Emergence and Dissemination of Quinolone-Resistant Escherichia coli in the Community

Abstract

We studied the evolution of resistance to quinolones inEscherichia coli from 1992 to 1997 in Barcelona, Spain. An increasing proportion of quinolone-resistant E. coli (QREC) infections was observed. QREC strains were more common in patients with nosocomial infections but also increased in patients with community-acquired infections (9% in 1992 to 17% in 1996). Seventy (12%) of 572 episodes of E. coli bacteremia were due to QREC. Factors significantly associated with QREC bacteremia were the presence of underlying disease, recent exposure to antibiotics, and bacteremia of unknown origin. In the multivariate analysis, only prior exposure to antimicrobial agents (P < 0.001; odds ratio [OR] = 2), specifically, to quinolones (P < 0.001; OR = 14), and the presence of a urinary catheter (P < 0.001; OR = 2) were significantly associated with QREC bacteremia. Among 16 QREC isolates from cultures of blood of community origin selected at random, 13 different pulsed-field gel electrophoresis patterns were recognized, showing the genetic diversity of these isolates and in turn indicating the independent emergence of QREC in the community. The prevalence of QREC in the feces of healthy people was unexpectedly high (24% in adults and 26% in children). A survey of the prevalence of QREC of avian and porcine origin revealed a very high proportion of QREC in animal feces (up to 90% of chickens harbored QREC). The high prevalence of QREC in the stools of healthy humans in our area could be linked to the high prevalence of resistant isolates in poultry and pork.

Quinolone resistance in the food chain

“…Most of the nalidixic acidresistant strains (31 of 36) came from poultry. These results correlate with the studies by Garau et al [34] who evaluated the prevalence of ciprofloxacin-resistant E. coli in the area of Barcelona (Spain) and found that 90.4% of the strains isolated from poultry were resistant to ciprofloxacin. Some studies have reported that the fluoroquinolone-resistant strains from poultry represent serologically and genetically diverse populations of various subgroups.…”

Risk Factors for Community-Acquired Urinary Tract Infection Due to Quinolone-Resistant E. coli

“…In 1999, Garau et al [21] described the dissemination of QREc in the community. They found significantly high prevalence rates of QREc in healthy-human fecal samples and in animal fecal samples of the same region.…”

Plasmid-mediated quinolone resistance: an update

“…In the decades following the introduction of FQs, quinolone resistance in Enterobacteriaceae has become common, widespread, and generally nonclonal. In this respect, it may be concluded that FQ resistance has emerged independently on many occasions [3][4][5].…”