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Antimicrobial Agents and Chemotherapy, November 1999, p. 2736-2741, Vol. 43, No. 11
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Emergence and Dissemination of Quinolone-Resistant Escherichia coli in the Community

Javier Garau,1,* Mariona Xercavins,2 Mónica Rodríguez-Carballeira,1 Josep Ramón Gómez-Vera,1 Ignacio Coll,1 Dolors Vidal,3 Teresa Llovet,4 and Ana Ruíz-Bremón5

Services of Internal Medicine1 and Microbiology,2 Hospital Mútua de Terrassa, and Department of Pathology, Facultad de Veterinaria,3 and Department of Microbiology, Facultad de Medicina,4 Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, and Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid,5 Spain

Received 9 April 1999/Returned for modification 1 July 1999/Accepted 17 August 1999

We studied the evolution of resistance to quinolones in Escherichia coli from 1992 to 1997 in Barcelona, Spain. An increasing proportion of quinolone-resistant E. coli (QREC) infections was observed. QREC strains were more common in patients with nosocomial infections but also increased in patients with community-acquired infections (9% in 1992 to 17% in 1996). Seventy (12%) of 572 episodes of E. coli bacteremia were due to QREC. Factors significantly associated with QREC bacteremia were the presence of underlying disease, recent exposure to antibiotics, and bacteremia of unknown origin. In the multivariate analysis, only prior exposure to antimicrobial agents (P < 0.001; odds ratio [OR] = 2), specifically, to quinolones (P < 0.001; OR = 14), and the presence of a urinary catheter (P < 0.001; OR = 2) were significantly associated with QREC bacteremia. Among 16 QREC isolates from cultures of blood of community origin selected at random, 13 different pulsed-field gel electrophoresis patterns were recognized, showing the genetic diversity of these isolates and in turn indicating the independent emergence of QREC in the community. The prevalence of QREC in the feces of healthy people was unexpectedly high (24% in adults and 26% in children). A survey of the prevalence of QREC of avian and porcine origin revealed a very high proportion of QREC in animal feces (up to 90% of chickens harbored QREC). The high prevalence of QREC in the stools of healthy humans in our area could be linked to the high prevalence of resistant isolates in poultry and pork.

* Corresponding author. Mailing address: Department of Medicine, Hospital Mútua de Terrassa, Pza. Dr. Robert no. 5, 08221 Terrassa, Barcelona, Spain. Phone: 34.93.785.74.61. Fax: 34.93.736.50.37. E-mail: jgarau{at}retemail.es.

Antimicrobial Agents and Chemotherapy, November 1999, p. 2736-2741, Vol. 43, No. 11
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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