ABSTRACT. Fluoroquinolone resistance is mainly caused by mutations in quinolone resistance-determining regions of DNA gyrase and topoisomerase IV in Escherichia coli. The AcrAB-TolC efflux pump contributes to resistance against fluoroquinolone and other antimicrobials. In this study, we investigated a high-level mechanism of fluoroquinolone resistance in E. coli that was isolated from human clinical samples and canine fecal samples. E. coli strains with high levels of fluoroquinolone resistance have been found to be frequently resistant to cephalosporins. Strains with high-level fluoroquinolone resistance exhibited lower intracellular enrofloxacin (ENR) concentrations, higher expression of AcrA, and a greater reduction in the fluoroquinolone minimum inhibitory concentration for treatment with an efflux pump inhibitor. The frequency of strains with enhanced ENR resistance selection and the survival rate of E. coli in the presence of ENR in vitro were correlated well with AcrA protein expression levels in the parental strains. These results suggest that AcrAB-TolC efflux pump over-expression is related to high-level fluoroquinolone resistance and the selection of strains with enhanced fluoroquinolone resistance. Antimicrobials that are intended for human use are also used on companion animals. Their excessive and inappropriate administration in animals leads to the generation and spread of antimicrobial-resistant bacteria, which in veterinary medicine represent a potential hazard to human health [1,26,33,36]. Companion animals live in close proximity to humans and receive medical treatment more frequently than food-producing animals [23]. Platell et al. reported that some fluoroquinolone-resistant Escherichia coli isolates that were derived from companion animals (i.e., dogs and cats) were very similar to the ones found in humans [27].Fluoroquinolones are widely used to treat various bacterial infections in humans and companion animals. E. coli infections, especially urinary tract infections, are frequently treated with fluoroquinolones. Thus, fluoroquinolone resistance has increased among clinical isolates of humans and companion animals [7,24]. Previous studies reported that extended-spectrum β-lactamase (ESBL)-producing E. coli and Klebsiella pneumoniae are frequently resistant to fluoroquinolone [20,30,32]. Cephalosporins and fluoroquinolones are among the most important antimicrobials that are used on humans and animals, mainly because of their broad-spectrum effectiveness against both gram-positive and gram-negative bacteria. Therefore, the appearance of fluoroquinolone-and/ or cephalosporin-resistant bacteria is a serious problem in clinical medicine.Fluoroquinolone resistance mechanisms are mainly based on chromosomal mutations in the quinolone resistancedetermining regions (QRDRs) of gyrA and gyrB, which encode DNA gyrase subunits, and parC and pare, which encode topoisomerase IV subunits [2,8,11,37]. Resistance to nalidixic acid (NAL) and slightly decreased susceptibility to fluoroquinolones is attribute...