title: Significant ecological impact on the progression of fluoroquinolone resistance in Escherichia coli with increased community use of moxifloxacin, levofloxacin and amoxicillin/clavulanic acid.
abstract: OBJECTIVE
  To determine trends in ciprofloxacin resistance and co-resistance to other antibiotic classes in blood isolates of Escherichia coli, and to investigate if there is an ecological relationship to the community use of fluoroquinolones and other antibiotics.
  
  
  METHODS
  Forty-two Spanish hospitals of the European Antimicrobial Resistance Surveillance Network collected ciprofloxacin and other antibiotic susceptibility data for non-duplicate consecutive E. coli isolates from patients with bacteraemia between 2001 and 2009. The nationwide ambulatory use of antibiotics between 1997 and 2008 was determined by WHO methods, and the co-evolution of both parameters was further analysed.
  
  
  RESULTS
  Of the 28 307 E. coli blood isolates, 27.9% were ciprofloxacin non-susceptible (CIPNS), increasing from 17.6% in 2001 to 32.7% in 2009. A continuous increase was observed between CIPNS and other resistances, including cephalosporin resistance due to the production of extended-spectrum β-lactamases (ESBLs) and non-susceptibility to both amoxicillin/clavulanic acid and tobramycin. Although the total use of antibiotics did not increase, community use of levofloxacin, moxifloxacin and amoxicillin/clavulanic acid increased by 307.2%, 62.6% and 70.1%, respectively. Yearly rates of CIPNS E. coli strongly correlated with the use of levofloxacin, moxifloxacin and amoxicillin/clavulanic acid (r(2 )> 0.80; P < 0.005 in all cases).
  
  
  CONCLUSIONS
  The rapid increase in CIPNS E. coli causing bacteraemia was closely related to the increase in resistance to amoxicillin/clavulanic acid, production of ESBLs and resistance to aminoglycosides. Community use of fluoroquinolones (mainly moxifloxacin and levofloxacin) and of amoxicillin/clavulanic acid represents a significant driver in the progression of fluoroquinolone resistance in bacteraemic E. coli.
authors.affiliation: Antibiotic Laboratory, Bacteriology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Pozuelo a Majadahonda, 28220 Majadahonda, Madrid, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Cuevas
authors.forename: Jesús
authors.initials: J
authors.lastname: Oteo
authors.forename: Edurne
authors.initials: E
authors.lastname: Lázaro
authors.forename: Belén
authors.initials: B
authors.lastname: Aracil
authors.forename: Francisco
authors.initials: F
authors.lastname: de Abajo
authors.forename: Silvia
authors.initials: S
authors.lastname: García-Cobos
authors.forename: Adriana
authors.initials: A
authors.lastname: Ortega
authors.forename: José
authors.initials: J
authors.lastname: Campos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use*; D001372:Aza Compounds / Q000627:therapeutic use*; D016470:Bacteremia / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006761:Hospitals; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D015242:Ofloxacin / Q000627:therapeutic use*; D011804:Quinolines / Q000627:therapeutic use*; D013030:Spain; D055815:Young Adult
chemical_list: D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D064704:Levofloxacin; D019980:Amoxicillin-Potassium Clavulanate Combination; D015242:Ofloxacin; D000077266:Moxifloxacin