Prevalence of Plasmid-Mediated Quinolone Resistance Genes among Ciprofloxacin-NonsusceptibleEscherichia coliandKlebsiella pneumoniaeIsolated from Blood Cultures in Korea
OBJECTIVES:To analyze the prevalence of plasmid-mediated quinolone resistance (PMQR) determinants in ciprofloxacin-nonsusceptibleEscherichia coliandKlebsiella pneumoniaeisolated from patients at a tertiary care hospital in Korea.METHODS: A total of 102 nonduplicate isolates of ciprofloxacin-intermediate or ciprofloxacin-resistantE coli(n=80) andK pneumoniae(n=22) from blood cultures were obtained. Theqnr(qnrA, qnrB,qnrS),aac(6′)-Ib-cr,qepAandoqxABgenes were detected using polymerase chain reaction (PCR) and confirmed using direct sequencing. To determine whether the PMQR-positive plasmid was horizontally transferable, conjugation experiments were performed.RESULTS: Of the 102 isolates, 81 (79.4%) had one or more PMQR genes; these consisted of 59 (73.8%)E coliand 22 (100%)K pneumoniaeisolates. Theqnrgenes were present in 15 isolates (14.7%):qnrB4was detected in 10.8% andqnrS1was detected in 3.9%. Theaac(6′)-Ib-cr,qepAandoqxABgenes were detected in 77.5%, 3.9% and 10.8%, respectively. In conjugation experiments, PMQR genes were successfully transferred from seven (8.6%) isolates. The range of minimum inhibitory concentrations of ciprofloxacin for these seven transconjugants increased to 0.5 mg/L to 1 mg/L, which was 16- to 33-fold that of the recipientE coliJ53 bacteria.CONCLUSIONS: PMQR genes were highly prevalent among ciprofloxacin-nonsusceptibleE coliandK pneumoniaefrom blood cultures in the authors’ hospital. Therefore, it is necessary to monitor for the spread of PMQR genes of clinical isolates and to ensure careful antibiotic use in a hospital setting.