FREQUENCY OF PLASMID-MEDIATED QUINOLONE RESISTANCE DETERMINANTS QNR AND QEPA AMONG CLINICAL ISOLATES OF Escherichia coli and Klebsiella pneumoniae PRODUCING EXTENDED- SPECTRUM β-LACTAMASES FROM SAUDI ARABIA INTENSIVE CARE UNITS

NERMIN H. IBRAHIM¹, FULWAH YAHYA ALQAHTANI², FADILAH SFOUQ ALEANIZY³, RIHAF ALFARAJ⁴, AMANY Z. MAHMOUD⁵, AZZA S. ZAKARIA⁶*
¹Medical Microbiology and Immunology Department, Faculty of Medicine, Beni-Suef University, Egypt
²Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
³Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
⁴Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
⁵Pharmaceutical Medicinal Chemistry Department, College of Pharmacy, Assiut University, Egypt
⁶Microbiology and Immunology Department, Faculty of Pharmacy, Alexandria University, Egypt
* Corresponding Author : azzazakaria@gmail.com

Received : 29-07-2017     Accepted : 17-08-2017     Published : 28-08-2017
Volume : 9     Issue : 8       Pages : 924 - 929
Int J Microbiol Res 9.8 (2017):924-929

Keywords : ICU, PMQR, Fluoroquinolones, ESBL
Academic Editor : Dr Aakash Shah
Conflict of Interest : None declared
Acknowledgements/Funding : The authors extend their appreciation to the Deanship of Scientific Research at KingSaud University for funding this work through research group NO (RGP- 1438-003)
Author Contribution : All authors contributed equally to the work

The aim of this study is to investigate the plasmid mediated quinolone resistance (PMQR) determinants (Qnr-like, QepA genes) and the relationship between PMQR and ESBL in ESBL-producing Escherichia coli and Klebsiella pneumoniae isolated from ICU patients in Saudi Arabia. A total of 34 ESBL producing E. coli and K. pneumoniae isolates were collected from different ICUs in a tertiary care hospital and identified by double disk synergy test and phenotypic confirmatory disk diffusion test. blaCTX-M, blaSHV, blaTEM genes were investigated for their presence in the phenotypic positive ESBL producing Gram negative isolates. In addition, fluoroquinolone phenotypically identified resistant strains were tested for the presence of PMQR genes; QnrA, QnrB, QnrS, QepA using PCR assay. The relationship between ESBL production and fluoroquinolone resistance was then studied. MIC determination revealed that 100%and 88.2 % of the strains were resistant to nalidixic acid and ciprofloxacin, respectively. BlaCTX gene was seen in 50% of the isolates while blaSHV gene was detected in only one isolate of each. No blaTEM gene was found among the K. pneumoniae isolates while15.3% ESBL producing E. coli harbored the blaTEM gene. Qnr genes were detected in 4 strains and all of them carried QnrB-like gene (3 E. coli, 1 K. pneumoniae), while no QnrA neither QnrS could be detected. All Qnr strains showed ESBL phenotype. Moreover, the 34 isolates showed the presence of QepA gene in 6 E. coli and 1 K. pneumoniae. Only one K. pneumoniae isolate shared both the Qnr and the QepA gene. The association between one or more of the ESBL harboring genes and Qnr determinants was found in 7 isolates (6 E. coli and 1 K. pneumoniae). Although the Qnr genes carriage rate was found low among those strains, there was a clear correlation between PMQR genes and β-lactamase genes, as well as a high resistance rate against ciprofloxacin.

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