The Epidemiology of Ciprofloxacin Resistance in Coagulase-Negative Staphylococci in CAPD Patients

• Published in: Epidemiology and infection Vol. 109; no. 1; pp. 97 - 112
• Main Authors: Dryden, M. S., Talsania, H., McCann, M., Cookson, B. D., Phillips, I.
• Format: Journal Article
• Language: English
• Published: Cambridge Cambridge University Press 01.08.1992
• Subjects: Air Microbiology; Antibiotics; Bacteriology; Biological and medical sciences; Carrier State - epidemiology; Carrier State - microbiology; Catheters; Ciprofloxacin - pharmacology; Ciprofloxacin - therapeutic use; Continuous ambulatory peritoneal dialysis; Cross Infection - epidemiology; Cross Infection - microbiology; Drug Resistance, Microbial; Epidemiology; Fundamental and applied biological sciences. Psychology; Health Personnel; Humans; Immunoblotting; Infections; Microbial sensitivity tests; Microbiology; Occupational Diseases - epidemiology; Occupational Diseases - microbiology; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Peritonitis - drug therapy; Peritonitis - epidemiology; Peritonitis - microbiology; Plasmids; Skin; Skin - microbiology; Staphylococcal Infections - drug therapy; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcus; Staphylococcus - classification; Staphylococcus - drug effects; Staphylococcus epidermidis - classification; Staphylococcus epidermidis - drug effects; Infection; Resistance; Bacteriosis; Antibiotic; Staphylococcal infection; Epidemiology
• ISSN: 0950-2688; 1469-4409

Ciprofloxacin was used as empirical therapy for peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD) for 26 months, providing an opportunity to study the epidemiology of ciprofloxacin resistance amongst coagulase-negative staphylococci (CNS). Swabs were collected from the CAPD patients, staff, and clinic environment before, during and after the time this antibiotic was prescribed. Clinical isolates were also studied, and records kept of patient hospital attendance. Ciprofloxacin-resistant staphylococci were typed by antibiogram, biotype, plasmid profile, SDS-PAGE, and immunoblotting. No resistant strains were detected before the use of ciprofloxacin. During its use 30% of patients became skin carriers, and resistant strains caused 8% of peritonitis episodes in 7% of patients (38% of carriers). Resistant strains were isolated from the environment, but never from attending members of staff. A total of 208 resistant isolates with MIC's between 8 and 128 mg/l was collected and identified as Staphylococcus epidermidis or S. haemolyticus. Sixteen strain types were distinguished. There was epidemiological evidence for selection of resistant strains derived from the host commensal flora and also for cross-colonization, and cross-infection. Carriage of resistant strains fell to 15% of patients, 6 months after the use of ciprofloxacin had ceased.