[Evaluation of the relation between consumption of fluoroquinolones and emergence of resistance among Escherichia coli: contribution of observational and quasi-experimental studies].
The emergence of Escherichia coli (E. coli) resistance to fluoroquinolones (FQs) increased and spread gradually worldwide since the early 1990s. The selective pressure of FQs is the main mechanism responsible for the emergence of FQ resistance as shown by in vitro studies. Clinical trials are required to prove the causality between exposure to FQs and emergence of resistance. But this would not be ethical in humans. Non experimental studies must answer several principles to establish causality: association, anteriority, and directional change. We described and compared the contribution of observational and quasi-experimental studies implemented to answer several of these principles. Quasi-experimental studies using interventional models (ARIMA models with transfer function), can answer several of these principles, unlike observational studies. Thus, in addition to assessment of the association, they were able to show that the exposure to FQs precedes the emergence of FQ resistance to E. coli. They were also able to estimate the time necessary for the emergence of resistance and the dose effect, and to show if this association was reversible.
Mahamat
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Recherche clinique et épidémiologie, DIM, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, Nîmes, France. aba.mahamat@chu-nimes.fr
Daurès
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JP
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D016022:Case-Control Studies; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004926:Escherichia coli / Q000187:drug effects*; D024841:Fluoroquinolones / Q000494:pharmacology*; D006801:Humans
D024841:Fluoroquinolones