qnr Prevalence in Extended Spectrum Beta-lactamases (ESBLs) and None- ESBLs Producing Escherichia coli Isolated from Urinary Tract Infections in Central of Iran

Document Type : Original Article

Authors

1 Department Microbiology, Faculty of Medicine and Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran

2 Department Microbiology, Faculty of Medicine and Molecular Medicine Research Center, Arak University of Medical Sciences, Arak, Iran

3 Department Microbiology, Iranian Reference Health Laboratory, Tehran, Iran

4 Department Microbiology, Karaj Islamic Azad University, Karaj/Iran

Abstract

Objective(s)
Extensive use of quinolones has been associated with raising level of resistance. In the current, we focused on assessing the prevalence of Escherichia coli resistance to quinolones and frequency of qnrA, qnrB and qnrS in non ESBLs (extended spectrum beta-lactamases) and ESBLs producing E. coli with blaSHV and blaTEM.
Materials and Methods
One hundred and fifty E. coli isolates were identified during Mar. 2007 to Apr. 2008 in Milad (Tehran) hospital. They were tested for ESBLs production as well as quinolone resistance. PCR was performed for detection of blaSHV and blaTEM as well as qnrA, B and S.
Results
Of 150 isolates, forty-two (28%) ESBLs producing and one hundred and eight (72%) non-ESBLs producing E. coli were identified. 64.2% (n= 24) of E. coli producing ESBLs and 4.62% (n= 5) of non-ESBLs E. coli were resistance to ciprofloxacin. 95.2% (n= 40) and 26.1% (n= 11) of the isolates harbored blaTEM and blaSHV, respectively. 23.8% (n= 10) had both genes. 37.5% (n= 9) and 20.8% (n= 4) of ESBLs producing E. coli were positive for qnrA and qnrB respectively. qnrS was not identified in any isolate.
Conclusion
Our study showed high frequency of ESBLs producing E. coli as well as quinolone resistance genes (qnrA, qnrB) in Milad hospital.

