Prevalence and Characterization of Plasmid-Medicated Quinolone Resistance Genes among Clinical Isolates of Extended-Spectrum Cephalosporin Resistant Enterobacter cloacae

Yeon-Jae Kim; Mi-Ran Seo; Jieun Kim; Eun-Hwa Choi; Hoan-Jong Lee; Hyunjoo Pai

doi:10.3947/ic.2009.41.5.279

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Kim, Seo, Kim, Choi, Lee, and Pai: Prevalence and Characterization of Plasmid-Medicated Quinolone Resistance Genes among Clinical Isolates of Extended-Spectrum Cephalosporin Resistant Enterobacter cloacae

Original Article

Infection and Chemotherapy

Infection and Chemotherapy 2009; 41(5): 279-285.

Published online: 31 October 2009

DOI: https://doi.org/10.3947/ic.2009.41.5.279

Prevalence and Characterization of Plasmid-Medicated Quinolone Resistance Genes among Clinical Isolates of Extended-Spectrum Cephalosporin Resistant Enterobacter cloacae

Yeon-Jae Kim, M.D.¹, Mi-Ran Seo, M.D.¹, Jieun Kim, M.D.¹, Eun-Hwa Choi, M.D.², Hoan-Jong Lee, M.D.², Hyunjoo Pai, M.D.¹

¹Division of Infectious Diseases, Hanyang University College of Medicine, Seoul, Korea.

²Department of Pediatrics, Seoul National University college of Medicine, Seoul, Korea.

Correspondence author: Hyunjoo Pai M.D. Division of Infectious Diseases, College of Medicine, Hanyang University, 17 Heangdang-dong, Sungdong-gu, Seoul, 133-791, Korea. Tel: +82-2-2290-8356, Fax: +82-2-2298-9183, paihj@hanyang.ac.kr

Received 10 August 2009 Accepted 16 October 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Extended-spectrum cephalosporins (ESCs)-resistant Enterobacter cloacae is one of the pathogens of nosocomial infection the incidence of which is on the rise. Moreover, plasmid-mediated quinolone resistance genes (PMQR genes) that reduce quinolone sensitivity have been shown to be widely distributed among clinical isolates of Enterobacteriaceae. This study was carried out to observe the distribution of PMQR genes in clinical isolates of E. cloacae resistant to ESCs.

Materials and Methods

Fourty-three ESCs-resistant E. cloacae strains from the blood collected during the span of 7 years, from 1994 to 2001, at Seoul National University Children's Hospital (SNUCH) were included in this study. Isoelectric focusing and enzyme specific PCR were performed to characterize β-lactamase. The presence of qnrA, qnrB, qnrC, qnrS, qepA, and aac(6')-Ib-cr was determined by PCR, restriction enzyme analyses of PCR products, and DNA sequencing. Minimal inhibitory concentration (MIC) of several quinolones was measured by agar dilution method.

Results

The PMQR genes were detected in 9 (21%) of 43 ESCs-resistant E. cloacae isolates. Among them, five isolates were positive for qnrB2, and each two isolates harbored qnrB4 or qnrB5, respectively. qnrA, qnrC, qnrS or qepA was not identified. aac(6')-Ib was detected in 27 isolates, but aac(6')-Ib-cr was not found. Among the 9 qnrB-positive isolates, 5 produced SHV-12, 3 were derepressed mutants, and 1 produced pI 7.5 β-lactamase. MIC ranges and percent resistances of nalidixic acid, ofloxacin, levofloxacin, and moxifloxacin for the PMQR genes-positive isolates were higher than PMQR genes-negative isolates.

Conclusion

In this study, ESCs-resistant E. cloacae showed a high prevalence of PMQR genes, and qnrB was the only PMQR gene identified.

Keywords: Enterobacter cloacae, qnr, Extended-spectrum cephalosporin resistance

Figures and Tables

Table 1

Primers used for PCR Amplification

Table 2

Distribution of PMQR genes in Extended-spectrum cephalosporins-resistant E. cloacae

^*PD, partial derepressed mutant; ^†D, derepressed mutan

Table 3

MICs of Quinolones for Extended-spectrum cephalosporins-resistant E. cloacae which contains (Plasmid-Mediated Quinolone Resistance) PMQR Genes

^*MIC, minimal inhibitory concentration (µg/dL)

^†%R, % resistance (resistant isolates/total isolates)

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