Abstract
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 analyzed 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, and 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. A funnel plot was used to assess potential publication bias among the included studies. RESULTS: A total of 24 studies were included in the systematic review and meta-analysis. The pooled prevalence of FQR across pathogens was 35% (95% CI: 30%-40%), with species-specific rates of Campylobacter spp. (49%), Escherichia coli (35%), Klebsiella spp. (23%), Mycobacterium tuberculosis (40%), Pseudomonas aeruginosa (34%), Proteus spp. (45%), and others (26%). Subgroup analyses showed variation by fluoroquinolone generation and year of publication, with E. coli displaying increasing resistance trends over time. Risk factors significantly associated with FQR included the presence of an indwelling catheter, advanced age, prior hospitalization, previous fluoroquinolone or other antibiotic use, drug-resistant TB, international travel, sex, and unfavorable treatment outcomes. DISCUSSION: Although the overall prevalence of FQR was modest, increasing trends in E. coli and the presence of multiple associated risk factors highlight important clinical implications. These findings emphasize the need to consider prior antibiotic use and hospitalization when guiding treatment and antimicrobial stewardship. However, these results should be interpreted with caution due to high heterogeneity and variability across the included studies.