Identificatie van risicopatiënten op grond van patiënt- En ziektekenmerken: Determinanten van ciprofloxacineresistentie

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 (>130 μmol/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.