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

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.

Automated summary

This study found that patients taking fluoroquinolones (FQ) were at higher risk of colonization/infection by fluoroquinolone-resistant E. coli (QREC). The risk was highest in the first year after FQ treatment, decreased in the second year, and became undetectable thereafter. Older age, male sex, longer hospital stays, COPD, and diabetes were identified as independent risk factors for QREC colonization/infection. A single FQ course significantly increased the risk for at least two years, with higher risks in cases of longer hospital stays, COPD, diabetes, male gender, and older age. These findings could guide public health campaigns and prescriber education to promote rational antibiotic use.