International Journal of Antimicrobial Agents
Volume 25, Issue 5 , Pages 398-403, May 2005

Optimization of empirical antibiotic selection for suspected Gram-negative bacteraemia in the emergency department☆

  • Shmuel Benenson

      Affiliations

    • Infectious Diseases Unit, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Affiliated with the Ben-Gurion Faculty of Medicine, Be’er-Sheva, Israel
    • ,
  • Amos M. Yinnon

      Affiliations

    • Infectious Diseases Unit, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Affiliated with the Ben-Gurion Faculty of Medicine, Be’er-Sheva, Israel
    • Corresponding Author InformationCorresponding author. Tel.: +972 2 655 5076; fax: +972 2 666 6840.
    • ,
  • Yechiel Schlesinger

      Affiliations

    • Infectious Diseases Unit, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Affiliated with the Ben-Gurion Faculty of Medicine, Be’er-Sheva, Israel
    • ,
  • Bernard Rudensky

      Affiliations

    • Clinical Microbiology Laboratory, Shaare Zedek Medical Center, Jerusalem, Affiliated with the Ben-Gurion Faculty of Medicine, Be’er-Sheva, Israel
    • ,
  • David Raveh

      Affiliations

    • Infectious Diseases Unit, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Affiliated with the Ben-Gurion Faculty of Medicine, Be’er-Sheva, Israel

Received 2 November 2004; accepted 29 January 2005.

Abstract 

A 1-year prospective study of patients with a positive blood culture and admitted through the emergency department (ED), was conducted to detect incidence and risk factors for resistance of Enterobacteriaceae to gentamicin and ciprofloxacin. A total of 245 emergency department-admitted patients had positive blood cultures, of which 131 (54%) grew Enterobacteriaceae. Of these 131 isolates, 32 (24%) were resistant to gentamicin and 37 (28%) to ciprofloxacin. Risk factors, by multivariate analysis, for gentamicin and ciprofloxacin resistance were: male gender (P<0.05 and P<0.01, respectively), nursing home residence (P<0.001), diabetes mellitus (P<0.05) and presence of a foreign body (P<0.05 and P<0.005). An additional risk factor for ciprofloxacin resistance was recent hospitalisation (P<0.05). These data facilitate optimal selection of empirical antibiotic treatment of suspected Gram-negative infections, and may contribute to improved patient outcome and optimal use of antibiotics.

Keywords: Bacteraemia, Gram-negative bacteria, Empirical therapy

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☆ This work was presented in part at the 13th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), May 10–13, 2003, Glasgow, UK.

PII: S0924-8579(05)00053-1

doi:10.1016/j.ijantimicag.2005.01.019

International Journal of Antimicrobial Agents
Volume 25, Issue 5 , Pages 398-403, May 2005

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