All ETDs from UAB

Advisory Committee Chair

Russell Griffin

Advisory Committee Members

Rachael Lee

Sadeep Shrestha

Document Type


Date of Award


Degree Name by School

Master of Science (MS) School of Public Health


Antimicrobial stewardship programs are becoming more widespread to combat antibiotic resistance. This study aimed to evaluate the influence of patient-level characteristics on fluoroquinolone susceptibly among five gram-negative isolates to help better their implementation. We performed a retrospective analysis of patients over the age of 18 for five gram-negative isolates (Acinetobacter species, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa). We utilized Cox proportional hazards to determine the risk of patient-level characteristics, for both hospital and community-acquired infections, on fluoroquinolone resistance between 2016 and 2019. The population sample consisted of 8,285 patients receiving fluoroquinolones for at least one of the five organisms with 1,251 (15%) receiving FQ for more than one organism. In total, there were 12,055 cultures were positive for one of the organisms of interest. The model was adjusted for significant crude variables. There were 8,610 community-acquired infections (CAI), after adjustments females when compared with males saw a decrease risk of resistant E. coli. All ages when compared with 18-29 had an increased risk of resistant E. coli. Patients admitted from a physician’s office with an Acinetobacter species infection had a decreased risk of FQ resistance, while patients admitted through a skilled nursing facility had an increased risk of resistant E. coli, K. pneumoniae, and P. aeruginosa compared to those admitted not admitted through a healthcare facility. Several comorbidities, including chronic pulmonary disease, hemi or paraplegia, and patients with renal disease saw increased risks across varied organisms for FQ resistance. There were 3,445 hospital-acquired infections (HAI), after adjustments ages 30-39 and 40-49 when compared with 18-29 had an increased risk of resistance for P. aeruginosa. Patients with a length of stay of four or more weeks had an increased risk of resistant K. pneumoniae when compared with 2-3 week stay. Patients with chronic pulmonary disease or hemi or paraplegia had increased risks across various organisms. We have demonstrated several patient characteristics for both community and hospital-acquired infections that may increase the risk of FQ resistance among gram-negative isolates. These factors should be considered in the implementation of antimicrobial stewardship programs.

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