Risk factors for quinolone-resistant Escherichia coli infection: a systematic review and meta-analysis

Dong-Mei Zhu, Qiu-Hong Li, Yan Shen, Qin Zhang, Dong-Mei Zhu, Qiu-Hong Li, Yan Shen, Qin Zhang

Abstract

Background: Antimicrobial resistance to quinolone is rising worldwide, especially in Escherichia coli causing various infections. Although many studies have been conducted to identify the risk factors for quinolone-resistant Escherichia coli (QREC) infection, the results are inconsistent and have not been systematically reported. The aim of the present study is to conduct a systematic review and meta-analysis to evaluate the potential risk factors for QREC infection.

Methods: A systematic search was performed to collect published data in the EMBASE, PubMed, and the Cochrane Library up to April 2019. Risk factors were analyzed using the pooled odds ratio (ORs) with 95% confidence interval (CIs).

Results: Twenty-seven trials involving 67,019 participants were included in the present study. The following risk factors associated with QREC infection were identified: (1) male (OR = 1.41), (2) hepatic cirrhosis (OR = 2.05), (3) diabetes mellitus (OR = 1.62), (4) cardiovascular disease (OR = 1.76), (5) neurogenic bladder (OR = 8.66), (6) renal dysfunction (OR = 2.47), (7) transplantation (OR = 2.37), (8) urinary tract infection (OR = 2.79) and urinary tract abnormality (OR = 1.85), (9) dementia (OR = 5.83), (10) heart failure (OR = 5.63), (11) neurologic disease (OR = 2.80), (12) immunosuppressive drugs (OR = 2.02), (13) urinary catheter (OR = 4.39), (14) nursing home resident (OR = 4.63), (15) prior surgery (OR = 2.54), (16) quinolones (OR = 7.67), (17) other antibiotics (OR = 2.74), (18) hospitalization (OR = 2.06) and (19) nosocomial infection acquisition (OR = 2.35).

Conclusions: QREC infection was associated with nineteen risk factors including prior quinolones use, hospitalization, and several comorbidities. Reducing exposure to these risk factors and modification of antibiotic use are important to prevent quinolone resistance.

Keywords: Escherichia coli; Infection; Meta-analysis; Quinolone; Resistance; Risk factor.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s). 2020.

Figures

Fig. 1
Fig. 1
PRISMA flow chart of study selection in the meta-analysis
Fig. 2
Fig. 2
Forest plots for the association between exposure to quinolone and QREC infection. QREC, quinolone-resistant Escherichia coli; M-H, Mantel-Haenszel; CI, confidence interval
Fig. 3
Fig. 3
Funnel plot of comparison for immunosuppressive drugs uses as the potential risk factor. Each small circle represents an independent study for the indicated association. The funnel plot appears asymmetric. OR, odds ratio; SE, standard error

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