Global prevalence of fluoroquinolone resistance in common Campylobacter species associated with human infections

Fluoroquinolones have long been the primary choice in treating campylobacteriosis, yet rising resistance threatens their effectiveness. Understanding global resistance rates in common Campylobacter species is vital for guiding treatment, improving antimicrobial stewardship, and develop effective interventions for controlling this public health concern. This study aimed to investigate the global prevalence of fluoroquinolone resistance in common clinical Campylobacter species. We searched PubMed/MEDLINE, Web of Science, Scopus, and Embase for relevant studies published from 1992 to 2025 using the keywords: Campylobacter spp., Campylobacter , fluoroquinolone, quinolone, resistance, susceptible, and sensitive. A total of from 630 articles were found. After removing duplicates, irrelevant studies, non-English/review/non-human studies, and those with insufficient data/species-level resistance reporting, 81 eligible studies retained for final analysis. The data were then subjected to a comprehensive meta-analysis. The mean resistance rates (95% CI) to fluoroquinolones for C. jejuni were 53% (norfloxacin), 51.4% (ciprofloxacin), and 51.2% (nalidixic acid), and for C. coli were 27.1%, 54.7%, and 56.9%, respectively. The included studies mainly sampled stool and rectal swabs. Agar dilution and disk diffusion were common susceptibility testing methods. High heterogeneity (I 2 >50%) was common among the studies. Begg's test showed no publication bias (P>0.05), but Egger's test detected bias in some ciprofloxacin/nalidixic acid resistance analyses (P<0.05). Given the relatively high fluoroquinolone resistance observed, restricting fluoroquinolone use in animal agriculture to preserve treatment options as well as seeking for new therapeutic alternatives and enhancing global surveillance are essential for effectively managing the infections caused by Campylobacter species, especially in high-risk populations.