Positive Association between the Use of Quinolones in Food Animals and the Prevalence of Fluoroquinolone Resistance in and : A Global Ecological Analysis.

(1) Background: It is unclear what underpins the large global variations in the prevalence of fluoroquinolone resistance in Gram-negative bacteria. We tested the hypothesis that different intensities in the use of quinolones for food-animals play a role. (2) Methods: We used Spearman's correlation to assess if the country-level prevalence of fluoroquinolone resistance in human infections with , , and was correlated with the use of quinolones for food producing animals. Linear regression was used to assess the relative contributions of country-level quinolone consumption for food-animals and humans on fluoroquinolone resistance in these 4 species. (3) Results: The prevalence of fluoroquinolone resistance in each species was positively associated with quinolone use for food-producing animals ( [ρ = 0.55; < 0.001], [ρ = 0.58; < 0.001]; [ρ = 0.54; = 0.004]; [ρ = 0.48; = 0.008]). Linear regression revealed that both quinolone consumption in humans and food animals were independently associated with fluoroquinolone resistance in and . (4) Conclusions: Besides the prudent use of quinolones in humans, reducing quinolone use in food-producing animals may help retard the spread of fluoroquinolone resistance