A study on prevalence of plasmid mediated quinolone resistant genes in Klebsiella pneumoniae
Keywords:
Fluoroquinolone resistant genes, Klebsiella pneumoniae, E test, High level quinolone resistance
Abstract
Introduction: Fluoroquinolone resistance is increasingly been reported in Enterobacteriaceae. Resistance to quinolones among Enterobacteriaceae is mediated by point mutations in chromosomal genes that encode the subunits of DNA-gyrase and topoisomerase IV.
Objectives: The present study was done to identify quinolone resistant Klebsiella pneumoniae isolates from clinical samples and to detect the prevalence of plasmid mediated quinolone resistance genes.
Materials & Methods: A total of 63 isolates from various clinical samples were identified by standard biochemical methods. Antimicrobial resistance pattern of these isolates were performed by disk diffusion method as per guidelines of CLSI. Minimum Inhibitory Concentration for Ciprofloxacin was determined by E test strips with concentration gradient of 0.002-32 µg/ml. Detection of plasmid mediated quinolone resistance genes was performed by PCR.
Results: By disk diffusion, 90.99% isolates were found to be resistant to Ciprofloxacin. The sensitivity of isolates to Imipenem was found to be 99.10%. About 50.74% isolates were resistant to Aminoglycosides and 61.19% were resistant to third generation Cephalosporins. By E test, 80.95% isolates were resistant for Ciprofloxacin with MIC of >1µg/ml. By PCR, out of 63 isolates, 6 (9.52%) showed aac (6’) – Ib - cr gene, 7 (11.11%) were positive for qnr A gene, 29 (46.03%) for both qnr B and aac (6’) - Ib-cr gene and 8 (12.70%) for qnr B gene.
Conclusion: The transferrable nature of Plasmid mediated fluoroquinolone resistant genes favours the dissemination of the resistant genes between different bacterial genera and limit therapeutic options available. The prevalence of plasmid mediated quinolone resistance mediated by qnr A, qnrB and aac (6’) - Ib-cr gene results in multidrug resistance among Klebsiella pneumoniae.
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References
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20. Shilpa K, Ruby Thomas, Allavarapu Ramyashree. Isolation and Antimicrobial sensitivity pattern of Klebsiella pneumonia from sputum sample in a tertiary care hospital. Int J Biomed Advan Res. 2016; 7 (2):53-57. DOI: https:// doi.org/ 10. 7439/ ijbar. v7i2.2945
21. Narmatha W Nandhihal. Profile of Urinary tract infection and Quinolone resistance among Escherichia coli and Klebsiella species isolates. Int J Curr Microbiol App Sci. 2015; 4(7):749-756.
22. Yugendran T, Harish BN.2016. High incidence of plasmid-mediated quinolone resistance genes among Ciprofloxacin-resistant clinical isolates of Enterobacteriaceae at a tertiary care hospital in Puducherry, India. Peer Jl4:e1995. DOI: 0.7717/peerj. 1995
23. Soundararajan N, Shanmugam P, Devanbu C, Sattar SB. A study on the aac- (61) – lb - cr gene prevalence among Ciprofloxacin-resistant strains of uropathogenic Enterobacteriaceae. Int J Applied Basic Med Res. 2016; 6:258-6.DOI: 10.4103/2229-516X.192603
24. Fu-pin HU, Xiao-gang XU, De-mei ZHU, Ming-gui WANG. Coexistence of qnrB4 and qnrS1 in a clinical strain of Klebsiella pneumonia. Acta Pharmacologica Sinica 2008; 29 (3): 320–324. DOI:https:/ doi.org/ 10.1111/j.1745-7254.2008.00757.X
25. Endimiani A, Carias LL, Hujer AM, Bethel CR, Hujer KM, Perez F et al. Presence of Plasmid-Mediated Quinolone Resistance in Klebsiella pneumoniae Isolates Possessing blaKPC in the United States. Antimicrob AgentsChemother2008;52(7):2680-2682.DOI: 10.1128/ AAC. 00158-08
26. Magesh H, Kamatchi C, Vaidyanathan R, Sumathi G. Identification of plasmid-mediated quinolone resistance genes qnrA1, qnrB1 and aac(6’)-1b-cr in a multiple drug-resistant isolate of Klebsiella pneumoniae from Chennai. Indian J Med Microbiol. 2011;29(3): 262-8. DOI: 10.4103/0255-0857.83910
