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Rodríguez-Martínez JM, Lopez-Cerero L, García-Duque A, Rodriguez-Baño J, Pascual A. Interplay between IncF plasmids and topoisomerase mutations conferring quinolone resistance in the Escherichia coli ST131 clone: stability and resistance evolution. Eur J Clin Microbiol Infect Dis 2021:10.1007/s10096-021-04358-4. [PMID: 34787748 DOI: 10.1007/s10096-021-04358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/29/2021] [Indexed: 10/19/2022]
Abstract
The Escherichia coli ST131 H30-Rx subclone vehicles CTX-M-15 plasmids and mutations in gyrA and parC conferring multidrug resistance successfully in the clinical setting. The aim of this study was (1) to investigate the relationship of specific topoisomerase mutations on the stability of IncF (CTX-M producing) plasmids using isogenic E. coli mutants and (2) to investigate the impact of the IncF-type plasmids present in the E. coli clone ST131 on the evolution of quinolone resistance. E. coli ATCC 25922 (background strain) and derived mutants encoding specific QRDR substitutions were used. Also, NGS-characterized IncFIA and IncFIB plasmids (encoding CTX-M genes) were included. Plasmid stability was evaluated by sequential dilutions into Luria broth medium without antibiotics for 7 days. Mutant frequency to ciprofloxacin was also evaluated. Moderate differences in the IncF plasmids stability were observed among E. coli ATCC 25922 and isogenic mutants. Under our experimental conditions, the fluctuation of bacteria harboring plasmids was less than 0.5-log(10) in all cases. In the mutant frequency tests, it was observed that the presence of these IncF plasmids increased this value significantly (10-1000-fold). Quinolone resistance substitutions in gyrA or parC genes, frequently found associated with E. coli clone ST131, do not modify the stability of ST131-associated IncFIA and IncFIB plasmids under in vitro conditions. IncF-type plasmids present in E. coli clone ST131 facilitate the selection of resistance to quinolones. These results are consistent with the clinical scenario in which the combination of resistance to quinolones and beta-lactams is highly frequent in the E. coli clone ST131.
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Affiliation(s)
- Jose-Manuel Rodríguez-Martínez
- Departamento de Microbiología, Universidad de Sevilla, Avda Sanchez Pizjuan s/n. 41009, Seville, Spain.
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/CSIC, Universidad de Sevilla, Seville, Spain.
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
| | - Lorena Lopez-Cerero
- Departamento de Microbiología, Universidad de Sevilla, Avda Sanchez Pizjuan s/n. 41009, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/CSIC, Universidad de Sevilla, Seville, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Enfermedades Infecciosas, Microbiología Y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Ana García-Duque
- Departamento de Microbiología, Universidad de Sevilla, Avda Sanchez Pizjuan s/n. 41009, Seville, Spain
| | - Jesus Rodriguez-Baño
- Departamento de Microbiología, Universidad de Sevilla, Avda Sanchez Pizjuan s/n. 41009, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/CSIC, Universidad de Sevilla, Seville, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Enfermedades Infecciosas, Microbiología Y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Alvaro Pascual
- Departamento de Microbiología, Universidad de Sevilla, Avda Sanchez Pizjuan s/n. 41009, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/CSIC, Universidad de Sevilla, Seville, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Enfermedades Infecciosas, Microbiología Y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain
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2
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Kindle P, Zurfluh K, Nüesch-Inderbinen M, von Ah S, Sidler X, Stephan R, Kümmerlen D. Phenotypic and genotypic characteristics of Escherichia coli with non-susceptibility to quinolones isolated from environmental samples on pig farms. Porcine Health Manag 2019; 5:9. [PMID: 30867937 PMCID: PMC6396500 DOI: 10.1186/s40813-019-0116-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/18/2019] [Indexed: 12/16/2022] Open
