Determination of gyrA and parC mutations and prevalence of plasmid-mediated quinolone resistance genes in Escherichia coli and Klebsiella pneumoniae isolated from patients with urinary tract infection in Iran

Mirzaii, Mehdi; Jamshidi, Sanaz; Zamanzadeh, Maryam; Marashifard, Masoud; Hosseini, Seyed Ali; Haeili, Mehri; Jahanbin, Fariba; Mansouri, Fariba; Darban-Sarokhalil, Davood; Khoramrooz, Seyed Sajjad

doi:10.1016/j.jgar.2018.04.017

Cited by 36 publications

(29 citation statements)

References 33 publications

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“…This suggestion agrees with other results [34, 39]. Ser80Ile mutation of parC gene was frequent in both Q and FQs resistant strains that agrees with other studies [40, 41]. Single mutation in either gene occurred only in isolates with MIC of CIP ≤ 2 μg/mL, so the presence of double mutation in gyrA and parC genes seemed to be associated with high levels of resistance to FQs.…”

Section: Discussionsupporting

confidence: 92%

Impact of co-existence of PMQR genes and QRDR mutations on fluoroquinolones resistance in Enterobacteriaceae strains isolated from community and hospital acquired UTIs

et al. 2019

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BackgroundFluoroquinolones are commonly recommended as treatment for urinary tract infections (UTIs). The development of resistance to these agents, particularly in gram-negative microorganisms complicates treatment of infections caused by these organisms. This study aimed to investigate antimicrobial resistance of different Enterobacteriaceae species isolated from hospital- acquired and community-acquired UTIs against fluoroquinolones and correlate its levels with the existing genetic mechanisms of resistance.MethodsA total of 440 Enterobacteriaceae isolates recovered from UTIs were tested for antimicrobial susceptibility. Plasmid-mediated quinolone resistance (PMQR) genes and mutations in the quinolone resistance-determining regions (QRDRs) of gyrA and parC genes were examined in quinolone-resistant strains.ResultsAbout (32.5%) of isolates were resistant to quinolones and (20.5%) were resistant to fluoroquinolones. All isolates with high and intermediate resistance phenotypes harbored one or more PMQR genes. QnrB was the most frequent gene (62.9%) of resistant isolates. Co-carriage of 2 PMQR genes was detected in isolates (46.9%) with high resistance to ciprofloxacin (CIP) (MICs > 128 μg/mL), while co-carriage of 3 PMQR genes was detected in (6.3%) of resistant isolates (MICs > 512 μg/mL). Carriage of one gene only was detected in intermediate resistance isolates (MICs of CIP = 1.5–2 μg/mL). Neither qnrA nor qnrC genes were detected. The mutation at code 83 of gyrA was the most frequent followed by Ser80-Ile in parC gene, while Asp-87 Asn mutation of gyrA gene was the least, where it was detected only in high resistant E. coli isolates (MIC ≥128 μg/mL). A double mutation in gyrA (Lys154Arg and Ser171Ala) was observed in high FQs resistant isolates (MIC of CIP < 128 μg/mL).ConclusionFQs resistance is caused by interact between PMQR genes and mutations in both gyrA and parC genes while a mutation in one gene only can explain quinolone resistance. Accumulation of PMQR genes and QRDR mutations confers high resistance to FQs.

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Section: Discussionsupporting

confidence: 92%

Impact of co-existence of PMQR genes and QRDR mutations on fluoroquinolones resistance in Enterobacteriaceae strains isolated from community and hospital acquired UTIs

et al. 2019

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“…However, Huang reported much more resistance to Ciprofloxacin (more than 60%) and also point mutations in gyrA (more than 95%) in China hospitals (17). Thus, based on the results, the double mutation Ser83→Leu + Asp87→Asn was the most prevalent type of gyrA changes in antimicrobial-resistant isolates (15)(16)(17)(18). In 2014, Norouzi et al reported some K. pneumoniae strains substituting Ser 83 →Ile and Ser 83 →Phe in gyrA gene (8).…”

Section: Discussionmentioning

confidence: 93%

Mutations in gyrA and parC Genes in Quinolone-Resistant Klebsiella pneumoniae Isolates from Borujerd Hospitals

