ABSTRACT
We assessed the risk factors for acquisition of fluoroquinolone-resistant, gram-negative organisms in the gastrointestinal tract of hospitalized patients. We analyzed stool samples from 204 patients and recovered fluoroquinolone-resistant, gram-negative organisms from 63. Receipt of fluoroquinolone during the month preceding admission was the only risk factor identified, whereas female sex, duration of hospitalization, exposure to indwelling devices, admission from another hospital, and history of infection were risk factors for fecal colonization after day 4.
Subject(s)
Anti-Infective Agents/pharmacology , Digestive System/microbiology , Gram-Negative Bacteria/drug effects , Acinetobacter/drug effects , Adult , Aged , Aged, 80 and over , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/adverse effects , Drug Resistance, Microbial , Escherichia coli/drug effects , Female , Fluoroquinolones , Gram-Negative Bacterial Infections/microbiology , Humans , Klebsiella pneumoniae/drug effects , Male , Middle Aged , Pantoea/drug effects , Pantoea/genetics , Prospective Studies , Proteus mirabilis/drug effects , Pseudomonas aeruginosa/drug effects , Risk Factors , Serratia marcescens/drug effectsABSTRACT
INTRODUCTION: Infections due to Listeria monocytogenes usually occur in pregnant women, in the elderly and in immunocompromised patients. Arterial aneurysms due to this germ are rare. Only 16 cases have been previously described in the literature. EXEGESIS: We report the case of a patient who had been hospitalized for recurrent fever over the past 3 months. Aortic mycotic aneurysm was diagnosed; blood and aneurysm cultures revealed Gram-positive bacilli consistent with the presence of Listeria monocytogenes. We also review previous reports focusing on infections due to Listeria monocytogenes. Mycotic aneurysms due to this germ are mainly observed in elderly male patients and occur on large arteries. In the present study, only one patient was immunocompromised. Furthermore, all patients who were not operated on died. CONCLUSION: Arterial aneurysm due to Listeria moncytogenes is best managed via surgical resection in combination with antimicrobial therapy. Immunosuppression is not necessary for the development of arterial aneurysm due to Listeria. Bacteriological and histological examinations should be done systematically when surgical resection of an aneurysm is required.
Subject(s)
Aortic Aneurysm, Thoracic/microbiology , Listeria monocytogenes/isolation & purification , Listeriosis/complications , Aged , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/surgery , Doxycycline/therapeutic use , Female , Humans , Immunocompromised Host , Listeriosis/drug therapy , Listeriosis/physiopathology , Male , Pregnancy , Tetracyclines/therapeutic useABSTRACT
In an assessment of potential risk factors for nosocomial infections caused by fluoroquinolone-resistant gram-negative organisms, 68 patients who developed a nosocomial infection caused by a fluoroquinolone-resistant gram-negative bacillus were compared with 191 patients who developed a nosocomial infection caused by a fluoroquinolone-susceptible gram-negative bacillus. A history of previous infection, immunosuppression, prior receipt of fluoroquinolones, and hospitalization on the burn unit were independent risk factors. Except for immunosuppression, the same risk factors were identified when the 50 patients whose isolates were resistant to fluoroquinolones, aminoglycosides, and beta-lactam antibiotics were compared with the 95 patients whose isolates were susceptible to all of these classes of antimicrobial agents. The identification of hospitalization on the burn unit as a risk factor was attributable to an outbreak of infections caused by a resistant strain of Pseudomonas aeruginosa during the study period. The occurrence of nosocomial outbreaks and the selective pressure of fluoroquinolone use were the main exogenous risk factors involved in the emergence of resistance to fluoroquinolones.
