and PD 131628), 8 and 32 ,ug/ml (ofloxacin and BAY Y 3118), and 16 and 32 ,Lg/ml (sparfloxacin) and indicated resistance to trimethoprim-sulfamethoxazole, ...
ANTIMICROBIAL AGENTS
AND
CHEMOTHERAPY, Apr. 1994,
p.
Vol. 38, No. 4
681-687
0066-4804/94/$04.00+0 Copyright © 1994, American Society for Microbiology
Emergence of Fluoroquinolone-Resistant Escherichia coli at a Cancer Center WINFRIED V. KERN, 1,2* ELENA ANDRIOF,1 MARGRET OETHINGER,3 PETER KERN,1 JORG HACKER,4 AND REINHARD MARRE3 Section of Infectious Diseases and Clinical Immunology' and Departments of Hematology-Oncology2 and Bacteriology,3 University Hospital and Medical Center, D-89070 Ulm, and Theodor-Boveri-Institute for Biosciences, University of Wurzburg, D-97070 Wurzburg,4 Germany Received 19 August 1993/Returned for modification 29 December 1993/Accepted 14 January 1994
Prophylactic treatment with fluoroquinolones of patients with profound neutropenia has been found to be useful for preventing gram-negative bacteremia and has become a standard preventive-therapy strategy in many cancer centers, but the development of bacterial resistance is a cause of concern. During the past few years, we have observed an increasing number of patients with leukemia from whom fluoroquinolone-resistant strains of Escherichia coli were isolated. The increase was significant in this patient population, and among patients with other underlying diseases, the rates of isolation of such strains per number of discharges were significantly lower and did not increase. Most of the leukemia case patients (16 of 19) had been pretreated with an oral quinolone (ofloxacin), with cumulative doses until the first isolation of a resistant E. coli strain ranging from 0 to 97.8 g (median, 14.4 g). Repeated isolation of such strains was seen in 8 of 17 patients during a follow-up period of .4 weeks and in 1 of 6 patients during a follow-up period of .16 weeks. Ten patients developed bacteremia (mortality, 1 of 10). On the basis of the number of patients with leukemia admitted to the hematology-oncology service, the incidence of bacteremia caused by fluoroquinolone-resistant E. coli increased from
