Korean J Lab Med.  2011 Oct;31(4):257-264. 10.3343/kjlm.2011.31.4.257.

Prevalence of Plasmid-mediated Quinolone Resistance and Its Association with Extended-spectrum Beta-lactamase and AmpC Beta-lactamase in Enterobacteriaceae

• Jeong HS
• Bae IK
• Shin JH
• Jung HJ
• Kim SH
• Lee JY
• Oh SH
• Kim HR
• Chang CL
• Kho WG
• Lee JN

• KMID: 1781689
• DOI: http://doi.org/10.3343/kjlm.2011.31.4.257

Abstract

BACKGROUND
We investigated the prevalence of plasmid-mediated quinolone resistance and its association with extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase in Enterobacteriaceae.
METHODS
A total of 347 non-duplicated isolates of Enterobacteriaceae were collected between August and October 2006 from 2 hospitals. Qnr determinant screening was conducted using PCR amplification, and all positive results were confirmed by direct sequencing. Qnr-positive strains were determined on the basis of the presence of ESBL and AmpC beta-lactamase genes.
RESULTS
The qnr gene was detected in 47 of 347 clinical Enterobacteriaceae isolates. Among the 47 qnr-positive strains, Klebsiella pneumoniae (N=29) was the most common, followed by Escherichia coli (N=6), Enterobacter cloacae (N=6), Citrobacter freundii (N=5), and Enterobacter aerogenes (N=1). These isolates were identified as qnrA1 (N=6), 8 qnrB subtypes (N=40), and qnrS1 (N=1). At least 1 ESBL was detected in 38 of the 47 qnr-positive strains. Qnr-positive strains also showed high positive rates of ESBL or AmpC beta-lactamase, such as TEM, SHV, CTX-M, and DHA. DHA-1 was detected in 23 of 47 qnr-positive strains, and this was co-produced with 1 qnrA1 and 22 qnrB4. Strains harboring MIR-1T and CMY were also detected among the qnr-positive strains. Antimicrobial-resistance rates of qnr-positive strains to ciprofloxacin, levofloxacin, norfloxacin, nalidixic acid, and moxifloxacin were 51.1%, 46.8%, 46.8%, 74.5%, and 53.2%, respectively.
CONCLUSIONS
The qnr genes were highly prevalent in Enterobacteriaceae, primarily the qnrB subtypes. They were closely associated with EBSL and AmpC beta-lactamase.

Keyword

Qnr; Beta-lactamase; Quinolone; Enterobacteriaceae

MeSH Terms

Anti-Bacterial Agents/*pharmacology
Bacterial Proteins/biosynthesis/*genetics
DNA, Bacterial/chemistry/genetics
Drug Resistance, Bacterial/*genetics
Enterobacteriaceae/enzymology/*genetics/isolation & purification
Enterobacteriaceae Infections/microbiology
*Genetic Variation
Hospitals, University
Humans
Microbial Sensitivity Tests
Plasmids/genetics/*metabolism
Quinolones/*pharmacology
beta-Lactamases/biosynthesis/genetics

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