Neighborhood Antibiotic Use May Increase Individual Risk for Resistant Bacteria

There was an increased personal risk for acquiring fluoroquinolone-resistant E coli in certain neighborhoods with higher fluoroquinolone consumption.

According to data from a large health services organization in Israel, there was an increased personal risk for acquiring fluoroquinolone-resistant Escherichia coli in certain neighborhoods with higher fluoroquinolone consumption, even in individuals without prior fluoroquinolone use. Findings from this nationwide study were published in the Lancet Infectious Diseases.

In this population-based case-control study, researchers included data from 1733 geographic areas across the country and collected roughly 5 million urine samples between 2010 and 2014. Of the more than 2.5 million eligible urine cultures, 300,105 cultures with E coli growth and 1,899,168 cultures with no E coli growth were included in the analysis.

Of the 300,105 cultures with E coli growth, 270,190 occurred in women. The number of fluoroquinolone-resistant E coli events in women was 16.8% (45,427 of 270,190) and 29.5% in men (8835 of 29,915). Compared with women with a fluoroquinolone-susceptible E coli or with a sterile urine cultures, women with fluoroquinolone-resistant E coli events were in the oldest age group (>75 years). In both men and women with fluoroquinolone-resistant E coli, there was a higher comorbidity score, prevalence of nursing home residence, and number of hospitalizations in the year prior to their urine culture.

The fluoroquinolone resistance rate by geographic statistical area was 18% and the mean fluoroquinolone use in the entire population was 1.51 defined daily doses per 1000 people per day.

In the multivariate analysis, not unexpectedly, personal consumption of fluoroquinolones was strongly associated in a dose-response manner with subsequent isolation of fluoroquinolone-resistant E coli compared with fluoroquinolone-susceptible E coli and sterile urine cultures in women and men.

In addition, researchers found that increasing neighborhood fluoroquinolone consumption was associated with an increased risk for fluoroquinolone-resistant E coli vs fluoroquinolone-susceptible E coli with similar associations observed in women and men. In women, the odds ratios (OR) for the 4 quintiles with higher neighborhood consumption compared with the lowest quintile were 1.15 (95% CI, 1.06-1.24), 1.31 (95% CI, 1.20-1.43), 1.41 (95% CI, 1.29-1.54), and 1.51 (95% CI, 1.38-1.65). In men, the OR by quintile were 1.17 (95% CI, 1.02-1.35), 1.24 (95% CI, 1.06-1.45), 1.35 (95% CI, 1.15-1.59), and 1.50 (95% CI, 1.26-1.77).

These associations remained in both women and men when the researchers conducted a post-hoc subgroup analysis restricted to individuals who had not used fluoroquinolone in the year prior to their urine culture.

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“Our results suggest that increased [geographic statistical area]-level use of antibiotics might pose a small, but real, risk for other individuals in the community in terms of acquiring resistant bacteria,” noted the researchers. They added that while the effect on the individual may be quantitatively small, its “overall contribution to the spread of antibiotic resistance in the population is important,” highlighting “yet another driving force in the effort to avoid unnecessary antibiotic use.”


Low M, Neuberger A, Hooton TM, et al. Association between urinary community-acquired fluoroquinolone-resistant Escherichia coli and neighbourhood antibiotic consumption: a population-based case-control study [published online March 4, 2019]. Lancet Infect Dis. doi:10.1016/S1473-3099(18)30676-5