Shokoohizadeh

Saniee

Mirzaee

et al. 2019

J Adv Med Biomed Res

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Background & Objective: Quinolones are the antibiotics used to treat infections. Several reports have indicated the increased resistance to quinolone in Klebsiella pneumoniae strains all over the world. The aim of this study was to investigate amino acid substitutions in GyrA and ParC proteins among quinolone-resistant isolates of K. pneumoniae in Borujerd (west of Iran) hospitals. Materials & Methods: Totally, 100 isolates of K. pneumoniae were collected. After validating the isolates by conventional laboratory methods, an antimicrobial susceptibility test was carried out for some antibiotics from the quinolones family. Quinolone resistance and Minimum Inhibitory Concentration (MIC) of Ciprofloxacin were detected by disk diffusion and E-test methods, respectively. The amplification of gyrA and parC genes in quinolone-resistant strains was performed by PCR using specific primers. PCR products were sequenced in order to detect the mutations in gyrA and parC genes. Results: Generally, 38% of all the collected isolates were resistant to Nalidixic acid and Ciprofloxacin, 18% were resistant to Ofloxacin, and 15% were resistant to Norfloxacin. Concurrent resistance to Nalidixic acid, Ciprofloxacin, Ofloxacin, and Norfloxacin was determined in 15% of the cases. In 86% (n=20) of Ciprofloxacinresistant strains, MIC was measured 128 μg/mL. The mutation rate was 40% (n=9) in gyrA gene in quinolone-resistant strains and 35% (n=8) in parC gene. Conclusion: Briefly, our research findings revealed that a relatively high resistance to quinolones as well as fluoroquinolone was observed among K. pneumoniae isolates in Brojurd hospitals. It is likely that mutation occurrence in certain positions of gyrA and parC genes has a significant effect on developing high-level resistance to quinolone in K. pneumoniae.

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“…Wide ranges of resistance rates to different antibiotics among uropathogens have been reported by previous studies on UTIs in Iran. Many of these studies lacked clear case definitions and did not determine whether the isolates were community- or hospital-acquired [ 13 – 15 ], or included a mixed population of community- and hospital-acquired isolates [ 16 – 19 ]. This limitation significantly decreases their practical value due to the different nature of uropathogens in the community and hospital settings [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Resistance among Community-Acquired Uropathogens in Mashhad, Iran

Vakilzadeh

Heidari

Mehri

et al. 2020

Journal of Environmental and Public Health

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Background. Antimicrobial resistance among community-acquired uropathogens is an emerging concern over the past decades that warrants a continuing reevaluation of the appropriateness of recommended empiric antimicrobial regimens for treatment of urinary tract infections (UTIs). Aims. To describe the microbial spectrum and resistance profile of community-acquired uropathogens and predictors of isolation of resistant strains. Methods. Between October 2017 and June 2019, individuals who visited the outpatient clinics for diagnosis of UTIs or screening of asymptomatic bacteriuria were included in the study if they were tested for urine culture in one of the three main medical diagnostic laboratories of Mashhad, Iran. The standard disk diffusion antimicrobial susceptibility testing was used, with the Clinical and Laboratory Standards Institute (CLSI) threshold cutoffs for susceptibility of isolated uropathogens. Results. Three hundred thirty cases were included with a median age of 47 years. Two hundred seventy-six (83.6%) were female. The most common isolated uropathogens were Escherichia coli in 201 (60.9%) cases and Klebsiella species in 46 (13.9%) cases. E. coli isolates showed the highest rates of susceptibility to nitrofurantoin (89.3%), cefixime (75%), and gentamicin (72.4%). Exposure to antibiotics in the past 3 months was a predictor of resistance to ciprofloxacin (OR: 2.8, 95% CI: 1.33–6.28), and older age was a predictor of resistance to TMP-SMX (OR: 2.1, 95% CI: 1.07–3.97) among E. coli isolates. Conclusion. E. coli and Klebsiella species accounted for about two-thirds of community-acquired uropathogens. In regard to the high susceptibility rates, nitrofurantoin was identified as the first-choice agent for empiric treatment of community-acquired cystitis, while cefixime and gentamicin might be the second-choice alternatives. Ciprofloxacin and TMP-SMX, on the other hand, cannot be considered appropriate agents for empiric therapy of community-acquired UTIs, particularly in those who had exposure to antibiotics in the past 3 months and the elderly.

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Determination of gyrA and parC mutations and prevalence of plasmid-mediated quinolone resistance genes in Escherichia coli and Klebsiella pneumoniae isolated from patients with urinary tract infection in Iran

Cited by 36 publications

References 33 publications

Impact of co-existence of PMQR genes and QRDR mutations on fluoroquinolones resistance in Enterobacteriaceae strains isolated from community and hospital acquired UTIs

Impact of co-existence of PMQR genes and QRDR mutations on fluoroquinolones resistance in Enterobacteriaceae strains isolated from community and hospital acquired UTIs

Mutations in gyrA and parC Genes in Quinolone-Resistant Klebsiella pneumoniae Isolates from Borujerd Hospitals

Antimicrobial Resistance among Community-Acquired Uropathogens in Mashhad, Iran

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