Effect of Fluoroquinolone Use in Primary Care on the Development and Gradual Decay of <i>Escherichia coli</i> Resistance to Fluoroquinolones: A Matched Case-Control Study
Peter Konstantin Kurotschka,
Chiara Fulgenzio,
Roberto Da Cas,
Giuseppe Traversa,
Gianluigi Ferrante,
Orietta Massidda,
Ildikó Gágyor,
Richard Aschbacher,
Verena Moser,
Elisabetta Pagani,
Stefania Spila Alegiani,
Marco Massari
Affiliations
Peter Konstantin Kurotschka
Department of General Practice, University Hospital Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
Chiara Fulgenzio
Pharmacy Unit, IRCCS Regina Elena National Cancer Institute and San Gallicano Institute, 00128 Rome, Italy
Roberto Da Cas
Pharmacoepidemiology and Pharmacovigilance Unit, National Centre for Drug Research and Evaluation, Italian National Institute of Health (ISS), 00161 Rome, Italy
Giuseppe Traversa
Pharmacoepidemiology and Pharmacovigilance Unit, National Centre for Drug Research and Evaluation, Italian National Institute of Health (ISS), 00161 Rome, Italy
Gianluigi Ferrante
Azienda Ospedaliera-Universitaria Città della Salute e della Scienza di Torino, 10126 Turin, Italy
Orietta Massidda
Department of Cellular, Computational and Integrative Biology, Center of Medical Sciences (CISMed), University of Trento, 38122 Trento, Italy
Ildikó Gágyor
Department of General Practice, University Hospital Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
Richard Aschbacher
Health Service of the Autonomous Province of Bolzano/Bozen, 39100 Bolzano/Bozen, Italy
Verena Moser
Health Service of the Autonomous Province of Bolzano/Bozen, 39100 Bolzano/Bozen, Italy
Elisabetta Pagani
Health Service of the Autonomous Province of Bolzano/Bozen, 39100 Bolzano/Bozen, Italy
Stefania Spila Alegiani
Pharmacoepidemiology and Pharmacovigilance Unit, National Centre for Drug Research and Evaluation, Italian National Institute of Health (ISS), 00161 Rome, Italy
Marco Massari
Pharmacoepidemiology and Pharmacovigilance Unit, National Centre for Drug Research and Evaluation, Italian National Institute of Health (ISS), 00161 Rome, Italy
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 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.
