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

Fumitaka Terahara,Hiroshi Nishiura

doi:10.1186/s12889-019-6804-3

Abstract

BackgroundThe 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.MethodsWe 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.ResultsWe 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.ConclusionsFluoroquinolone 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.

Highlights

The frequency of antimicrobial resistance has steadily increased worldwide, induced by inappropriate use of antibiotics in a variety of settings
Among the 47 prefectures in Japan, the proportion of levofloxacin resistance in E. coli was overall lower in the eastern region than in the west, with the lowest proportions estimated in Yamagata and Aomori (27.1 and 26.2%, in 2015 and 2016, respectively; Fig. 1a and b)
Fluoroquinolone consumption was lower in eastern prefectures than in the west on a whole, and the lowest values were observed for Yamagata and Fukui

Summary

Introduction

The frequency of antimicrobial resistance has steadily increased worldwide, induced by inappropriate use of antibiotics in a variety of settings. The frequency of antimicrobial resistance (AMR) has steadily increased worldwide, induced by inappropriate use of antibiotics in a variety of settings [1]. Japan issued its National Action Plan on Antimicrobial Resistance in April 2016, explicitly specifying a number of priority goals to be achieved over the 5. In its Action Plan [2], Japan aims to lower the fraction of fluoroquinolone resistance in Escherichia coli from 45% in 2014 to less than 25% by 2020. It aims to reduce daily fluoroquinolone use by 50% by 2020. Quinolones are highly bioavailable, permitting oral administration and good tissue distribution, and may be one of the most frequently used antibiotics at both outpatient and inpatient settings

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