Abstract
Background In the last decade, the growth of the pig-farming industry has led to an increase in antibiotic use, including several used in human medicine, e.g. (fluoro)quinolones. Data from several studies suggest that there is a link between the agricultural use of antibiotics and the prevalence of antibiotic-resistant bacteria in the pig farm environment, including (fluoro)quinolone resistance. This poses a threat to human and animal health. Our goal was to phenotypically and genotypically characterize 174 E. coli showing non-susceptibility to quinolones isolated from environmental samples from pig farms. Antimicrobial susceptibility testing (AST) was performed using the disk diffusion method. PCR and sequence analysis were performed to identify chromosomal mutations in the quinolone resistance-determining regions (QRDR) of gyrA and the isolates were screened for the presence of the plasmid-mediated quinolone resistance (PMQR) genes aac-(6')-Ib-cr, qepA, qnrA, qnrB, qnrC, qnrD and qnrS. Strain relatedness was assessed by phylogenetic classification and multilocus sequence typing (MLST). Results Of 174 isolates, 81% (n = 141) were resistant to nalidixic acid, and 19% (n = 33) were intermediately resistant. Overall, 68.4% (n = 119) were multidrug resistant. This study revealed a prevalence of 79.9% (n = 139) for gyrA QRDR mutations, and detected 21.8% (n = 38) isolates with at least one PMQR gene. The two most frequently detected PMQR genes were qnrB and qnrS (13.8% (n = 24) and 9.8% (n = 17, respectively). E. coli belonging to phylogenetic group A (48.3%/n = 84) and group B1 (33.3% /n = 58) were the most frequent. E. coli ST10 (n = 20) and ST297 (n = 20) were the most common STs. Conclusions E. coli with non-susceptibility to quinolones are widespread among the environment of Swiss pig farms and are often associated with an MDR phenotype. In several cases these isolates possess at least one PMQR gene, which could spread by horizontal gene transfer. E. coli from pig farms have diverse STs, some of which are associated with human and animal disease. Electronic supplementary material The online version of this article (10.1186/s40813-019-0116-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrick Kindle
- 1Vetsuisse Faculty, Institute for Food Safety and Hygiene, University of Zurich, Winterthurerstrasse 272, CH-8057 Zurich, Switzerland
| | - Katrin Zurfluh
- 1Vetsuisse Faculty, Institute for Food Safety and Hygiene, University of Zurich, Winterthurerstrasse 272, CH-8057 Zurich, Switzerland
| | - Magdalena Nüesch-Inderbinen
- 1Vetsuisse Faculty, Institute for Food Safety and Hygiene, University of Zurich, Winterthurerstrasse 272, CH-8057 Zurich, Switzerland
| | - Sereina von Ah
- 2Department of Farm Animals, Division of Swine Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Xaver Sidler
- 2Department of Farm Animals, Division of Swine Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Roger Stephan
- 1Vetsuisse Faculty, Institute for Food Safety and Hygiene, University of Zurich, Winterthurerstrasse 272, CH-8057 Zurich, Switzerland
| | - Dolf Kümmerlen
- 2Department of Farm Animals, Division of Swine Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
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3
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Wootton M, MacGowan AP, Howe RA. Towards better antimicrobial susceptibility testing: impact of the Journal of Antimicrobial Chemotherapy. J Antimicrob Chemother 2017; 72:323-329. [PMID: 28115501 DOI: 10.1093/jac/dkw494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Susceptibility testing of bacteria is one of the most important tests performed in a clinical microbiology laboratory. Improvements in laboratory techniques, especially the move towards standardized susceptibility testing, has provided better consistency and accuracy of testing. When used in conjunction with the most recently developed interpretative criteria, the result is better prediction of the outcome of antimicrobial therapy for infected patients. Throughout the last four decades this Journal has published numerous articles evidencing improvements and new techniques, a valuable source of information for microbiology laboratories.
