Login Register Cart 0
Generic placeholder image

Infectious Disorders - Drug Targets

Editor-in-Chief

ISSN (Print): 1871-5265
ISSN (Online): 2212-3989

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Plasmid-Mediated Quinolone Resistance in Pseudomonas aeruginosa Isolated from Burn Patients in Tehran, Iran

Author(s): Azam Molapour, Amir Peymani*, Parvaneh Saffarain, Narges Habibollah-Pourzereshki and Pooya Rashvand

Volume 20, Issue 1, 2020

Page: [49 - 55] Pages: 7

DOI: 10.2174/1871526519666190206205521

Price: $65

Abstract

Introduction: Plasmid-induced quinolone resistance has raised a great concern in the treatment of serious infections worldwide. The aims of this study were to determine the antibiotic susceptibility, the frequency of qepA, aac(6')-Ib and qnr genes by PCR and sequencing, and typing of the resistant isolates using repetitive extragenic palindromic sequence-based PCR (REPPCR) in Pseudomonas aeruginosa isolated from burn wound infections.

Methods: In the current cross-sectional study, 149 P. aeruginosa were isolated from the burn wound samples of patients admitted to Motahari hospital in Tehran, Iran, from February to December 2016. The bacterial isolates were identified using standard laboratory methods and their antibiotic susceptibility to quinolones was evaluated using the standard Kirby-Bauer method, according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The presence of aac(6')-Ib, qepA, qnrA, qnrB4, qnrB and qnrS genes was assessed using PCR and sequencing methods and clonal relationship of the resistant isolates was evaluated using REP-PCR method.

Results: All (100%) isolates showed complete resistance to used quinolone compounds in this study. The qnr and qepA genes were not found, but all (100%) isolates were positive for the presence of aac(6')-Ib gene and the sequencing revealed that all (100%) belong to the aac(6')-Ib-cr variant. REP-PCR showed that the studied isolates belonged to three distinct clones of A (77.9%), B (18.1%), and C (4%).

Conclusion: The findings of the present study indicated the presence of aac(6')-Ib-cr variant and lack of the contribution of qnr and qepA in the emergence of resistance to quinolones in P. aeruginosa isolated from burn patients. Considering the importance of clonal spread of these resistant isolates and their significant role in the development of clinical infections, especially in patients with burns, more attention should be paid to the prevention of the dissemination of these resistant isolates.

Keywords: Pseudomonas aeruginosa, plasmid-mediated quinolone resistance, aac(6`)-Ib, qnr, qepA, PCR, gram-negative pathogens.

