Prevalence and risk factors of fluoroquinolone resistance in Gram-negative bacterial infections: a systematic review and meta-analysis

Background The widespread use of fluoroquinolones for the treatment of Gram-negative bacterial infections has contributed to the rising prevalence of antimicrobial resistance. However, limited studies have systematically analysed the prevalence of fluoroquinolone resistance (FQR) and its associated risk factors. Methods A systematic review and meta-analysis were conducted, screening studies published between January 1, 2014, and October 31, 2024, from the PubMed, Medline, Embase, and CINAHL databases. Studies were included based on the following criteria: observational designs, evaluation of Gram-negative bacteria for FQR in human subjects, investigation of FQR and associated risk factors. Data analysis, including pooled prevalence estimation and odds ratio calculation, was performed using R Studio (version 4.2.3) with the metafor package. Heterogeneity among studies was assessed using Q and I 2 statistics. Results A total of 24 studies were included in the systematic review and meta-analysis. The pooled prevalence of FQR was estimated for various pathogens as follows: Campylobacter spp. (49%), Escherichia coli (35%), Klebsiella pneumoniae (23%), Mycobacterium tuberculosis (40%), Pseudomonas aeruginosa (34%), Proteus spp. (45%), and Other (26%). The overall prevalence was 35% 95% (CI: 30-40%). Identified risk factors for FQR included presence of an indwelling catheter, age, previous hospitalized, history of fluoroquinolones uses, drug resistant TB, prior antibiotic history, international travel history, sex, and unfavourable treatment outcomes. Conclusions Although the prevalence of FQR was relatively modest, its associated risk factors should be considered in clinical practice, particularly in patients with recurrent use of antibiotic and hospitalised.