27. Park CH, Robicsek A, Jacoby GA, Sahm D, Hooper DC. Prevalence in the United States of aac (6’)-Ib-cr Encoding a Ciprofloxacin-Modifying Enzyme. Antimicrob Agents Chemother 2006; 50(11):3953-5. DOI: 10.1128/AAC.00915-06
28. Dasgupta N , Dhar D , Kharkongor N, Chakravarty A, Bhattacharjee A. Molecular detection of aac (6’)-Ib-cr among clinical Enterobacterial isolates conferring quinolone resistance:- A study from North east India. J Microbiol Infect Dis.2016; 6(3):97-102 DOI: 10.5799/ ahinjs. 02.2016.03.0225
29. Stefana Sabtcheva, Mitsuo Kaku, Tomoo Saga, Yoshikazu Ishii,Todor Kantrdijiev. High Prevalence of theaac (6)-Ib-crGene and Its Dissemination among Enterobacteriaceae Isolates by CTX-M-15 Plasmids in Bulgaria. Antimicrob Agents Chemother. 2009; 53(1): 335–336. DOI:10.1128/AAC.00584-08
2. Domagala, J. M. Structure-activity and structure-side effect relationships for the quinolone antibacterials. J Antimicrob Chemother.1994;33:685-706.DOI:10.1093 / jac/ 33.4.685
3. Wang H, Dzink-Fox JL, Chen M, Levy SB. Genetic characterization of highly fluoroquinolone-resistant clinical Escherichia coli strains from China: role of acrR mutations. Antimicrob Agents Chemother. 2001; 45(5): 1515–21. DOI: 10.1128/AAC.45.5.1515-1521. 2001
4. Ho PL, Yung RW, Tsang DN. Increasing resistance of Streptococcus pneumoniae to fluoroquinolones: results of a Hong Kong multicentre study in 2000. J Antimicrob Chemother. 2001; 48(5):659–65.DOI:10. 1093 / jac/ 48.5.659
5. Johnson AP, Sheppard CL, Harnett SJ. Emergence of a fluoroquinolone- resistant strain of Streptococcus pneumonia in England. J Antimicrob Chemother. 2003; 52 (6):953-60. DOI: 10.1093/jac/dkg469
6. Drlica K, Zhao X. DNA gyrase, topoisomerase IV, and the 4-quinolones. Microbiol Mol Biol Rev.1997; 61: 377–92.
7. Aschbacher R, Doumith M, Livermore DM, Larcher C, Woodford N. Linkage of acquired quinolone resistance (qnrS1) and metallo-b-lactamase (blaVIM-1) genes in multiple species of Enterobacteriaceae from Bolzano, Italy. J Antimicrob Chemother. 2008;61(3): 515–523. DOI: 10.1093/jac/dkm508.
8. Andriole VT. Andriole. The Quinolones: Past, Present, and Future.Clin Infect Dis. 2005; 41:S113–9. DOI: https:/doi.org/10.1086/428051.
9. Mammeri H, Van De Loo M, Poirel L, Martinez-Martinez L, Nordmann P. Emergence of Plasmid-Mediated Quinolone Resistance in Escherichia coli in Europe. Antimicrob Agents Chemother. 2005; 49 (1): 71-76. DOI: 10.1128/AAC.49.1.71-76.2005
10. Koneman E, Winn WJ, Allen S, Janda W, Procop G, Woods G, Schreckenberger P. Koneman’s color atlas and textbook of diagnostic microbiology [chapter 6] 6th ed. London: Lippincott Williams & Wilkins; 2006; 211–294.
11. Clinical and Laboratory Standard Institute (CLSI). Performance standards for antimicrobial disk susceptibility tests. Approved Standard M2-A7, 11th edn. Wayne, pa; 2005.
12. 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(7):DOI : 2242-2248 10.1128/AAC.47.7.2242-2248.2003
13. Wang M, Sahm DF, Jacoby GA, Zhang Y, Hooper DC. Activities of newer quinolones against Escherichia coli and Klebsiella pneumonia containing the plasmid-mediated quinolone resistance determinant qnr. Antimicrob Agents Chemother. 2004; 48(4): 1400–1401. DOI:10.1128/AAC.48.4.1400-1401.2004
14. Cattoir V, Nordmann P, Silva-Sanchez J, Espinal P, Poirel L. ISEcp1-Mediated Transposition of qnr B-Like Gene in Escherichia coli. Antimicrob Agents Chemother. 2008;52(8):2929-2932.DOI:10.1128/ AAC. 00349-08
15. Poirel L, Rodriguez-Martinez JM, Mammeri H, Liard A, Nordmann P.. Origin of Plasmid - Mediated Quinolone Resistance Determinant QnrA. Antimicrob AgentsChemother.2005;49(8):3523-3525.DOI:10. 1128 / AAC.49.8.3523-3525.2005
16. Cavaco LM, Hasman H, Xia S, Aarestrup FM. qnrD, a Novel Gene Conferring Transferable Quinolone Resistance in Salmonella enterica serovar Kentucky and Bovis morbificans strains of Human Origin Antimicrob Agents Chemother.2009;53(2):603-608. DOI: 10.1128/ AAC. 00997-08.