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Affiliation(s)
- Mandy Wootton
- Welsh Antimicrobial Resistance Programme, Public Health Wales, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - Alasdair P MacGowan
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Department of Infection Sciences, Pathology Sciences Building, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - Robin A Howe
- Welsh Antimicrobial Resistance Programme, Public Health Wales, University Hospital of Wales, Cardiff CF14 4XW, UK
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4
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Maamar E, Ferjani S, Jendoubi A, Hammami S, Hamzaoui Z, Mayonnove-Coulange L, Saidani M, Kammoun A, Rehaiem A, Ghedira S, Houissa M, Boutiba-Ben Boubaker I, Slim A, Dubois V. High Prevalence of Gut Microbiota Colonization with Broad-Spectrum Cephalosporin Resistant Enterobacteriaceae in a Tunisian Intensive Care Unit. Front Microbiol 2016; 7:1859. [PMID: 27965626 PMCID: PMC5126703 DOI: 10.3389/fmicb.2016.01859] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/04/2016] [Indexed: 11/15/2022] Open
Abstract
Healthcare-associated infections due to cefotaxime-resistant (CTX-R) Enterobacteriaceae have become a major public health threat, especially in intensive care units (ICUs). Often acquired nosocomially, CTX-R Enterobacteriaceae can be introduced initially by patients at admission. This study aimed to determine the prevalence and genetic characteristics of CTX-R Enterobacteriaceae-intestinal carriage in ICU patients, to evaluate the rate of acquisition of these organisms during hospitalization, and to explore some of the associated risk factors for both carriage and acquisition. Between December 2014 and February 2015, the 63 patients admitted in the ICU of Charles Nicolle hospital were screened for rectal CTX-R Enterobacteriaceae colonization at admission and once weekly thereafter to identify acquisition. CTX-R Enterobacteriaceae fecal carriage rate was 20.63% (13/63) at admission. Among the 50 non-carriers, 35 were resampled during their hospitalization and the acquisition rate was 42.85% (15/35). Overall, 35 CTX-R Enterobacteriaceae isolates were collected from 28 patients (25 Klebsiella pneumoniae, seven Escherichia coli, and three Enterobacter cloacae strains). Seven patients were simultaneously colonized with two CTX-R Enterobacteriaceae isolates. CTX-M-15 was detected in most of the CTX-R Enterobacteriaceae isolates (30/35, 88.23%). Three strains co-produced CMY-4 and 22 strains were carbapenem-resistant and co-produced a carbapenemase [OXA-48 (n = 13) or NDM-1 (n = 6)]. Molecular typing of K. pneumoniae strains, revealed eight Pulsed field gel electrophoresis (PFGE) patterns and four sequence types (ST) [ST101, ST147, ST429, and ST336]. However, E. coli isolates were genetically unrelated and belonged to A (n = 2), B1 (n = 2) and B2 (n = 3) phylogenetic groups and to ST131 (two strains), ST572 (two strains), ST615 (one strain) and ST617 (one strain). Five colonized patients were infected by CTX-R Enterobacteriaceae (four with the same strain identified from their rectal swab and one with a different strain). Whether imported or acquired during the stay in the ICU, colonization by CTX-R Enterobacteriaceae is a major risk factor for the occurrence of serious nosocomial infections. Their systematic screening in fecal carriage is mandatory to prevent the spread of these multidrug resistant bacteria.
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Affiliation(s)
- Elaa Maamar
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Faculty of Sciences of Tunis, University of Tunis El ManarTunis, Tunisia
| | - Sana Ferjani
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar Tunis, Tunisia
| | - Ali Jendoubi
- Intensive Care Unit, Charles Nicolle Hospital Tunis, Tunisia
| | - Samia Hammami
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Faculty of Sciences of Gafsa, University of GafsaGafsa, Tunisia
| | - Zaineb Hamzaoui
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar Tunis, Tunisia
| | | | - Mabrouka Saidani
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia
| | - Aouatef Kammoun
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia
| | - Amel Rehaiem
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia
| | - Salma Ghedira
- Intensive Care Unit, Charles Nicolle Hospital Tunis, Tunisia
| | - Mohamed Houissa
- Intensive Care Unit, Charles Nicolle Hospital Tunis, Tunisia
| | - Ilhem Boutiba-Ben Boubaker
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia
| | - Amine Slim
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia
| | - Veronique Dubois
- University Bordeaux, Microbiologie Fondamentale et Pathogénicité, UMR5234 Bordeaux, France
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Plasmid-mediated quinolone resistance: Two decades on. Drug Resist Updat 2016; 29:13-29. [PMID: 27912841 DOI: 10.1016/j.drup.2016.09.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/03/2016] [Accepted: 08/29/2016] [Indexed: 11/21/2022]
Abstract
After two decades of the discovery of plasmid-mediated quinolone resistance (PMQR), three different mechanisms have been associated to this phenomenon: target protection (Qnr proteins, including several families with multiple alleles), active efflux pumps (mainly QepA and OqxAB pumps) and drug modification [AAC(6')-Ib-cr acetyltransferase]. PMQR genes are usually associated with mobile or transposable elements on plasmids, and, in the case of qnr genes, are often incorporated into sul1-type integrons. PMQR has been found in clinical and environmental isolates around the world and appears to be spreading. Although the three PMQR mechanisms alone cause only low-level resistance to quinolones, they can complement other mechanisms of chromosomal resistance to reach clinical resistance level and facilitate the selection of higher-level resistance, raising a threat to the treatment of infections by microorganisms that host these mechanisms.
