Occurrence of qnr-positive clinical isolates in Klebsiella pneumoniae producing ESBL or AmpC-type β-lactamase from five pediatric hospitals in China

Wang, Aihua; Yang, Yonghong; Lu, Quan; Wang, Yi; Chen, Yuan; Deng, Li; Ding, Hui; Deng, Qiulian; Wang, Li; Shen, Xuzhuang

doi:10.1111/j.1574-6968.2008.01163.x

Cited by 29 publications

(25 citation statements)

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“…Studies have shown that Extended-Spectrum Beta-Lactamase (ESBL)-producing Klebsiella pneumoniae have rapidly spread worldwide and pose a serious threat for health care-associated infections [1] . Increasingly the ESBL Klebsiella pneumoniae are also showing co-resistance to quinolones and aminoglycoside antibiotics [5,6] present in plasmids which can be transferred by conjugation to other strains.…”

Section: Introductionmentioning

confidence: 99%

Identification of Clonal Clusters of Klebsiella pneumoniae Isolates from Chennai by Extended Spectrum Beta Lactamase Genotyping and Antibiotic Resistance Phenotyping Analysis

Kamatchi¹,

Magesh²,

Sekhar³

et al. 2009

American J. of Infectious Diseases

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Problem statement: An increased resistance to antibiotics has been reported in Klebsiella pneumoniae, an opportunistic gram negative pathogen belonging to Entrobacteraceae due to the evolution and spread of plasmid encoded extended spectrum beta lactamases and other genes conferring cross-resistance to other antibiotics. This is of concern due to the increasing cost of antibiotic treatment and the spread of multidrug resistance to more pathogenic microorganisms. This study was undertaken to analyze the extent of the problem, to identify the most prevalent MDR isolates of Klebsiella pneumoniae in Chennai and to identify new plant based drugs. Approach: About 188 clinical isolates of Klebsiella pneumoniae were collected from Chennai during the period Nov. 2007-Oct. 2008 and their resistance to different groups of antibiotics were analyzed. These isolates were further characterized by molecular studies to identify the ESBL genes conferring the resistance phenotype. Plant extracts were tested against the MDR isolates to identify new treatment methods. Results: Our results showed that the combination therapy of clavulanic acid with cephalosporins and fluroroquinolones-norfloxacin and ciprofloxacin were the most effective antibiotics for treatment of Klebsiella pneumoniae infections. However resistance to clavulanic acid was increasing among the isolates (17%). All the isolates harbored a plasmid containing one or more of the genes for ESBL resistance. Plasmid isolation from the Isolates followed by ESBL PCR genotyping showed that CTX-M was present in 75 % isolates and TEM in 73% isolates either alone or in combination with the other ESBL genes. SHV ESBL type was present only in 42% of isolates. We identified 4 presumptive clonal spreads which were likely to be prevalent in India by clustering based on ESBL genotypic and antibiotic resistance. The isolates with both SHV and CTX were correlated with the most pathogenic and clavulanic acid resistant isolates. The extracts of Hemidesmus indicus and Terminalia arjuna had a significant antimicrobial activity against the MDR isolates. Conclusion: There was an increase in the spread of the ESBL genes and clavulanic acid resistance in the clinical isolates of Klebsiella pneumoniae in Chennai. Our data also supported a higher incidence of CTX-M genotype in India though the SHV genotype was associated with the most resistant forms of ESBL. Future research with separation of plant extracts to identify bioactive principles will pave the way for newer plant based antibiotics.

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Section: Introductionmentioning

confidence: 99%

Identification of Clonal Clusters of Klebsiella pneumoniae Isolates from Chennai by Extended Spectrum Beta Lactamase Genotyping and Antibiotic Resistance Phenotyping Analysis

Kamatchi¹,

Magesh²,

Sekhar³

et al. 2009

American J. of Infectious Diseases

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“…Mutations in the quinolone resistance-determining region (QRDR) and the presence of plasmidmediated quinolone resistance (PMQR) genes contribute to quinolone resistance in complex and diverse ways (1)(2)(3). However, only limited studies have addressed the quinolone resistance of Enterobacteriaceae in pediatric isolates so far; long-term studies involving bloodstream isolates are even fewer in number (4)(5)(6).…”

mentioning

confidence: 99%

“…A plasmid carrying a PMQR gene is transferable to other organisms, which facilitates the selection of high-level resistance (13). Previous studies showed an association between PMQR gene-bearing plasmids and plasmids with ESBL, suggesting the association with resistance to other agents (4). PMQR genes were first described in a clinical isolate of K. pneumoniae in 1998 (14).…”

mentioning

confidence: 99%

Prevalence of Plasmid-Mediated Quinolone Resistance Genes and Ciprofloxacin Resistance in Pediatric Bloodstream Isolates of Enterobacteriaceae over a 9-Year Period

