Effect of Fluoroquinolone Use in Primary Care on the Development and Gradual Decay of Escherichia coli Resistance to Fluoroquinolones: A Matched Case-Control Study

Abstract

The reversibility of bacterial resistance to antibiotics is poorly understood. Therefore, the aim of this study was to determine, over a period of five years, the effect of fluoroquinolone (FQ) use in primary care on the development and gradual decay of Escherichia coli resistance to FQ. In this matched case–control study, we linked three sources of secondary data of the Health Service of the Autonomous Province of Bolzano, Italy. Cases were all those with an FQ-resistant E. coli (QREC)-positive culture from any site during a 2016 hospital stay. Data were analyzed using conditional logistic regression. A total of 409 cases were matched to 993 controls (FQ-sensitive E. coli) by the date of the first isolate. Patients taking one or more courses of FQ were at higher risk of QREC colonization/infection. The risk was highest during the first year after FQ was taken (OR 2.67, 95%CI 1.92–3.70, p < 0.0001), decreased during the second year (OR 1.54, 95%CI 1.09–2.17, p = 0.015) and became undetectable afterwards (OR 1.09, 95%CI 0.80–1.48, p = 0.997). In the first year, the risk of resistance was highest after greater cumulative exposure to FQs. Moreover, older age, male sex, longer hospital stays, chronic obstructive pulmonary disease (COPD) and diabetes mellitus were independent risk factors for QREC colonization/infection. A single FQ course significantly increases the risk of QREC colonization/infection for no less than two years. This risk is higher in cases of multiple courses, longer hospital stays, COPD and diabetes; in males; and in older patients. These findings may inform public campaigns and courses directed to prescribers to promote rational antibiotic use.

Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial

“…Kurotschka and colleagues showed that resistance of Escherichia coli gradually decreased over time after fluoroquinolone use declined. 33 Similar results were shown in previous studies. 34 35 Thus, a positive effect on resistance rates of E coli can be expected.…”

“…Furthermore, data inform guidelines for treatment recommendations. Kurotschka and colleagues showed that resistance of Escherichia coli gradually decreased over time after fluoroquinolone use declined 33. Similar results were shown in previous studies 3435.…”

Antimicrobial Stewardship at Transitions of Care to Outpatient Settings: Synopsis and Strategies

“…While multiple drugs may all adequately treat an indication, stewardship efforts to optimize medication selection based on evidence-directed practice may improve overall appropriate antibiotic use and minimize collateral consequences such as the development of resistance, the risk of which may persist beyond the immediate antibiotic course. One recent case–control study evaluating fluoroquinolone resistance in Escherichia coli found that receiving at least one fluroquinolone prescription preceding the diagnosis of resistance was associated with a higher risk of fluoroquinolone-resistant E. coli colonization or infection, with the risk of resistance highest in the first year after the antibiotic is taken (OR 2.67) and progressively decreasing to undetectable after two years (OR 1.09) [ 39 ]. Thus, judicious drug selection to spare unnecessary or overly broad antibiotic use serves as an important opportunity to potentially curtail some of these repercussions.…”

Effects of a Primary Care Antimicrobial Stewardship Program on Meticillin-Resistant Staphylococcus aureus Strains across a Region of Catalunya (Spain) over 5 Years

“…Several meta-analyses have demonstrated a direct relationship between exposure to certain antimicrobial classes and microbiological resistance [12]. Cephalosporins and betalactams combined with beta-lactamase inhibitors are potential selectors of resistant strains, 3 of 17 but fluoroquinolones (FQ) are the most concerning and dangerous antibiotics [13,14]. Recent guidelines from the Infectious Diseases Society of America (IDSA) recommend reserving their use to protect the ecosystem from MDR and harm [15].…”