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Machuca J, Briales A, Díaz-de-Alba P, Martínez-Martínez L, Rodríguez-Martínez JM, Pascual Á. Comparison of clinical categories for Escherichia coli harboring specific qnr and chromosomal-mediated fluoroquinolone resistance determinants according to CLSI and EUCAST. Enferm Infecc Microbiol Clin 2015; 34:188-90. [PMID: 25772329 DOI: 10.1016/j.eimc.2015.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/19/2015] [Accepted: 01/30/2015] [Indexed: 11/17/2022]
Abstract
EUCAST breakpoints are more restrictive than those defined by CLSI. This study highlights the discrepancies between CLSI and EUCAST in a well characterized isogenic Escherichia coli collection and their correlations with specific quinolone resistance mechanisms. The greatest number of discrepancies was observed in strains containing 2-4 resistance mechanisms (MIC values on the borderline of clinical resistance). Bearing in mind that quinolones are concentration dependent antimicrobial agents, small changes in MIC may have relevant consequences for treatment outcomes.
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Affiliation(s)
- Jesús Machuca
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain
| | - Alejandra Briales
- Department of Microbiology, University of Seville, Seville, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Luis Martínez-Martínez
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; University Hospital Marques de Valdecilla and Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain; Department of Molecular Biology, University of Cantabria, Santander, Spain
| | - José-Manuel Rodríguez-Martínez
- Department of Microbiology, University of Seville, Seville, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
| | - Álvaro Pascual
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain; Department of Microbiology, University of Seville, Seville, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
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7
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Rodriguez-Martinez JM, Machuca J, Calvo J, Diaz-de-Alba P, Rodríguez-Mirones C, Gimeno C, Martinez-Martinez L, Pascual Á. Challenges to accurate susceptibility testing and interpretation of quinolone resistance in Enterobacteriaceae: results of a Spanish multicentre study. J Antimicrob Chemother 2015; 70:2038-47. [PMID: 25745103 DOI: 10.1093/jac/dkv059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/11/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the proficiency of Spanish laboratories with respect to accurate susceptibility testing and the detection and interpretation of quinolone resistance phenotypes in Enterobacteriaceae. METHODS Thirteen strains of Enterobacteriaceae were sent to 62 participating centres throughout Spain; strains harboured GyrA/ParC modifications, reduced permeability and/or plasmid-mediated quinolone resistance genes. The centres were requested to evaluate nalidixic acid and five quinolones, provide raw/interpreted clinical categories and to detect/infer resistance mechanisms. Consensus results from reference centres were used to assign minor, major and very major errors (mEs, MEs and VMEs, respectively). RESULTS Susceptibility testing in the participating centres was frequently performed using the MicroScan WalkAway, Vitek 2 and Wider systems (48%, 30% and 8%, respectively). CLSI/EUCAST breakpoints were used in 71%/29% of the determinations. The percentage of VMEs for all quinolones was well below 2%. Only ofloxacin and moxifloxacin showed higher values for raw VMEs (6.6%), which decreased to 0% and 2.9%, respectively, in the interpreted VMEs. These errors were particularly associated with the CC-03 strain [qnrS2 + aac(6')-Ib-cr]. For MEs, percentages were always <10%, except in the case of ofloxacin and nalidixic acid. There was a significantly higher percentage of all types of errors for strains whose MICs were at the border of clinical breakpoints. CONCLUSIONS The use of different breakpoints and methods, the complexity of mutation-driven and transferable resistance mechanisms and the absence of specific tests for detecting low-level resistance lead to high variability and represent a challenge to accuracy in susceptibility testing, particularly in strains with MICs on the border of clinical breakpoints.