Graphical Abstract

[1]
Driscoll, J.A.; Brody, S.L.; Kollef, M.H. The epidemiology, pathogenesis and treatment of Pseudomonas aeruginosa infections. Drugs, 2007, 67(3), 351-368.
[http://dx.doi.org/10.2165/00003495-200767030-00003] [PMID: 17335295]
[2]
Milczewska, J.; Wołkowicz, T.; Zacharczuk, K.; Kwiatkowska, M. Cross-infections with Pseudomonas aeruginosa in patients with cystic fibrosis attending the Warsaw Centre. Dev Period Med, 2015, 19(1), 60-65.
[PMID: 26003071]
[3]
Rastegar Lari, A.; Bahrami Honar, H.; Alaghehbandan, R. Pseudomonas infections in Tohid Burn Center, Iran. Burns, 1998, 24(7), 637-641.
[http://dx.doi.org/10.1016/S0305-4179(98)00090-4] [PMID: 9882062]
[4]
Church, D.; Elsayed, S.; Reid, O.; Winston, B.; Lindsay, R. Burn wound infections. Clin. Microbiol. Rev., 2006, 19(2), 403-434.
[http://dx.doi.org/10.1128/CMR.19.2.403-434.2006] [PMID: 16614255]
[5]
Lister, P.D.; Wolter, D.J.; Hanson, N.D. Antibacterial-resistant Pseudomonas aeruginosa: clinical impact and complex regulation of chromosomally encoded resistance mechanisms. Clin. Microbiol. Rev., 2009, 22(4), 582-610.
[http://dx.doi.org/10.1128/CMR.00040-09] [PMID: 19822890]
[6]
Hirsch, E.B.; Tam, V.H. Impact of multidrug-resistant Pseudomonas aeruginosa infection on patient outcomes. Expert Rev. Pharmacoecon. Outcomes Res., 2010, 10(4), 441-451.
[http://dx.doi.org/10.1586/erp.10.49] [PMID: 20715920]
[7]
Emami, S.; Shafiee, A.; Foroumadi, A. Quinolones: recent structural and clinical developments. Iran. J. Pharm. Res., 2010, 20, 123-136.
[8]
Wiles, J.A.; Bradbury, B.J.; Pucci, M.J. New quinolone antibiotics: a survey of the literature from 2005 to 2010. Expert Opin. Ther. Pat., 2010, 20(10), 1295-1319.
[http://dx.doi.org/10.1517/13543776.2010.505922] [PMID: 20645884]
[9]
Drlica, K.; Malik, M.; Kerns, R.J.; Zhao, X. Quinolone-mediated bacterial death. Antimicrob. Agents Chemother., 2008, 52(2), 385-392.
[http://dx.doi.org/10.1128/AAC.01617-06] [PMID: 17724149]
[10]
Wada, K.; Kariyama, R.; Mitsuhata, R.; Uehara, S.; Watanabe, T.; Monden, K.; Kumon, H. Experimental and clinical studies on fluoroquinolone-insusceptible Escherichia coli isolated from patients with urinary tract infections from 1994 to 2007. Acta Med. Okayama, 2009, 63(5), 263-272.
[PMID: 19893602]
[11]
Jacoby, G.A.; Strahilevitz, J.; Hooper, D.C. Plasmid-mediated quinolone resistance. Microbiol. Spectr., 2014, 2(5)
[http://dx.doi.org/10.1128/microbiolspec.PLAS-0006-2013] [PMID: 25584197]
[12]
Cayci, Y.T.; Coban, A.Y.; Gunaydin, M. Investigation of plasmid-mediated quinolone resistance in Pseudomonas aeruginosa clinical isolates. Indian J. Med. Microbiol., 2014, 32(3), 285-289.
[http://dx.doi.org/10.4103/0255-0857.136567] [PMID: 25008822]
[13]
Guan, X.; Xue, X.; Liu, Y.; Wang, J.; Wang, Y.; Wang, J.; Wang, K.; Jiang, H.; Zhang, L.; Yang, B.; Wang, N.; Pan, L. Plasmid-mediated quinolone resistance--current knowledge and future perspectives. J. Int. Med. Res., 2013, 41(1), 20-30.
[http://dx.doi.org/10.1177/0300060513475965] [PMID: 23569126]
[14]
Jiang, Y.; Zhou, Z.; Qian, Y.; Wei, Z.; Yu, Y.; Hu, S.; Li, L. Plasmid-mediated quinolone resistance determinants qnr and aac(6′)-Ib-cr in extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in China. J. Antimicrob. Chemother., 2008, 61(5), 1003-1006.
