title: Antibiotic use and Escherichia coli resistance trends for quinolones and cotrimoxazole in Sweden.
abstract: Resistance rates among Escherichia coli isolates for quinolones and cotrimoxazole were analysed at 12 Swedish hospitals, and compared with antibiotic use. Resistance figures for E. coli were retrieved from the diagnostic microbiology service databases for the period 1989-99, and antibiotic sales figures were obtained from the National Corporation of Swedish Pharmacies. At the 2 university teaching hospitals included, norfloxacin resistance of E. coli increased significantly (p < 0.001) from 0% to 2.7% and 2.5%, respectively. Ciprofloxacin resistance increased (p < 0.001) in parallel. Quinolone use increased until 1992; subsequently, sales have remained at a stable level. The increase in norfloxacin and ciprofloxacin resistance started relatively simultaneously in all hospitals, around 1991. Cotrimoxazole resistance has also been increasing significantly in most hospitals, in spite of decreasing sales of cotrimoxazole and trimethoprim. Similar trends could be seen in blood isolates from the same hospitals for the period 1991-98. Clinical laboratory data are subject to bias but surveillance over longer periods of time provides a useful method for detecting trends in increasing resistance and therefore functions as a resistance warning system.
authors.affiliation: Infectious Disease Section, Karolinska Hospital, Stockholm, Sweden. anna.farra@ks.se
authors.forename: Anna
authors.initials: A
authors.lastname: Farra
authors.forename: Gunilla
authors.initials: G
authors.lastname: Skoog
authors.forename: Leif
authors.initials: L
authors.lastname: Wallén
authors.forename: Gunnar
authors.initials: G
authors.lastname: Kahlmeter
authors.forename: Göran
authors.initials: G
authors.lastname: Kronvall
authors.forename: Mikael
authors.initials: M
authors.lastname: Sörberg
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D004352:Drug Resistance, Microbial; D004926:Escherichia coli / Q000187:drug effects*; D024841:Fluoroquinolones; D007755:Laboratories, Hospital / Q000706:statistics & numerical data*; D016015:Logistic Models; D013548:Sweden; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology*
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D015662:Trimethoprim, Sulfamethoxazole Drug Combination