Association between pre-diagnostic fluoroquinolone exposure and possible acquired fluoroquinolone resistance in Mycobacterium tuberculosis in Shanghai: An EHR-based case-control study using whole-genome sequencing - 17/11/25
, Biao Xu a, ⁎ Summary |
Objectives |
Fluoroquinolones (FQ) are one of the most prescribed broad-spectrum antibiotics and a cornerstone of tuberculosis (TB) treatment. TB patients may have had FQ resistance before treatment initiation. However, the association between pre-diagnostic FQ exposure and acquired FQ-resistant TB remains unclear.
Methods |
A case-control study was conducted among all pulmonary TB patients in Shanghai during 2022–2023. Cases were TB patients who had possible acquired FQ resistance identified through whole-genome sequencing (WGS), while controls were FQ susceptible patients. Pre-diagnostic FQ prescriptions were extracted from the Shanghai Electronic Health Record (EHR) platform.
Results |
Among 3496 patients, 7.4% had FQ-resistant TB, with 93.5% (243/260) phylogenetically inferred as possible acquired resistance. Multivariate analysis revealed FQ exposure was the strongest predictor of possible acquired FQ resistance with an aOR of 4.31 for a single prescription and 13.18 for multiple prescriptions. A nonlinear dose-response relationship between resistance probability and prescription number was found. Most prescriptions to cases were from non-TB-designated tertiary hospitals for non-TB respiratory diseases, with an exposure interval of ≥61 days prior to TB diagnosis.
Conclusion |
Acquired resistance dominates FQ resistance in Shanghai TB patients. The dose-response relationship between pre-diagnostic FQ exposure and possible acquired resistance underscores the need for judicious FQ use.
Le texte complet de cet article est disponible en PDF.Graphical Abstract |
Highlights |
● | FQ-resistant TB in Shanghai was worrisome, which was dominated by possible acquired resistance. |
● | The risk of possible acquiring FQ resistance increases significantly with greater pre-diagnostic FQ exposure. |
● | Most FQ prescriptions linked to possible acquired resistance came from non-TB hospitals (non-TB respiratory diseases). |
Keywords : Tuberculosis, Fluoroquinolones resistance, Whole-genome sequencing, Electronic health records
Plan
Vol 91 - N° 5
Article 106648- novembre 2025 Retour au numéro
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