Active Ingredients: Ciprofloxacin
However, we did not find that case-mix index a marker for overall severity of illness for hospitalized patients was significantly associated with resistance in the study organisms. Another possibility is that population density influences the circulation of antimicrobial resistance in the community through a higher rate of cross-transmission among people living in close proximity.
Bruinsma et al. They found that correlations between community antimicrobial use and levels of resistance were stronger when population density was accounted for. We found that both population density and total fluoroquinolone use in the community were independent predictors of the burden of fluoroquinolone resistance in E.
These findings suggest that the factors that are considered important in the spread of antimicrobial resistance in hospitalized patients i. When we investigated the effects of use of individual fluoroquinolones on resistance, we observed that resistance in both MRSA and E.
Of interest, the volumes of use of levofloxacin and ciprofloxacin in the surrounding communities were correlated to the use of those drugs in the hospital e.
Also, patients who are discharged from a hospital will likely be prescribed the hospital formulary drug, which will be reflected in community prescribing data.
We also observed that community levofloxacin use was correlated to population density; areas with the greatest population tended to use more levofloxacin.
It is unclear whether this represents a general trend or is unique to our sample. The associations between population density and levofloxacin use in the community and hospital made it difficult to determine the independent effect of levofloxacin use.
When controlling for population size and levofloxacin use in the hospital, a trend towards a higher percentage of MRSA in hospitals with the highest use of levofloxacin in the surrounding community remained. Although true community-associated MRSA clones are largely susceptible to fluoroquinolones, most MRSA infections that are associated with community onset occur in patients with health care—associated risk factors.
These organisms are often resistant to fluoroquinolone. However, levofloxacin's greater in vitro potency against gram-positive organisms suggests that it would be less likely than ciprofloxacin which has marginal activity against S.
Gilbert et al. They found that emergence of resistance in E. However, their study also demonstrated that levofloxacin was less likely to select for resistance in S. Of interest, Bhavnani et al.