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Co-existence of plasmid-mediated quinolone resistance determinants and mutations in gyrA and parC among fluoroquinolone-resistant clinical Enterobacteriaceae isolated in a tertiary hospital in Warsaw, Poland.
Int J Antimicrob Agents. 2015 Mar; 45(3):238-43.IJ

Abstract

Plasmid-mediated quinolone resistance (PMQR) determinants and the distribution of mutations in the quinolone resistance-determining regions (QRDRs) of gyrA and parC were investigated in 215 ciprofloxacin-resistant (MIC>1mg/L) clinical Enterobacteriaceae collected during a 6-month prospective study in a tertiary hospital in Warsaw, Poland. PMQR determinants were present in 49 isolates (22.8%), among which aac(6')-Ib-cr and qnrB1 predominated (85.7% and 26.5%, respectively). Mutations in gyrA and parC QRDRs were detected among 89.8% of isolates (MIC≥4mg/L). Changes in Ser-83, Ala-84 and Asp-87 in GyrA and Ser-80 and Glu-84 in ParC were detected. Five isolates with ciprofloxacin MICs in the range 1.5-16 mg/L were found to have unaltered QRDRs, with PMQR as the only fluoroquinolone (FQ) resistance trait detected. The remaining 44 PMQR-positive isolates were found to carry altered QRDRs. Three substitutions (two in GyrA and one in ParC) were detected in 23 isolates, whilst 8 isolates carried four mutations (two in GyrA and two in ParC). One isolate of Klebsiella pneumoniae with two amino acid substitutions in the ParC QRDR in the presence of aac(6')-Ib-cr and qnrB1 had a ciprofloxacin MIC of 16mg/L. The results presented here show that FQ resistance in these clinical Enterobacteriaceae is a complex interplay between PMQR determinants and mutations in gyrA and parC rather than a single stepwise accumulation of mutations in the gyrase and topoisomerase subunits. In addition, these results show the role of PMQR determinants in promoting QRDR mutations and the acquisition of high-level FQ resistance in clinical settings.

Authors+Show Affiliations

Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland. Electronic address: kpiekarska@pzh.gov.pl.Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.Department of Laboratory Diagnostics, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland.Department of Laboratory Diagnostics, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland.Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25468717

Citation

Piekarska, Katarzyna, et al. "Co-existence of Plasmid-mediated Quinolone Resistance Determinants and Mutations in gyrA and parC Among Fluoroquinolone-resistant Clinical Enterobacteriaceae Isolated in a Tertiary Hospital in Warsaw, Poland." International Journal of Antimicrobial Agents, vol. 45, no. 3, 2015, pp. 238-43.
Piekarska K, Wołkowicz T, Zacharczuk K, et al. Co-existence of plasmid-mediated quinolone resistance determinants and mutations in gyrA and parC among fluoroquinolone-resistant clinical Enterobacteriaceae isolated in a tertiary hospital in Warsaw, Poland. Int J Antimicrob Agents. 2015;45(3):238-43.
Piekarska, K., Wołkowicz, T., Zacharczuk, K., Rzeczkowska, M., Chróst, A., Bareja, E., Olak, M., & Gierczyński, R. (2015). Co-existence of plasmid-mediated quinolone resistance determinants and mutations in gyrA and parC among fluoroquinolone-resistant clinical Enterobacteriaceae isolated in a tertiary hospital in Warsaw, Poland. International Journal of Antimicrobial Agents, 45(3), 238-43. https://doi.org/10.1016/j.ijantimicag.2014.09.019
Piekarska K, et al. Co-existence of Plasmid-mediated Quinolone Resistance Determinants and Mutations in gyrA and parC Among Fluoroquinolone-resistant Clinical Enterobacteriaceae Isolated in a Tertiary Hospital in Warsaw, Poland. Int J Antimicrob Agents. 2015;45(3):238-43. PubMed PMID: 25468717.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Co-existence of plasmid-mediated quinolone resistance determinants and mutations in gyrA and parC among fluoroquinolone-resistant clinical Enterobacteriaceae isolated in a tertiary hospital in Warsaw, Poland. AU - Piekarska,Katarzyna, AU - Wołkowicz,Tomasz, AU - Zacharczuk,Katarzyna, AU - Rzeczkowska,Magdalena, AU - Chróst,Anna, AU - Bareja,Elżbieta, AU - Olak,Monika, AU - Gierczyński,Rafał, Y1 - 2014/11/13/ PY - 2014/06/02/received PY - 2014/08/25/revised PY - 2014/09/27/accepted PY - 2014/12/4/entrez PY - 2014/12/4/pubmed PY - 2015/11/6/medline KW - Enterobacteriaceae KW - PMQR KW - Poland KW - QRDR mutations SP - 238 EP - 43 JF - International journal of antimicrobial agents JO - Int J Antimicrob Agents VL - 45 IS - 3 N2 - Plasmid-mediated quinolone resistance (PMQR) determinants and the distribution of mutations in the quinolone resistance-determining regions (QRDRs) of gyrA and parC were investigated in 215 ciprofloxacin-resistant (MIC>1mg/L) clinical Enterobacteriaceae collected during a 6-month prospective study in a tertiary hospital in Warsaw, Poland. PMQR determinants were present in 49 isolates (22.8%), among which aac(6')-Ib-cr and qnrB1 predominated (85.7% and 26.5%, respectively). Mutations in gyrA and parC QRDRs were detected among 89.8% of isolates (MIC≥4mg/L). Changes in Ser-83, Ala-84 and Asp-87 in GyrA and Ser-80 and Glu-84 in ParC were detected. Five isolates with ciprofloxacin MICs in the range 1.5-16 mg/L were found to have unaltered QRDRs, with PMQR as the only fluoroquinolone (FQ) resistance trait detected. The remaining 44 PMQR-positive isolates were found to carry altered QRDRs. Three substitutions (two in GyrA and one in ParC) were detected in 23 isolates, whilst 8 isolates carried four mutations (two in GyrA and two in ParC). One isolate of Klebsiella pneumoniae with two amino acid substitutions in the ParC QRDR in the presence of aac(6')-Ib-cr and qnrB1 had a ciprofloxacin MIC of 16mg/L. The results presented here show that FQ resistance in these clinical Enterobacteriaceae is a complex interplay between PMQR determinants and mutations in gyrA and parC rather than a single stepwise accumulation of mutations in the gyrase and topoisomerase subunits. In addition, these results show the role of PMQR determinants in promoting QRDR mutations and the acquisition of high-level FQ resistance in clinical settings. SN - 1872-7913 UR - https://www.unboundmedicine.com/medline/citation/25468717/Co_existence_of_plasmid_mediated_quinolone_resistance_determinants_and_mutations_in_gyrA_and_parC_among_fluoroquinolone_resistant_clinical_Enterobacteriaceae_isolated_in_a_tertiary_hospital_in_Warsaw_Poland_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0924-8579(14)00332-X DB - PRIME DP - Unbound Medicine ER -