Emergence of Reduced Susceptibility and Resistance to Fluoroquinolones in Escherichia coli in Taiwan and Contributions of Distinct Selective Pressures

doi:10.1128/AAC.45.11.3084-3091.2001

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Antimicrobial Agents and Chemotherapy, November 2001, p. 3084-3091, Vol. 45, No. 11
0066-4804/01/$04.00+0 DOI: 10.1128/AAC.45.11.3084-3091.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Emergence of Reduced Susceptibility and Resistance to Fluoroquinolones in Escherichia coli in Taiwan and Contributions of Distinct Selective Pressures

L. Clifford McDonald,¹^, Feng-Jui Chen,¹ Hsiu-Jung Lo,¹ Hsiao-Chuan Yin,¹ Po-Liang Lu,² Cheng-Hua Huang,³ Pei Chen,¹ Tsai-Ling Lauderdale,¹ and Monto Ho¹^,^*

Division of Clinical Research, National Health Research Institutes,¹ and Cathay General Hospital,³ Taipei, and Kaohsiung Medical University Hospital, Kaohsiung,² Taiwan

Received 20 March 2001/Returned for modification 11 June 2001/Accepted 9 August 2001

A survey of 1,203 Escherichia coli isolates from 44 hospitals in Taiwan revealed that 136 (11.3%) isolates were resistantto fluoroquinolones and that another 261 (21.7%) isolates hadreduced susceptibility. Resistance was more common in isolatesresponsible for hospital-acquired (mostly in intensive care units)infections (17.5%) than in other adult inpatient (11.4%; P = 0.08)and outpatient isolates (11.9%; P > 0.1). Similarly, reduced susceptibilitywas more common in isolates responsible for hospital-acquiredinfections (30.9%) than in other adult inpatient (21.0%; P = 0.04)and outpatient (21.4%; P = 0.06) isolates. Isolates from pediatricpatients were less likely to be resistant (1.3 versus 12.0%; P< 0.01) but were nearly as likely to have reduced susceptibility(17.7 versus 21.9%; P > 0.1) as nonpediatric isolates. There wasan inverse relationship in the proportion of isolates that wereresistant versus the proportion that had reduced susceptibilityamong isolates from individual hospitals (R = 0.031; P < 0.05).In an analysis of isolates from two hospitals, all 9 resistantstrains possessed double point mutations in gyrA and all 19 strainswith reduced susceptibility strains had single point mutations;no mutations were found among fully susceptible strains. Riskfactors for resistance included underlying cancer (odds ratio[OR], 83; 95% confidence interval [CI₉₅], 7.3 to 2,241; P < 0.001),exposure to a quinolone (OR, undefined; P = 0.02), and exposureto a nonquinolone antibiotic (OR, 20; CI₉₅, 2.2 to 482; P < 0.001);underlying cancer was the only independent risk factor (OR, 83;CI₉₅, 8.6 to 807; P < 0.001). There were no significant associationsbetween any of these factors and reduced susceptibility. Whereasacute and chronic quinolone use in cancer patients is a majorselective pressure for resistance, other undetermined but distinctselective pressures appear to be more responsible for reducedsusceptibility to fluoroquinolones in E. coli.

^* Corresponding author. Mailing address: Division of Clinical Research, National Health Research Institutes, 128 Yen-Chiu-YuanRd. Sec. 2, Taipei 11529, Taiwan, Republic of China. Phone: 886-2-2653-4401,ext. 7120. Fax: 886-2-2789-0254. E-mail: monto{at}nhri.org.tw.

Present address: Division of Infectious Diseases, University of Louisville, Louisville,Ky.

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