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Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis
Open AccessArticle

Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates

1
Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC 29203, USA
2
Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA
3
Department of Medicine, Baylor Scott and White, Texas A&M Health Science Center College of Medicine, Temple, TX 76502, USA
4
Department of Medicine, University of South Carolina School of Medicine, Columbia, SC 29209, USA
5
Prisma Health-Midlands, Columbia, SC 29203, USA
*
Author to whom correspondence should be addressed.
Received: 11 March 2020 / Revised: 9 April 2020 / Accepted: 13 April 2020 / Published: 17 April 2020
(This article belongs to the Special Issue Gram-Negative Bloodstream Infections)
The Clinical Laboratory Standards Institute lowered the fluoroquinolone minimum inhibitory concentration (MIC) susceptibility breakpoints for Enterobacteriaceae and glucose non-fermenting Gram-negative bacilli in January 2019. This retrospective cohort study describes the impact of this reappraisal on ciprofloxacin susceptibility overall and in patients with risk factors for antimicrobial resistance. Gram-negative bloodstream isolates collected from hospitalized adults at Prisma Health-Midlands hospitals in South Carolina, USA, from January 2010 to December 2014 were included. Matched pairs mean difference (MD) with 95% confidence intervals (CI) were calculated to examine the change in ciprofloxacin susceptibility after MIC breakpoint reappraisal. Susceptibility of Enterobacteriaceae to ciprofloxacin declined by 5.2% (95% CI: −6.6, −3.8; p < 0.001) after reappraisal. The largest impact was demonstrated among Pseudomonas aeruginosa bloodstream isolates (MD −7.8, 95% CI: −14.6, −1.1; p = 0.02) despite more conservative revision in ciprofloxacin MIC breakpoints. Among antimicrobial resistance risk factors, fluoroquinolone exposure within the previous 90 days was associated with the largest change in ciprofloxacin susceptibility (MD −9.3, 95% CI: −16.1, −2.6; p = 0.007). Reappraisal of fluoroquinolone MIC breakpoints has a variable impact on the susceptibility of bloodstream isolates by microbiology and patient population. Healthcare systems should be vigilant to systematically adopt this updated recommendation in order to optimize antimicrobial therapy in patients with bloodstream and other serious infections. View Full-Text
Keywords: sepsis; bacteremia; ciprofloxacin; chemotherapeutics; Escherichia coli; non-fermenters/Pseudomonas aeruginosa sepsis; bacteremia; ciprofloxacin; chemotherapeutics; Escherichia coli; non-fermenters/Pseudomonas aeruginosa
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MDPI and ACS Style

Shealy, S.C.; Brigmon, M.M.; Justo, J.A.; Bookstaver, P.B.; Kohn, J.; Al-Hasan, M.N. Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates. Antibiotics 2020, 9, 189. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9040189

AMA Style

Shealy SC, Brigmon MM, Justo JA, Bookstaver PB, Kohn J, Al-Hasan MN. Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates. Antibiotics. 2020; 9(4):189. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9040189

Chicago/Turabian Style

Shealy, Stephanie C.; Brigmon, Matthew M.; Justo, Julie A.; Bookstaver, P. B.; Kohn, Joseph; Al-Hasan, Majdi N. 2020. "Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates" Antibiotics 9, no. 4: 189. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9040189

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