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Affiliation(s)
- José-Manuel Rodriguez-Martinez
- Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Machuca
- Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Jorge Calvo
- Hospital Universitario Marques de Valdecilla and Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain
| | | | - Cristina Rodríguez-Mirones
- Hospital Universitario Marques de Valdecilla and Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Concha Gimeno
- Servicio de Microbiología, Hospital General de Valencia, Valencia, Spain
| | - Luis Martinez-Martinez
- Hospital Universitario Marques de Valdecilla and Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain
| | - Álvaro Pascual
- Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Rodríguez-Martínez JM, Cano ME, Calvo J, Pascual Á, Martínez-Martínez L. Plasmid-mediated quinolone resistance. Microb Drug Resist 2013. [DOI: 10.2217/ebo.12.362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- José Manuel Rodríguez-Martínez
- José Manuel Rodríguez-Martínez is a Researcher in molecular microbiology aspects related to mechanisms of antimicrobial resistance and resistance gene dissemination. His doctoral thesis focused on the characterization of plasmid-mediated quinolone resistance in Enterobacteriaceae. He is Professor at the University of Seville, Spain
| | - María Eliecer Cano
- María Eliecer Cano is a Clinical Microbiologist at the University Hospital Marqués de Valdecilla (Santander, Spain). She is applying and developing molecular methods for typing of clinically relevant microorganisms and for detection of genes involved in antimicrobial resistance
| | - Jorge Calvo
- Jorge Calvo is a Clinical Microbiologist at the University Hospital Marqués de Valdecilla. His area of expertise is susceptibility testing (including automatic devices) and interpretation of antibiogram data. He is also involved in surveillance of antimicrobial resistance
| | - Álvaro Pascual
- Álvaro Pascual is Professor of Microbiology at the University of Seville and Head of the Clinical Microbiology Laboratory at University Hospital Virgen Macarena (Seville, Spain). He is an expert on the genetic basis of antimicrobial resistance and epidemiology of infections caused by multidrug-resistant Gram-negative bacteria
| | - Luis Martínez-Martínez
- Luis Martínez-Martínez is Professor of Microbiology at the University of Cantabria (Santander, Spain) and Head of Clinical Microbiology of the University Hospital Marqués de Valdecilla. His research is focused on molecular aspects of antimicrobial resistance, particularly in multidrug-resistant bacteria
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9
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Domínguez-Herrera J, Velasco C, Docobo-Pérez F, Rodríguez-Martínez JM, López-Rojas R, Briales A, Pichardo C, Díaz-de-Alba P, Rodríguez-Baño J, Pascual A, Pachón J. Impact of qnrA1, qnrB1 and qnrS1 on the efficacy of ciprofloxacin and levofloxacin in an experimental pneumonia model caused by Escherichia coli with or without the GyrA mutation Ser83Leu. J Antimicrob Chemother 2013; 68:1609-15. [PMID: 23493313 DOI: 10.1093/jac/dkt063] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of qnrA1, qnrB1 and qnrS1 on the in vivo efficacies of ciprofloxacin and levofloxacin in an experimental model of pneumonia caused by Escherichia coli. METHODS Two isogenic groups of E. coli transformants, based on two ATCC 25922 strains, with or without the GyrA mutation Ser83Leu, and carrying qnrA1, qnrB1 or qnrS1, were used in an experimental pneumonia model. The efficacies of ciprofloxacin (40 mg/kg/day) and levofloxacin (50 and 150 mg/kg/day) were evaluated. RESULTS For the pneumonia caused by the parental strains lacking qnr genes, both fluoroquinolones significantly (P<0.05) reduced the bacterial lung concentration by >7 log10 cfu/g against E. coli ATCC/pBK and between 5.09 and 6.34 log10 cfu/g against E. coli ATCC-S83L/pBK. The presence of any qnr genes in the strains of both isogenic groups diminished the reduction of bacterial lung concentration with any therapy (P<0.05). Furthermore, all therapeutic schemes reduced the percentage of positive blood cultures in both isogenic groups (P<0.05). Finally, the survival results suggest a higher mortality with the strains expressing qnr genes. CONCLUSIONS The presence of qnrA1, qnrB1 and qnrS1 in E. coli reduced the efficacy of ciprofloxacin and levofloxacin in a murine pneumonia model.
