BackgroundBacterial resistance to antibiotics is thought to develop only in the presence of antibiotic pressure. Here we show evidence to suggest that fluoroquinolone resistance in Escherichia coli has developed in the absence of fluoroquinolone use.MethodsOver 4 years, outreach clinic attendees in one moderately remote and five very remote villages in rural Guyana were surveyed for the presence of rectal carriage of ciprofloxacin-resistant Gram-negative bacilli (GNB). Drinking water was tested for the presence of resistant GNB by culture, and the presence of antibacterial agents and chloroquine by HPLC. The development of ciprofloxacin resistance in E. coli was examined after serial exposure to chloroquine. Patient and laboratory isolates of E. coli resistant to ciprofloxacin were assessed by PCR-sequencing for quinolone-resistance-determining-region (QRDR) mutations.ResultsIn the very remote villages, 4.8% of patients carried ciprofloxacin-resistant E. coli with QRDR mutations despite no local availability of quinolones. However, there had been extensive local use of chloroquine, with higher prevalence of resistance seen in the villages shortly after a Plasmodium vivax epidemic (p<0.01). Antibacterial agents were not found in the drinking water, but chloroquine was demonstrated to be present. Chloroquine was found to inhibit the growth of E. coli in vitro. Replica plating demonstrated that 2-step QRDR mutations could be induced in E. coli in response to chloroquine.ConclusionsIn these remote communities, the heavy use of chloroquine to treat malaria likely selected for ciprofloxacin resistance in E. coli. This may be an important public health problem in malarious areas.
neering, where she teaches a variety of courses in biomedical digital signal processing, medical imaging, computing in biomedical engineering, biomaterials, anatomy and physiology. In addition to her academic responsibilities, she acts as a consultant to GE Healthcare for product development with emphasis on advanced imaging applications for neurology, cardiology, and oncology. Olga's technical areas of expertise include signal and imaging processing, and statistical analysis. In her previous and current product development roles, Olga gained extensive experience in clinical product management involving market analysis for new and existing imaging products, and clinical product marketing. She has experience in managing product evaluations at multiple clinical sites, and has a comprehensive knowledge of neurology, oncology, and cardiology imaging markets. She has established a number of strong collaborations with clinical experts in recognized neuroimaging and oncology centers. Olga has earned her undergraduate degree in biomedical engineering from the Milwaukee School of Engineering in 1999, and a doctorate degree in biomedical engineering and functional imaging from the Joint Functional Imaging program at Marquette University and Medical College of Wisconsin in 2004. Prior to entering academia full-time in 2009, Olga completed a three-year postdoctoral fellowship in anesthesiology at the Medical College of Wisconsin, where she studied the effects of general anesthetic agents on brain function. She then worked at GE Healthcare as a product development specialist in CT and Molecular Imaging with emphasis on post-processing software applications for neurology, oncology, and cardiology. Olga has over twenty peer-reviewed publications and three pending patents. Her professional interests include physiological mechanisms of Alzheimer's disease, anesthetic ablation of consciousness, and applicability of medical imaging in stroke and brain trauma. Dr. Jeffrey A. LaMack, Milwaukee School of Engineering Dr. LaMack teaches full-time in the Biomedical Engineering program in the Electrical Engineering and Computer Science Department at the MIlwaukee School of Engineering (MSOE). His areas of specialty include biophysical transport phenomena, biocomputing, physiology, and engineering design. Dr. LaMack holds a Ph.D. in Biomedical Engineering from Duke University, and he is an alumnus of the Biology Scholars Program of the American Society of Microbiology. Prior to becoming focused on engineering education, his research interests included hemodynamics and the study of how vascular cells respond to fluid forces and its implications in vascular pathologies.
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