Prevalence of ciprofloxacin-resistant Escherichia coli in hematologic-oncologic patients

Background: The objective of this study was to characterize the prevalence and clinical significance of ciprofloxacin-resistant Escherichia coli in pe rianal swabs of patients with hematologic malignancies in a German universi ty hospital. Patients and Methods: Weekly surveillance cultures were performed for 26 we eks. 294 perianal swabs were obtained from 104 consecutive patients. Specie s discrimination, susceptibility testing and genotyping using pulsed-field gelelectrophoresis (PFGE) was performed for all E. coli isolates. Preceding antibiotic prophylaxis and treatment as well as the frequency and duration of the hospital stay in the 6 months prior to the study were analyzed. Results: A total of 31 patients (29.8%) were colonized with E .coli. 11 Pat ients (10.6%) carried ciprofloxacin-resistant E. coli strains. Although 81. 8% of the patients colonized with ciprofloxacin-resistant E. coli had recei ved former treatment with ciprofloxacin, this finding did not reach statist ical significance, probably due to the small study population. During the s urveillance period one of the colonized patients developed septicemia with a ciprofloxacin-resistant E. coli. Genotypic identity was demonstrated for the E. coli isolates from perianal swab and blood culture. Conclusion: We propose that selective gut decontamination with ciprofloxaci n should be discontinued as a routine measure for all neutropenic patients in the department under investigation. We propose waiving oral decontaminat ion in low-risk patients with neutropenia of only a few days duration. For all other patients, a regimen with alternating prophylactic treatments of c otrimoxazol and a fluoroquinolone should be considered.