응급실에서 부적절하게 사용된 Ciprofloxacin의 위험 인자 = Risk Factors for Inappropriate Use of Ciprofloxacin in the Emergency Department

다국어 초록 (Multilingual Abstract)

O b j e c t i v e s: Ciprofloxacin, one of the most widely used fluoroquinolone,
has been used for some abdominal and genitourinary
infections in emergency departments (EDs). This
investigation was performed to identify the risk factors of
inappropriate use of ciprofloxacin in the ED.
M e t h o d s: We retrospectively reviewed the medical records
of patients who had visited the ED of Seoul National
University Hospital from January 2002 to December 2002
and who had been prescribed ciprofloxacin as an initial
empirical antibiotic. The appropriateness of ciprofloxacin
use was judged according to existing institutional guidelines.
R e s u l t s: Of the total 577 patients (219 males, mean age
5 3 . 0± 17.1; 358 females, mean age 50.3 ± 1 8 . 7 ) ,
ciprofloxacin was used appropriately in 289 (50.1%). In the
univariate analysis, gender, site of suspected infection,
route of administration, and disposition were significantly
different between the appropriate and the inappropriate use
groups (p<0.005). In multivariate analysis, the adjusted
odds ratio for related factors for inappropriate ciprofloxacin
use was significantly higher in old age patients (>65 years
old) than in younger patients (under 30 years old; OR=2.02,
95% CI=1.01-4.03), in patients having the GI tract infections
than in patients having genitourinary tract infections
(OR=14.28, 95% CI=8.76-23.29), in patients who were
administered orally than intravenously (OR=2.45, 95%
CI=2.08-5.71), and in patients who stayed in the ED than in
those who were admitted (OR=4.29, 95% CI=1.98-9.34).
C o n c l u s i o n: Inappropriate use of ciprofloxacin in the ED is
very common. If the emergence of ciprofloxacin resistance
is to be avoided, education and efforts for judicious use of
ciprofloxacin are warranted.

참고문헌 (Reference)

1 "Trends in hospital antibiotic prescribingafter introduction of an antibiotic policy" 38 : 895-904, 1996

2 "The SanfordGuide to Antimicrobial Therapy" Antimicrobial therapy, Inc 2003

3 "Surveillance ofantimicrobial use and antimicrobial resistance in UnitedStates hospitals: Project ICARE phase 2. Project IntensiveCare Antimicrobial Resistance Epidemiology (ICARE)hospitals" 29 : 245-252, 1999

4 "Risk factors for fluoroquinoloneresistance in nosocomial Escherichia coli andKlebsiella pneumoniae infections" 162 : 2469-2477, 2002

5 "Quinolones, a comprehensivereview" 65 : 455-464, 2002

6 "Maintaining fluoroquinolone class efficacy:review of influencing factors" 9 : 1-9, 2003

7 "Inadequate antimicrobialtreatment of infections. A risk factors for hospitalmortality among critically ill patients" 115 : 462-474, 1999

8 "Inadequate antimicrobial treatment: an importantdeterminant of outcome for hospitalized patients" 31 : 131-138, 2000

9 "Improved antimicrobialinterventions have benefits" 39 : 2823-2828, 2001

10 "Impact of adequate empirical antimicrobialtherapy on the outcome of patients admitted to the intensivecare unit with sepsis" 31 : 2742-2751, 2003

11 "Fluoroquinolone utilization inthe emergency departments of academic medical centers" 163 : 601-605, 2003

12 "Empirical antimicrobial therapy of septic shockpatients adequacy and impact of the outcome" 31 : 462-467, 2003

13 "Emergence of ciprofloxacinresistance in Escherichia coli isolates after widespread useof fluoroquinolones" 30 : 103-107, 1998

14 "Decreased susceptibility of Streptococcus pneumoniae tofluoroquinolones in Canada. Canadian BacterialSurveillance Network" 341 : 233-239, 1999

15 "Antimicrobial resistance of Neisseria gonorrhoeae isolatedin Korea" 33 : 338-345, 2001

16 "Antibiotic resistance in the intensivecare unit" 134 : 298-314, 2001

17 "Antibiotic misuse in twoclinical situations" 405-12, revinfectdis1991;13

18 "Antibiotic Sensitivity of the causative organisms anduse of antibiotics in women with community-acquiredacute pyelonephritis" 34 : 353-359, 2002

19 "A study on the clinical and microbiologic features ofcommunity-acquired acute pyelonephritis for the recent 5years in a university hospital" 21 : 905-913, 2002