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. 2019 Apr 23;19(1):426.
doi: 10.1186/s12889-019-6804-3.

Fluoroquinolone consumption and Escherichia coli resistance in Japan: an ecological study

Fumitaka Terahara  1   2 , Hiroshi Nishiura  3   4
Affiliations

Fluoroquinolone consumption and Escherichia coli resistance in Japan: an ecological study

Fumitaka Terahara et al. BMC Public Health. .

Abstract

Background: The frequency of antimicrobial resistance has steadily increased worldwide, induced by inappropriate use of antibiotics in a variety of settings. We analyzed the ecological correlation between fluoroquinolone consumption and levofloxacin resistance in Escherichia coli in Japan.

Methods: We collected information on cases of E. coli resistant to levofloxacin in 2015-2016 in all 47 prefectures from the Japan Nosocomial Infections Surveillance system. Information on fluoroquinolone consumption was obtained from pharmaceutical sales data. To address potential confounding, we also collected information on the number of physicians, nurses, and medical facilities per 100,000 individuals.

Results: We identified higher fluoroquinolone consumption and higher resistance in western prefectures, and lower consumption and resistance in eastern prefectures. Multivariate analysis identified a positive correlation between fluoroquinolone consumption and levofloxacin resistance in both 2015 and 2016.

Conclusions: Fluoroquinolone consumption and levofloxacin-resistant E. coli are potentially associated on a nationwide scale. The relationship between the two must be elucidated using additional studies with different epidemiological designs, so that any possible counter-measures, including alternative prescription, can be considered in the future.

Keywords: Antibiotic resistance; Antimicrobial stewardship; Drug prescription; Epidemiology; Escherichia coli; Quinolones.

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Conflict of interest statement

Authors’ information

The authors are experts with interest in Infectious Disease Epidemiology and also in Theoretical Epidemiology, and the corresponding author acts as the chairperson and team leader of the Department of Hygiene, Hokkaido University Graduate School of Medicine.

Ethics approval and consent to participate

The present study analyzed data that is publicly available. As such, the datasets used in our study were de-identified and fully anonymized in advance, and the analysis of publicly available data without identity information does not require ethical approval [41].

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Geographic distribution of fluoroquinolone consumption and levofloxacin resistance in Escherichia coli in Japan by prefecture, 2015–2016. Proportion of E. coli resistant to levofloxacin in 2015 (a) and 2016 (b). Fluoroquinolone consumption in 2015 (c) and 2016 (d), as defined daily dose per 1000 inhabitants per day (DID)
Fig. 2
Fig. 2
Univariate correlation between fluoroquinolone consumption and levofloxacin resistance in Escherichia coli in Japan, 2015–2016. Correlation between fluoroquinolone consumption and the proportion of E. coli resistant to levofloxacin in 2015 (a) and 2016 (b), as defined daily dose per 1000 inhabitants per day (DID)
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