Investigation of the susceptibility trends in Japan to fluoroquinolones and other antimicrobial agents in a nationwide collection of clinical isolates: A longitudinal analysis from 1994 to 2016

Abstract

The susceptibilities of clinical isolates to fluoroquinolones and other antimicrobial agents were surveyed to obtain an accurate understanding of trends in incidence and antimicrobial resistance. The samples were collected from across Japan, biennially or triennially, between 1994 and 2016 and a defined level of resistance to fluoroquinolone was determined. Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae exhibited stable and high rates of susceptibility to fluoroquinolones over the period examined. For methicillin-resistant Staphylococcus aureus the rate of resistance to levofloxacin and ciprofloxacin was 81.3e93.5% and 83.2e94.2%, respectively, which was markedly higher than that of methicillin-susceptible S. aureus, while sitafloxacin-resistant methicillin-susceptible and methicillin-resistant S. aureus were isolated at 0.3e0.7% and 16.9e36.5%, respectively. The rate of levofloxacin or ciprofloxacin-resistant Escherichia coli increased from around 2e3% between 1994 and 1998 to around 35% in 2016, but the rate of fluoroquinolonesusceptible Klebsiella pneumoniae stayed high at over 94.6% during the study period. Although no fluoroquinolone-resistance in clinical isolates of Salmonella spp. was detected from 1994 to 2002, the resistance rate increased slightly after 2004 and reached to 1.9%e4.7% in 2016. The rate of fluoroquinolone-susceptible Pseudomonas aeruginosa isolated from urinary tract and respiratory tract infections improved during the period examined from 41.8e67.0% to 91.2e94.2%, and from 78.9-88.5% to 90.1e94.6%, respectively. Against Acinetobacter spp., the susceptibility rate of fluoroquinolones was almost constant at around 90%, but one multidrug-resistant isolate was detected in 2013. Overall, the susceptibility to fluoroquinolones was maintained over 20 years against tested bacteria except for MRSA and E. coli.

Efficacy and Safety of Sitafloxacin in the Treatment of Acute Bacterial Infection: A Meta-analysis of Randomized Controlled Trials

“…Even for ESBL-producing pathogens, the sitafloxacin resistant rate was only 5.6% (2/36) in Malasiri et al's study [8]. All these findings were consistent with previous studies [4,[13][14][15][16] and confirmed the potent in vitro activity of sitafloxacin. Therefore, the favorable clinical efficacy of sitafloxacin in the treatment of acute bacterial infections may be partially explained by the findings of these in vitro studies.…”

Monitoring Quinolone Resistance Due to Mutations in GyrA and ParC in <i>Haemophilus Influenzae</i>（2012-17）

“…In Japan, no Hib strains have been detected in children with invasive infections after Hib vaccines were introduced in 2008 14 . However, the frequency of isolation of BLNAR strains is 15 ; a rate of 36.9 has also been reported for 2016 surveillance isolates in Japan 16 .…”

“…Fluoroquinolone resistance rates of H. in uenzae previously studied in Japan were extremely low, and the 2016 respiratory specimen surveillance isolates report also stated that the resistance to CPFX and LVFX was found in 0. 6 and STFX resistance was found in 0 of isolates 16 . STFX is characterized by the strong inhibitory potencies against both DNA gyrase and topoisomerase IV 18 .…”

High-Level Quinolone-ResistantHaemophilus haemolyticusin Pediatric Patient with No History of Quinolone Exposure

“…H. haemolyticus 2019-19 showed high-level quinolone-resistance and multiple amino acid substitutions in quinolone-targeting proteins, which are known to contribute to high-level quinolone resistance ( 12 – 14 , 17 , 31 ). In addition, quinolone-resistant H. parainfluenzae has been reported ( 32 , 33 ) in Taiwan and Europe and these isolates showed various amino acid substitutions in quinolone target genes, like those observed in 2019-19.…”