et al. 2013

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SUMMARY:A total of 279 isolates of Escherichia coli (n ＝ 128) and Klebsiella pneumoniae (n ＝ 151) were obtained from blood samples from children at the Seoul National University Children's Hospital, Seoul, Korea from 1999 to 2007. Five plasmid-mediated quinolone resistance (PMQR) genes, qnrA, qnrB, qnrS, qepA, and aac(6?)-Ib-cr, and the minimal inhibitory concentration (MIC) values for ciprofloxacin were tested for all the strains. Mutations in both gyrA and parC were analyzed in 57 representative strains. Twenty-seven strains (9.7z) had at least 1 of the 5 PMQR genes: qnrB in 20 isolates, qnrS in 1, aac(6?)-Ib-cr in 5, and both qnrB and aac(6?)-Ib-cr in 1 isolate. The overall PMQR prevalence rates tended to increase over time ( P ＝ 0.001). The non-susceptibility rate to ciprofloxacin was 11.0z (31/279). PMQR-harboring isolates tended to have increased ciprofloxacin MIC values among both quinolone resistance-determining region (QRDR) mutation-present (P ＝ 0.016) and QRDR mutation-absent isolates ( P º 0.001). The increasing prevalence of PMQR genes was associated with increase in quinolone use over time ( P º 0.001) and increasing frequency of non-susceptibility to ciprofloxacin ( P º 0.001).Quinolone resistance in Enterobacteriaceae has increased in line with the increased number of quinolone prescriptions being administered for the treatment of infections by multidrug-resistant Enterobacteriaceae isolates. Mutations in the quinolone resistance-determining region (QRDR) and the presence of plasmidmediated quinolone resistance (PMQR) genes contribute to quinolone resistance in complex and diverse ways (1-3). However, only limited studies have addressed the quinolone resistance of Enterobacteriaceae in pediatric isolates so far; long-term studies involving bloodstream isolates are even fewer in number (4-6).In this study, we identified PMQR genes from Escherichia coli and Klebsiella pneumoniae isolates obtained from pediatric patients with bloodstream infections. We analyzed the isolates for changes in the prevalence of the PMQR genes and also regarding whether the presence of the PMQR genes is related to the amount of quinolones prescribed and to quinolone-resistance profiles.

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“…Lin J-C, Chang F-Y, Fung C-P, Xu J-Z, Cheng H-P, Wang J-J, et al fluoroquinolones (15,16). The excessive use of antibiotics has further increased the incidence of antibiotic resistance in bacteria, resulting in treatment failure, development of complications, and increased cost of treatment (17).…”

Section: Conflict Of Interestmentioning

confidence: 99%

Evaluation of Antibiotic Resistance Patterns of Clinical Klebsiella pneumoniae Isolates from Educational Hospitals in Zahedan, Iran

et al. 2018

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Background and Objectives: The resistance of gram-negative bacteria to antibiotics has become a serious problem, which imposes a significant increase in treatment costs. Klebsiella pneumoniae is an important nosocomial pathogen from the Enterobacteriaceae family. The aim of this study was to investigate the frequency and pattern of antibiotic resistance in K. pneumoniae strains isolated from clinical samples.Methods: This descriptive, cross-sectional study was performed on 150 K. pneumonia strains isolated from different clinical samples such as urine, sputum, blood, ulcers, lung secretions and abdominal abscess. Antibiogram test was performed using the disk diffusion method (Kirby-Bauer). Minimum inhibitory concentration of amikacin, tobramycin and gentamicin was determined via the E-test for 50 strains with high resistance rates.Results: In this study, the highest rate of resistance was observed against carbenicilin, ceftriaxone, cefepime and streptomycin. K. pneumonia isolates were most frequent in urine and sputum samples. In the E-test, the highest rate of resistance was observed against gentamicin, tobramycin (16µg/ml) and amikacin (64µg/ml).Conclusion: Based on our results, tigecycline, netilmicin, kanamycin and amikacin are the most effective antibiotics for the treatment of K. pneumoniae infections.

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Occurrence of qnr-positive clinical isolates in Klebsiella pneumoniae producing ESBL or AmpC-type β-lactamase from five pediatric hospitals in China

Cited by 29 publications

References 30 publications

Identification of Clonal Clusters of Klebsiella pneumoniae Isolates from Chennai by Extended Spectrum Beta Lactamase Genotyping and Antibiotic Resistance Phenotyping Analysis

Identification of Clonal Clusters of Klebsiella pneumoniae Isolates from Chennai by Extended Spectrum Beta Lactamase Genotyping and Antibiotic Resistance Phenotyping Analysis

Prevalence of Plasmid-Mediated Quinolone Resistance Genes and Ciprofloxacin Resistance in Pediatric Bloodstream Isolates of Enterobacteriaceae over a 9-Year Period

Evaluation of Antibiotic Resistance Patterns of Clinical Klebsiella pneumoniae Isolates from Educational Hospitals in Zahedan, Iran

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