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Affiliation(s)
- J Domínguez-Herrera
- Institute of Biomedicine of Seville, University Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain.
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10
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Rodríguez-Martínez JM, Díaz de Alba P, Briales A, Machuca J, Lossa M, Fernández-Cuenca F, Rodríguez Baño J, Martínez-Martínez L, Pascual Á. Contribution of OqxAB efflux pumps to quinolone resistance in extended-spectrum-β-lactamase-producing Klebsiella pneumoniae. J Antimicrob Chemother 2012; 68:68-73. [PMID: 23011289 DOI: 10.1093/jac/dks377] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aims of this study were to analyse the presence of oqxA and oqxB genes in a collection of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae strains, to determine their chromosomal and/or plasmidic locations and to analyse expression levels in relation to susceptibility or resistance to quinolones. METHODS A collection of 114 non-repetitive isolates of ESBL-producing K. pneumoniae was used. K. pneumoniae ATCC 27799 and K. pneumoniae ATCC 700603 were also included. Detection of oqxA and oqxB genes was performed by PCR. Testing for chromosomal and/or plasmidic location was carried out using plasmid DNA and subsequent hybridization. oqxA gene expression was analysed using real-time RT-PCR. Transfer of the plasmid-encoded OqxAB was evaluated. RESULTS The prevalence of both oqxA and oqxB detected in K. pneumoniae was high: 76% and 75%, respectively. Hybridization assays showed that oqxA (16%) and oqxB (13%) were simultaneously present in locations on the chromosome and on large plasmids. The plasmids were transferable by transformation into K. pneumoniae. RT-PCR assays showed higher expression (4-fold) in strains with reduced susceptibility to quinolones than in susceptible strains. Interestingly, K. pneumoniae ATCC 700603 showed an 18-fold higher expression than K. pneumoniae ATCC 27799. These differences were in accordance with quinolone susceptibility. CONCLUSIONS The prevalence of the OqxAB efflux pump (both chromosomal and plasmid encoded) in ESBL-producing K. pneumoniae is high in Spain and represents a potential reservoir for the spread of these genes. High expression of this pump contributes to reduced susceptibility to quinolones in clinical isolates of ESBL-producing K. pneumoniae.
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Cengiz M, Buyukcangaz E, Arslan E, Mat B, Sahinturk P, Sonal S, Gocmen H, Sen A. Molecular characterisation of quinolone resistance in Escherichia coli from animals in Turkey. Vet Rec 2012; 171:155, 1-4. [PMID: 22890400 DOI: 10.1136/vr.100719] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The aim of this study were to detect the gyrA, parC and marR mutations and qnr genes (qnrA, qnrB and qnrS) in 120 strains of Escherichia coli isolated from animals. European Committee on Antimicrobial Susceptibility Testing and Clinical Laboratory Standards Institute disc diffusion and minimum inhibitory concentration (MIC) tests, respectively, were used to determine fluoroquinolone (FQ) resistance, and molecular methods were used to detect the mutations and the genes. E coli isolates with an MIC of ≥8 mg/l had mutation at Ser-80 in parC in addition to mutations at Ser-83, Asp-87 or both in gyrA. The nucleotide change was detected in marR (Ser-3 → Asn, Ala-53 → Glu, Gly-103 → Ser, Tyr-137 → His). Only four E coli isolates (3.3 per cent) contained qnrA and qnrS, and qnrB was not detected. Two E coli isolates from healthy calves also contained qnrA and qnrS. The MICs of enrofloxacin and danofloxacin for qnr-containing E coli isolates ranged from 32 mg/l to 256 mg/l. The results of this study indicated that the FQ-resistant E coli isolates presented an alteration in gyrA (Ser-83 → Leu, Asp-87 → Asn) and parC (Ser-80 → Ile) with high MICs (8-256 mg/l), and there was a low prevalence of qnr genes among E coli isolated from animals.
