Chapter 23 : Quinolone Resistance and Its Clinical Relevance

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Although the introduction of the quinolones proved to be a major therapeutic advance, shortly after their introduction resistance in both gram-negative and gram-positive bacteria was reported and in some circumstances was dramatic. This chapter focuses on important examples of where resistance has emerged to the fluoroquinolones, the factors responsible, and how this resistance has affected patient management. One possible driver of fluoroquinolone resistance in pneumococci may have been the use of fluoroquinolones, with marginal pneumococcal activity, for respiratory tract infections. Once clinical failures were recognized to occur when ciprofloxacin was used for the treatment of pneumococcal infections, it was no longer promoted or widely used for the treatment of pneumococcal infections, including community-acquired pneumonia. In most countries, reporting increasing ciprofloxacin resistance has been the result of the emergence of de novo resistance in many different serotypes. Ciprofloxacin resistance was more prevalent among erythromycin-nonsusceptible group A streptococci than among erythromycin-susceptible ones. Food-borne infections are an important cause of illness and hospitalization in developing and developed countries. The reason for the differences in the ease of acquisition of fluoroquinolone resistance in methicillin-resistant (MRSA), as compared with methicillin-susceptible (MSSA), has not yet been elucidated. This difference may be explained in part by the dissemination of clonal strains, coselection of MRSA with other antimicrobial agents, the more frequent use of fluoroquinolones to treat patients colonized/infected with MRSA, as opposed to MSSA, and/or as yet unrecognized genetic traits.

Citation: Low D. 2003. Quinolone Resistance and Its Clinical Relevance, p 355-386. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch23
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Figure 1

The prevalence of ciprofloxacin-resistant (MIC, ≥ 4 µg/ml) and levofloxacin-nonsusceptible (MIC, ≥ 4 μg/ml) worldwide. Adapted from references , and .

Citation: Low D. 2003. Quinolone Resistance and Its Clinical Relevance, p 355-386. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch23
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Figure 2

Fluoroquinolone prescriptions per capita (curve) and frequency of pneumococci with ciprofloxacin MICs of ≥ 4 µg/ml in Canada according to the patient's age (bars). Reprinted from reference with permission. © 1999 Massachusetts Medical Society. All rights reserved.

Citation: Low D. 2003. Quinolone Resistance and Its Clinical Relevance, p 355-386. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch23
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Figure 3

The increasing prevalence and MICs of resistant to ciprofloxacin (MIC, ≥ 4 µg/ml) in Canada. The hatched, white, and black bars represent isolates for which the MICs were 4, 8 and 16, and > 16 µg/ml, respectively. Reprinted from Clinical Infectious Diseases ( ) with permission from University of Chicago Press.

Citation: Low D. 2003. Quinolone Resistance and Its Clinical Relevance, p 355-386. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch23
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Figure 4

Emergence of fluoroquinolone resistance among serovar Choleraesuis isolates in Taiwan. Shown here are the total quarterly numbers of serovar Choleraesuis isolates from Chang Gung Memorial Hospital and Chang Gung Children's Hospital from the fourth quarter of 1996 through the third quarter of 2001 (bars) and the percentage of these isolates that were resistant to ciprofloxacin (curve). Ciprofloxacin was not available in these hospitals before October 1996. Reprinted from reference with permission. © 2002 Massachusetts Medical Society. All rights reserved.

Citation: Low D. 2003. Quinolone Resistance and Its Clinical Relevance, p 355-386. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch23
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Figure 5

Prevalence of with decreased susceptibility to ciprofloxacin (MIC, > 0.06 μg/ml). Adapted from references .

Citation: Low D. 2003. Quinolone Resistance and Its Clinical Relevance, p 355-386. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch23
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Figure 6

Prevalence of fluoroquinolone resistance in . Adapted from references .

Citation: Low D. 2003. Quinolone Resistance and Its Clinical Relevance, p 355-386. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch23
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Figure 7

Prevalence of fluoroquinolone-resistant (MIC, ≥4 μg/ml) in the hospital and community. Adapted from references .

Citation: Low D. 2003. Quinolone Resistance and Its Clinical Relevance, p 355-386. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch23
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