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Ciprofloxacin Resistance — It’s in the Feces!

Presence of quinolone-resistant gram-negative bacteria in children’s stools was not associated with quinolone or antibiotic use by the children or by members of their households.

Worldwide, quinolone-resistance rates among gram-negative bacilli are rising rapidly. Widespread use of this class of antibiotics can cause selection of resistant organisms in the gut flora. Because these agents are rarely administered before age 18, children provide an opportunity to investigate the prevalence of quinolone-resistant gram-negative bacilli in individuals not exposed to quinolones. Investigators recently reported the results of stool screening among children without diarrhea who attended a general ambulatory pediatric office in Seattle between September 2001 and June 2002. Information on antibiotic use by the child and by other household members during the preceding 4 weeks was collected by questionnaire.

Stools from 13 of 455 children (2.9%) grew gram-negative bacteria with high-level quinolone resistance (Escherichia coli, 7 children; Stenotrophomonas maltophilia, 4 children; Enterobacter aerogenes and Achromobacter xylosoxidans, 1 child each). Six of the 7 E. coli isolates were found to have additional extraintestinal virulence factors. Besides quinolone resistance, the 13 isolates showed varying resistance rates to other classes of antibiotics. None of the 13 children with resistant isolates had used a quinolone during the preceding 4 weeks, nor had members of their households. Use of other antibiotics by the children or their household members was not associated with detection of quinolone-resistant bacteria.

Comment: Quinolone resistance of fecal flora usually susceptible to these agents appears to be more widespread than previously thought and does not seem to require selective pressure. Some experts believe that, in addition to human use, administration of quinolones to food animals might contribute to such resistance. Further investigation into the spread of resistant pathogens in the absence of selective pressure should help us to understand the dynamics of resistance rates.

— Thomas Glück, MD

Published in Journal Watch Infectious Diseases November 15, 2006

Citation(s):

Qin X et al. Ciprofloxacin-resistant gram-negative bacilli in the fecal microflora of children. Antimicrob Agents Chemother 2006 Oct; 50:3325-9.

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