[http://dx.doi.org/10.1093/jac/dkn063] [PMID: 18299311]
[15]
Aldred, K.J.; Kerns, R.J.; Osheroff, N. Mechanism of quinolone action and resistance. Biochemistry, 2014, 53(10), 1565-1574.
[http://dx.doi.org/10.1021/bi5000564] [PMID: 24576155]
[16]
Martínez-Martínez, L.; Pascual, A.; García, I.; Tran, J.; Jacoby, G.A. Interaction of plasmid and host quinolone resistance. J. Antimicrob. Chemother., 2003, 51(4), 1037-1039.
[http://dx.doi.org/10.1093/jac/dkg157] [PMID: 12654766]
[17]
Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; Twenty-third informational supplement M100-S23 2013; CLSI: Wayne, PA, 2013.
[18]
Minarini, L.A.; Poirel, L.; Cattoir, V.; Darini, A.L.; Nordmann, P. Plasmid-mediated quinolone resistance determinants among enterobacterial isolates from outpatients in Brazil. J. Antimicrob. Chemother., 2008, 62(3), 474-478.
[http://dx.doi.org/10.1093/jac/dkn237] [PMID: 18552340]
[19]
Kim, H.B.; Park, C.H.; Kim, C.J.; Kim, E.C.; Jacoby, G.A.; Hooper, D.C. Prevalence of plasmid-mediated quinolone resistance determinants over a 9-year period. Antimicrob. Agents Chemother., 2009, 53(2), 639-645.
[http://dx.doi.org/10.1128/AAC.01051-08] [PMID: 19064896]
[20]
Wolska, K.; Szweda, P. A comparative evaluation of PCR ribotyping and ERIC PCR for determining the diversity of clinical Pseudomonas aeruginosa isolates. Pol. J. Microbiol., 2008, 57(2), 157-163.
[PMID: 18646404]
[21]
Azimi, A.; Peymani, A.; Pour, P.K. Phenotypic and molecular detection of metallo-β-lactamase-producing Pseudomonas aeruginosa isolates from patients with burns in Tehran, Iran. Rev. Soc. Bras. Med. Trop., 2018, 51(5), 610-615.
[http://dx.doi.org/10.1590/0037-8682-0174-2017] [PMID: 30304266]
[22]
Gad, G.F.; el-Domany, R.A.; Ashour, H.M. Antimicrobial susceptibility profile of Pseudomonas aeruginosa isolates in Egypt. J. Urol., 2008, 180(1), 176-181.
[http://dx.doi.org/10.1016/j.juro.2008.03.081] [PMID: 18499192]
[23]
Singh, N.P.; Rani, M.; Gupta, K.; Sagar, T.; Kaur, I.R. Changing trends in antimicrobial susceptibility pattern of bacterial isolates in a burn unit. Burns, 2017, 43(5), 1083-1087.
[http://dx.doi.org/10.1016/j.burns.2017.01.016] [PMID: 28153582]
[24]
Peymani, A.; Naserpour Farivar, T.; Nikooei, L.; Najafipour, R.; Javadi, A.; Pahlevan, A.A. Emergence of plasmid-mediated quinolone-resistant determinants in Klebsiella pneumoniae isolates from Tehran and Qazvin provinces, Iran. J. Prev. Med. Hyg., 2015, 56(2), E61-E65.
[PMID: 26789990]
[25]
Peymani, A.; Farivar, T.N.; Najafipour, R.; Mansouri, S. High prevalence of plasmid-mediated quinolone resistance determinants in Enterobacter cloacae isolated from hospitals of the Qazvin, Alborz, and Tehran provinces, Iran. Rev. Soc. Bras. Med. Trop., 2016, 49(3), 286-291.
[http://dx.doi.org/10.1590/0037-8682-0454-2015] [PMID: 27384824]
[26]
Rezazadeh, M.; Baghchesaraei, H.; Peymani, A. Plasmid-mediated quinolone- resistance (qnr) genes in clinical isolates of Escherichia coli collected from several hospitals of Qazvin and Zanjan provinces, Iran. Osong Public Health Res. Perspect., 2016, 7(5), 307-312.
