体培养结果联系起来。病例是病原体耐药性从环丙沙星开始前的敏感转变为开始后耐药的患者。对照组为持续存在环丙沙星敏感病原体的患者。评估患者（例如年龄，合并症，壁前使用环丙沙星之前）和疾病特征（例如发烧，CRP水平）作为环丙沙星耐药性的决定因素。结果将近80％的患者被排除在外。由于开始环丙沙星后没有培养结果或未培养病原体，因此无法检测到耐药性的变化。在可评估的患者中，将19例分类为病例，将81例分类为对照。尽管在这些病例中更常见的是血清肌酐（>130μmol/ L）和CRP（> 100 mg / L）水平升高，但没有患者或疾病特征与环丙沙星耐药相关。在医院档案中，以前使用环丙沙星和耐环丙沙星的病原体的社区患者数据很少记录，这妨碍了对这些决定因素的评估。结论有可能在患者水平上分析环丙沙星耐药性的发生及其决定因素。由于常规培养数据收集的性质（例如，一旦患者对开始的治疗有所改善，就不会进行任何培养），该研究受到可评估患者数量少的限制。为了解决这一局限性，需要进行前瞻性研究，包括监测文化和更全面的社区患者数据收集。

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