Association between fluoroquinolone usage and a dramatic rise in ciprofloxacin-resistant Streptococcus pneumoniae in Canada, 1997–2006

This study evaluated the prevalence of fluoroquinolone usage and investigated the association between usage and resistance in respiratory isolates of Streptococcus pneumoniae in Canada. Fluoroquinolone susceptibility testing was conducted on S. pneumoniae collected from 25 medical centres across Canada over nine study years. Fluoroquinolone prescriptions and consumption figures were derived from data in the IMS Health, Canada CompuScript Audit. Between 1997 and 2006, 11 825 S. pneumoniae isolates were collected. Ciprofloxacin resistance rates increased significantly (P < 0.01) during the study from 0% to 4.5% in children (0–15 years), from 0.2% to 5.4% in adults (16–64 years) and from 1.4% to 11.6% in the elderly (≥65 years). Outpatient ciprofloxacin and respiratory fluoroquinolone prescriptions increased by 55.6% (38.2 prescriptions/1000 population to 59.4 prescriptions/1000 population; P < 0.01) and 416.2% (5.3 prescriptions/1000 to 27.4 prescriptions/1000; P < 0.01), respectively. Ciprofloxacin and respiratory fluoroquinolone consumption increased by 10.6% [1.1 defined daily doses (DDDs)/1000/day to 1.2 DDDs/1000/day; P = 0.02] and 38.2% (0.5 to 0.7 DDDs/1000/day; P = 0.02), respectively, from 2001 to 2006. A strong association between ciprofloxacin use and resistance (R2 = 0.89) was identified. Fluoroquinolone resistance in S. pneumoniae increased significantly in Canada from 1997 to 2006 in conjunction with increased ciprofloxacin and respiratory fluoroquinolone consumption. Ciprofloxacin usage appears to be the biggest driver of resistance; however, total fluoroquinolone usage is also important.