[http://dx.doi.org/10.1016/j.phrp.2016.08.003] [PMID: 27812489]
[27]
Khosravi, A.D.; Motahar, M.; Abbasi-Montazeri, E. The frequency of class1 and 2 integrons in Pseudomonas aeruginosa strains isolated from burn patients in a burn center of Ahvaz, Iran. PLoS One, 2017, 12(8)e0183061
[28]
Malek-Mohamad, S.; Rostami, S.; Zamanzad, B.; Gholipour, A.; Deris, F. Detection of exotoxin s and antimicrobial susceptibility pattern in clinical Pseudomonas aeruginosa isolates. Avicenna. J Clin. Microb. Infec., 2017, e44802.
[http://dx.doi.org/10.5812/ajcmi.44802]
[29]
Kamaria, P.A.; Aring, B.J.; Sinha, M. Incidence of multidrug resistant Pseudomonas aeruginosa isolated from Burn patients tertiary care hospital, Jamnagar, Gujarat, India. IOSR-JDMS., 2016, 1(15), 31-34.
[http://dx.doi.org/10.9790/0853-150773134]
[30]
Xu, Z.; Li, L.; Shirtliff, M.E.; Alam, M.J.; Yamasaki, S.; Shi, L. Occurrence and characteristics of class 1 and 2 integrons in Pseudomonas aeruginosa isolates from patients in southern China. J. Clin. Microbiol., 2009, 47(1), 230-234.
[http://dx.doi.org/10.1128/JCM.02027-08] [PMID: 19020065]
[31]
Sohail, M.; Khurshid, M.; Saleem, H.G.; Javed, H.; Khan, A.A. Characteristics and antibiotic resistance of urinary tract pathogens isolated from Punjab, Pakistan. Jundishapur J. Microbiol., 2015, 8(7)e19272
[http://dx.doi.org/10.5812/jjm.19272v2] [PMID: 26421129]
[32]
Alkaabi, S.A.G. Bacterial isolates and their antibiograms of burn wound infections in burns specialist hospital in Baghdad. J. Baghdad. Sci., 2013, 10(2), 331-340.
[33]
Saleh, M.A.; Balboula, M.M. Plasmid mediated quinolone resistance determinants among nosocomial clinical pseudomonas aeruginosa isolates. Int. J. Curr. Microbiol. Appl. Sci., 2017, 6(1), 42-50.
[http://dx.doi.org/10.20546/ijcmas.2017.601.006]
[34]
Araujo, B.F.; Ferreira, M.L.; Campos, P.A.; Royer, S.; Batistão, D.W.; Dantas, R.C.; Gonçalves, I.R.; Faria, A.L.; Brito, C.S.; Yokosawa, J.; Gontijo-Filho, P.P.; Ribas, R.M. Clinical and molecular epidemiology of multidrug-resistant P. aeruginosa carrying aac(6′)-Ib-cr, qnrS1 and blaSPM genes in Brazil. PLoS One, 2016, 11(5)e0155914
[http://dx.doi.org/10.1371/journal.pone.0155914] [PMID: 27219003]
[35]
Jiang, X.; Yu, T.; Jiang, X.; Zhang, W.; Zhang, L.; Ma, J. Emergence of plasmid-mediated quinolone resistance genes in clinical isolates of Acinetobacter baumannii and Pseudomonas aeruginosa in Henan, China. Diagn. Microbiol. Infect. Dis., 2014, 79(3), 381-383.
[http://dx.doi.org/10.1016/j.diagmicrobio.2014.03.025] [PMID: 24805186]
[36]
Yang, X.; Xing, B.; Liang, C.; Ye, Z.; Zhang, Y. Prevalence and fluoroquinolone resistance of pseudomonas aeruginosa in a hospital of South China. Int. J. Clin. Exp. Med., 2015, 8(1), 1386-1390.
[PMID: 25785142]
[37]
Michalska, A.D.; Sacha, P.T.; Ojdana, D.; Wieczorek, A.; Tryniszewska, E. Prevalence of resistance to aminoglycosides and fluoroquinolones among Pseudomonas aeruginosa strains in a University Hospital in Northeastern Poland. Braz. J. Microbiol., 2015, 45(4), 1455-1458.
[http://dx.doi.org/10.1590/S1517-83822014000400041] [PMID: 25763054]

Rights & Permissions Print Cite
Article Metrics
5
© 2024 Bentham Science Publishers | Privacy Policy