Abstract
BackgroundAntimicrobial resistance to quinolone is rising worldwide, especially in Escherichia coli causing various infections. Although many studies have been conducted to identify the risk factors for quinolone-resistant Escherichia coli (QREC) infection, the results are inconsistent and have not been systematically reported. The aim of the present study is to conduct a systematic review and meta-analysis to evaluate the potential risk factors for QREC infection.MethodsA systematic search was performed to collect published data in the EMBASE, PubMed, and the Cochrane Library up to April 2019. Risk factors were analyzed using the pooled odds ratio (ORs) with 95% confidence interval (CIs).ResultsTwenty-seven trials involving 67,019 participants were included in the present study. The following risk factors associated with QREC infection were identified: (1) male (OR = 1.41), (2) hepatic cirrhosis (OR = 2.05), (3) diabetes mellitus (OR = 1.62), (4) cardiovascular disease (OR = 1.76), (5) neurogenic bladder (OR = 8.66), (6) renal dysfunction (OR = 2.47), (7) transplantation (OR = 2.37), (8) urinary tract infection (OR = 2.79) and urinary tract abnormality (OR = 1.85), (9) dementia (OR = 5.83), (10) heart failure (OR = 5.63), (11) neurologic disease (OR = 2.80), (12) immunosuppressive drugs (OR = 2.02), (13) urinary catheter (OR = 4.39), (14) nursing home resident (OR = 4.63), (15) prior surgery (OR = 2.54), (16) quinolones (OR = 7.67), (17) other antibiotics (OR = 2.74), (18) hospitalization (OR = 2.06) and (19) nosocomial infection acquisition (OR = 2.35).ConclusionsQREC infection was associated with nineteen risk factors including prior quinolones use, hospitalization, and several comorbidities. Reducing exposure to these risk factors and modification of antibiotic use are important to prevent quinolone resistance.
Highlights
Antimicrobial resistance to quinolone is rising worldwide, especially in Escherichia coli causing various infections
quinolone-resistant Escherichia coli (QREC) infection was associated with nineteen risk factors including prior quinolones use, hospitalization, and several comorbidities
Our meta-analysis identified that the risk factors for acquisition of QREC infection varied about demographic factors, comorbidities, present and prior treatments as well as acquisition routes
Summary
Antimicrobial resistance to quinolone is rising worldwide, especially in Escherichia coli causing various infections. Many studies have been conducted to identify the risk factors for quinolone-resistant Escherichia coli (QREC) infection, the results are inconsistent and have not been systematically reported. It is generally accepted that antimicrobial resistance is directly associated with the use of antibiotics [4]. There are very few new antibiotic drugs in the pipeline [5], and current antibiotic drugs should be used prudently to decrease antimicrobial resistance rates [6]. Escherichia coli (E. coli) is the most common pathogen in both hospital and community settings, and the species can be divided into five major taxonomic lineages
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