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Affiliation(s)
- M Cengiz
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Uludag University, 16059, Nilufer, Bursa, Turkey.
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Lee CC, Lui G, Ip M, Ling TKW, Lee N. Frequent detection of plasmid-mediated quinolone resistance (qnr) genes in multidrug-resistant Enterobacteriaceae blood isolates, Hong Kong. Eur J Clin Microbiol Infect Dis 2012; 31:3183-9. [PMID: 22744730 DOI: 10.1007/s10096-012-1683-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 06/12/2012] [Indexed: 11/28/2022]
Abstract
Plasmid-mediated quinolone resistance (qnr) genes confer low-level resistance but provide background for selection of highly-resistant strains. We investigated their prevalence and significance in clinical Enterobacteriaceae bacteremic isolates in Hong Kong. A prospective, hospital-based study was conducted (January 2008 to March 2009). Consecutive, non-duplicate blood isolates of extended-spectrum-β-lactamase (ESBL) and/or plasmid-mediated AmpC (PMAmpC) β-lactamase-producing Enterobacteriaceae were collected and subjected to qnr genes detection using multiplex PCR. Direct sequencing was performed to characterize the qnr and the co-existing bla genes. Clinical and microbiological variables, including antimicrobial resistance profiles, were compared between infections by 'qnr-positive' and 'qnr-negative' Enterobacteriaceae. Altogether 199 ESBL/PMAmpC-producing Enterobacteriaceae isolates were studied. qnr genes were detected in 20 % (qnrB, n = 24; qnrS, n = 16; qnrA, n = 0), of which 85% were Klebsiella spp. There was a strong association with PMAmpC genes (qnrB and DHA-1; p < 0.001). 'qnr-positive' isolates were more commonly hospital-acquired (60.0% vs 35.8%; adjusted OR 2.68, 95%CI 1.32-5.46) and multidrug-resistant (e.g. amoxicillin-clavulanate 90-100%, piperacillin-tazobactam 40-57%, ceftazidime 53-78%; sulfamethoxazole/trimethoprim 60-70%; ciprofloxacin 53-65%, levofloxacin 35-48%). Patients with 'qnr-positive' Enterobacteriaceae bacteremia had a higher 30-day mortality (45% vs 22%, p = 0.003). High Pitt bacteremia score, development of pneumonia, and failure to receive susceptible fluoroquinolone (adjusted HR 4.27; 95%CI 1.45-12.61) or carbapenem (adjusted HR 3.04; 95%CI 1.49-6.20) treatment were independent factors associated with death. A high proportion of ESBL/PMAmpC-producing Enterobacteriaceae (typically Klebsiella) bacteremic isolates carried qnr. These strains were multidrug-resistant, which was associated with inappropriate treatment and high fatality. Further dissemination of qnr and selection of fluoroquinolone/β-lactam-resistant strains should be closely monitored and controlled.
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Affiliation(s)
- C C Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 9/F, Clinical Sciences Building, Shatin, Hong Kong SAR, China
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Smati M, Emond JP, Arlet G, Tankovic J. In Vivo Sequential Selection of Escherichia coli with Topoisomerase- and Efflux-Mediated Misleading Quinolone Resistance Phenotypes. Microb Drug Resist 2012; 18:19-22. [DOI: 10.1089/mdr.2011.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mounira Smati
- Service de Bactériologie, Hôpital Avicenne, APHP, Bobigny and Université Paris, Bobigny, France
| | | | - Guillaume Arlet
- Service de Bactériologie, Hôpital Tenon, APHP, Paris and Université Paris, Paris, France
| | - Jacques Tankovic
- Service de Bactériologie-Virologie, Hôpital Saint-Antoine, APHP, Paris and Université Paris, Paris, France
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