17. Pitout JD, Wei Y, Church DL, Gregson DB. Surveillance for plasmid-mediated quinolone resistance determinants in Enterobacteriaceae within the Calgary Health Region, Canada: the emergence of aac (6) -Ib-cr. Antimicrob Agents Chemother, 2008: 61(5):999-1002. DOI:https://doi.org/10.1111/j. 1469-0691.2010.03440X
18. Garau J, Xercavins M, Rodríguez-Carballeira M, Gómez-Vera JR, Coll I, Vidal D et al. Emergence and Dissemination of Quinolone - Resistant Escherichia coli in the Community. Antimicrob Agents Chemother. 1999; 43(11):2736–2741.
19. Yang H, Chen H, Yang Q, Chen M and Wang H. High Prevalence of Plasmid-Mediated Quinolone Resistance Genes qnr and aac (6)-Ib-cr in Clinical Isolates of Enterobacteriaceae from Nine Teaching Hospitals in China. Antimicrob Agents Chemother. 2008; 52 (12): 4268–4273. DOI: 10. 1128/AAC. 008 30-08.
20. Shilpa K, Ruby Thomas, Allavarapu Ramyashree. Isolation and Antimicrobial sensitivity pattern of Klebsiella pneumonia from sputum sample in a tertiary care hospital. Int J Biomed Advan Res. 2016; 7 (2):53-57. DOI: https:// doi.org/ 10. 7439/ ijbar. v7i2.2945
21. Narmatha W Nandhihal. Profile of Urinary tract infection and Quinolone resistance among Escherichia coli and Klebsiella species isolates. Int J Curr Microbiol App Sci. 2015; 4(7):749-756.
22. Yugendran T, Harish BN.2016. High incidence of plasmid-mediated quinolone resistance genes among Ciprofloxacin-resistant clinical isolates of Enterobacteriaceae at a tertiary care hospital in Puducherry, India. Peer Jl4:e1995. DOI: 0.7717/peerj. 1995
23. Soundararajan N, Shanmugam P, Devanbu C, Sattar SB. A study on the aac- (61) – lb - cr gene prevalence among Ciprofloxacin-resistant strains of uropathogenic Enterobacteriaceae. Int J Applied Basic Med Res. 2016; 6:258-6.DOI: 10.4103/2229-516X.192603
24. Fu-pin HU, Xiao-gang XU, De-mei ZHU, Ming-gui WANG. Coexistence of qnrB4 and qnrS1 in a clinical strain of Klebsiella pneumonia. Acta Pharmacologica Sinica 2008; 29 (3): 320–324. DOI:https:/ doi.org/ 10.1111/j.1745-7254.2008.00757.X
25. Endimiani A, Carias LL, Hujer AM, Bethel CR, Hujer KM, Perez F et al. Presence of Plasmid-Mediated Quinolone Resistance in Klebsiella pneumoniae Isolates Possessing blaKPC in the United States. Antimicrob AgentsChemother2008;52(7):2680-2682.DOI: 10.1128/ AAC. 00158-08
26. Magesh H, Kamatchi C, Vaidyanathan R, Sumathi G. Identification of plasmid-mediated quinolone resistance genes qnrA1, qnrB1 and aac(6’)-1b-cr in a multiple drug-resistant isolate of Klebsiella pneumoniae from Chennai. Indian J Med Microbiol. 2011;29(3): 262-8. DOI: 10.4103/0255-0857.83910
27. Park CH, Robicsek A, Jacoby GA, Sahm D, Hooper DC. Prevalence in the United States of aac (6’)-Ib-cr Encoding a Ciprofloxacin-Modifying Enzyme. Antimicrob Agents Chemother 2006; 50(11):3953-5. DOI: 10.1128/AAC.00915-06
28. Dasgupta N , Dhar D , Kharkongor N, Chakravarty A, Bhattacharjee A. Molecular detection of aac (6’)-Ib-cr among clinical Enterobacterial isolates conferring quinolone resistance:- A study from North east India. J Microbiol Infect Dis.2016; 6(3):97-102 DOI: 10.5799/ ahinjs. 02.2016.03.0225
29. Stefana Sabtcheva, Mitsuo Kaku, Tomoo Saga, Yoshikazu Ishii,Todor Kantrdijiev. High Prevalence of theaac (6)-Ib-crGene and Its Dissemination among Enterobacteriaceae Isolates by CTX-M-15 Plasmids in Bulgaria. Antimicrob Agents Chemother. 2009; 53(1): 335–336. DOI:10.1128/AAC.00584-08
CITATION
DOI: 10.17511/jopm.2019.i07.02
Published: 2019-07-31
How to Cite
Dr. Indra Priyadharsini R, Dr. Venkata Raghavendra Rao A, & Dr. Kavyashri. J. (2019). A study on prevalence of plasmid mediated quinolone resistant genes in Klebsiella pneumoniae. Tropical Journal of Pathology and Microbiology, 5(7), 420-430. https://doi.org/10.17511/jopm.2019.i07.02
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