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The purpose of this study is to determine the correlation between use of antimicrobials, such as fluoroquinolone, cefoxitin, and cefotaxime, and  Escherichia coli  resistance using a nationwide database. Nationwide data on antimicrobial consumption for 12 years (2002 to 2013) were acquired from a database of subjects (n = 1,025,340) included in the National Health Insurance Service-National Sample Cohort. National antimicrobial resistance rates of  E .  coli  were obtained from the Korean Antimicrobial Resistance Monitoring System, which has been administered by the Korean Centers for Disease Control and Prevention since 2002. Fluoroquinolone-resistance rates of  E .  coli  isolated from general hospitals have continuously increased since 2002 and were correlated with nationwide fluoroquinolone use (r = 0.82,  P  = 0.0012) or ciprofloxacin use (r = 0.90,  P <0.0001). Cefotaxime-resistance rates of  E .  coli  isolated from general hospitals markedly increased since 2008 and were correlated with nationwide cefotaxime use (r = 0.94,  P <0.0001) or third-generation cephalosporin use (r = 0.96,  P <0.0001). Cefoxitin-resistance rates of  E .  coli  isolated from general hospitals peaked in 2010 and significantly correlated with cephamycin use at a two-year interval (r = 0.64,  P  = 0.0256). In conclusion, consumption of antimicrobials such as fluoroquinolone, cefoxitin, and cefotaxime is well correlated with the resistance rates of  E .  coli  to these agents. This study provides background data for national antimicrobial management policies to reduce antimicrobial resistance.

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Trends in South Korean antimicrobial use and association with changes in Escherichia coli resistance rates: 12-year ecological study using a nationwide surveillance and antimicrobial prescription database