Keywords


1.Cheung TK, Chu, YW, Chu MY, Ma CH, Yung RW, Kam KM. Plasmid-mediated resistance to ciprofloxacin and cefotaxime in clinical isolates of Salmonella enterica serotype Enteritidis in Hong Kong. J Antimicrob Chemother 2005; 56:586-589.
2.Cerquetti M, Garcia-Fernandez A, Giufre M, Fortini D, Accogli M, Graziani C, et al. First report of plasmid- mediated quinolone resistance determinant qnrSl in an Escherichia coli strain of animal origin in Italy. Antimicrob Agents Chemother 2009; 53:3112-3114.
3.Robicsek A, Jacoby GA, Hooper DC.The worldwide emergence of plasmidmediated quinolone resistance. Lancet Infect Dis 2006; 6:629-640.
4.Oktem IM, Gulay Z, Bicmen M, Gur D. qnrA prevalence in extended-spectrum beta-lactamase-positive Enterobacteriaceae isolates from Turkey. Jpn J Infect Dis 2008 ;61:13-17.
5.Allou N, Cambau E, Massias L, Chau F, Fantin B. Impact of low-level resistance to fluoroquinolones due to qnrA1 and qnrS1 genes or a gyrA mutation on ciprofloxacin bactericidal activity in a murine model of Escherichia coli urinary tract infection. Antimicrob Agents Chemother 2009; 53:4292-4297.
6.Poirel L, Pitout J, Calvo L, Rodriguez-Martinez JM, Church D, Nordmann P. In vivo selection of fluoroquinolone-resistant Escherichia coli isolates expressing plasmid-mediated quinolone resistance and expanded-spectrum beta-lactamase. Antimicrob Agents Chemother 2006; 50:1525-1527.
7.Robicsek A, Strahilevitz J, Sahm DF,Jacoby GA, Hooper DC. qnr prevalence in ceftazidime-resistant Enterobacteriaceae isolates from the United States. Antimicrob Agents Chemother 2006; 50:2872-2874.
8.Shin SY, Kwon KC, Park JW, Song JH, Ko YH, Sung JY, et al. Characteristics of aac(6')-Ib-cr gene in extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolated from Chungnam area. Korean J Lab Med 2009; 29:541-550.
9.Nordmann P, Poirel L.Emergence of plasmid-mediated resistance to quinolones in Enterobacteriaceae. J Antimicrob Chemother 2005; 56:463-469.
10.Dbaibo GS. Old and new targets of antibacterial therapy. J Med Liban 2000; 48:177-181.
11.ParkY, Kang HK, Bae IK, Kim J, Kim JS, UhY, et al. Prevalence of the extended-spectrum beta-lactamase and qnr genes in clinical isolates of Escherichia coli. Korean J Lab Med 2009; 29:218-223.
12.Kim MH, Lee HJ, Park KS, Suh JT. Molecular characteristics of extended spectrum beta-lactamases in Escherichia coli and Klebsiella pneumoniae and the prevalence of qnr in Extended spectrum beta-lactamase isolates in a tertiary care hospital in Korea. Yonsei Med J 2010: 51:768-774.
13.Shahcheraghi F, Moezi H, Feizabadi MM. Distribution of TEM and SHV beta-lactamase genes among Klebsiella pneumoniae strains isolated from patients in Tehran. Med Sci Monit 2007; 13:BR247-250.
14.Tenover FC, Raney PM, Williams PP, Rasheed JK, Biddle JW, Oliver A, et al. Evaluation of the NCCLS extended-spectrum beta-lactamase confirmation methods for Escherichia coli with isolates collected during Project ICARE. J Clin Microbiol 2003; 41:3142-3146.
15.Cormican MG, Marshall SA, Jones RN. Detection of extended-spectrum beta-lactamase (ESBL)-producing strains by the Etest ESBL screen. J Clin Microbiol 1996; 34:1880-1884.
16.Song S, Lee EY, Koh EM, Ha HS, Jeong HJ, Bae IK, et al. Antibiotic resistance mechanisms of Escherichia coli Isolates from urinary specimens. Korean J Lab Med 2009; 29:17-24.
17.Paterson DL, BonomoRA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005; 18:657-686.
18.Hyle EP, Lipworth AD, Zaoutis TE, Nachamkin I, Fishman NO, Bilker WB, et al. Risk factors for increasing multidrug resistance among extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species. Clin Infect Dis 2005; 40:1317-1324.
19.Paterson DL, Bonomo RA. Resistance in gram-negative bacteria: Enterobacteriaceae. Am J Infect Control 2006;34 :S20-28; discussion S64-73.
20.Han C, Yang Y, Wang M, Wang A, Lu Q, Xu X, et al. The prevalence of plasmid-mediated quinolone resistance determinants among clinical isolates of ESBL or AmpC-producing Escherichia coli from Chinese pediatric patients. J Microbiol Immunol 2010:54:123-128.
21.Wang M, Tran JH, Jacoby GA, Zhang Y, Wang F, Hooper DC.Plasmid-mediated quinolone resistance in clinical isolates of Escherichia coli from Shanghai, China. Antimicrob Agents Chemother 2003; 47:2242-2248. 
22.Jonas D, Biehler K, Hartung D, Spitzmuller B, Daschner FD. Plasmid-mediated quinolone resistance in isolates obtained in german intensive care units. Antimicrob Agents Chemother 2005; 49:773-775.
23.Pallecchi L, Riccobono E, Mantella A, Bartalesi F, Sennati S, Gamboa H, et al. High prevalence of qnr genes in commensal enterobacteria from healthy children in Peru and Bolivia. Antimicrob Agents Chemother 2009; 53: 2632-2635(2009).
24.Ode T, Saito R, Kumita W, SatoK, Okugawa S, Moriya K, et al. Analysis of plasmid-mediated multidrug resistance in Escherichia coli and Klebsiella oxytoca isolates from clinical specimens in Japan. Int J Antimicrob Agents 2009; 34:347-350.
25.Poirel, Van De Loo M, Mammeri H, Nordmann P. Association of plasmid-mediated quinolone resistance with extended-spectrum beta-lactamase VEB-1. Antimicrob Agents Chemother 2005; 49:3091-3094.