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Akiya A, Elahi A, Jafari S, Chegane Lorestani R, Rostamian M, Javadirad E. Frequency of Plasmid-mediated Quinolone Resistance in Citrobacter Isolated From Urinary Tract Infection. Qom Univ Med Sci J 2023; 17 : 2784.2
URL: http://journal.muq.ac.ir/article-1-3623-en.html
1- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
2- Development and Clinical Research Unit, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
3- Department of Pathology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. , pathologist84@yahoo.com
Abstract:   (407 Views)
Background and Objectives: Plasmid-mediated quinolone resistance (PMQR) plays an essential role in developing resistance to quinolones. This study aimed to investigate the presence and effect of PMQR genes in clinical isolates of Citrobacter from urinary tract infections.
Methods: Fifty-one citrobacter isolates were found in urinary samples of patients referred to Imam Reza Hospital in Kermanshah City, Iran, in 2019. The susceptibility to antibiotics was determined by disk diffusion and broth microdilution methods. The qnrA, qnrB, qnrS, aac (6 ')-Ib, and qepA genes of isolates were detected by the polymerase chain reaction (PCR) method. Then, the PCR-RFLP (restriction fragment length polymorphism) method was used to differentiate the aac (6')-Ib gene from its aac (6')-Ib-cr variant. The obtained data were analyzed using the chi-square and Mann-Whitney statistical methods.
Results: The highest resistance of isolates was seen against cefazolin (74.5%), ciprofloxacin (41.2%), and cotrimoxazole (35.3%). More than 80% of isolates were susceptible to carbapenems, gentamicin, and piperacillin/tazobactam. The frequency of qnr genes in isolates was 41.5%. The qnrB gene was the most frequent (43.2%), followed by qnrS (5.9%) and qnrA (1.9%). The aac (6') -Ib gene was found in 27.5% of the isolates; all were aac (6')-Ib-cr. The qepA gene was not found in any isolate.
Conclusion: The results of this study indicate the importance of Citrobacter freundii as an agent of urinary tract infection and its high resistance to ciprofloxacin. PMQR genes are highly prevalent in Citrobacter isolates, and there is a significant correlation between the qnrB and qnrS genes with the increased minimum inhibitory concentration of ciprofloxacin. Therefore, antibiotic susceptibility should be performed before treating Citrobacter urinary tract infections.
Article number: 2784.2
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Type of Study: Original Article | Subject: میکروب شناسی
Received: 2022/12/7 | Accepted: 2023/05/9 | Published: 2023/08/1

References
1. ones ME, Avison MB, Damdinsuren E, MacGowan AP, Bennett PM. Heterogeneity at the beta-lactamase structural gene ampC amongst Citrobacter spp. assessed by polymerase chain reaction analysis: Potential for typing at a molecular level. J Med Microbiol. 1994; 41(3):209-14. [DOI:10.1099/00222615-41-3-209] [PMID] [DOI:10.1099/00222615-41-3-209]
2. Akya A, Jafari S, Ahmadi K, Elahi A. [The frequency of carbapenemase genes in citrobacter Frundii and citrobacter Koseri isolated from clinical specimens in Imam Reza Hospital, Kermanshah, Iran (Persian)]. J Kerman Univ Med Sci. 2015; 22(5):629-38. [Link]
3. Richter SN, Frasson I, Bergo C, Manganelli R, Cavallaro A, Palù G. Characterisation of qnr plasmid-mediated quinolone resistance in Enterobacteriaceae from Italy: Association of the qnrB19 allele with the integron element ISCR1 in Escherichia coli. Int J Antimicrob Agents. 2010; 35(6):578-83.[DOI:10.1016/j.ijantimicag.2010.02.015] [PMID] [DOI:10.1016/j.ijantimicag.2010.02.015]
4. Ruiz J. Mechanisms of resistance to quinolones: Target alterations, decreased accumulation and DNA gyrase protection. J Antimicrob Chemother. 2003; 51(5):1109-17. [DOI:10.1093/jac/dkg222] [PMID] [DOI:10.1093/jac/dkg222]
5. Rodríguez-Martínez JM, Cano ME, Velasco C, Martínez-Martínez L, Pascual A. Plasmid-mediated quinolone resistance: an update. J Infect Chemother. 2011; 17(2):149-82. [DOI:10.1007/s10156-010-0120-2] [PMID] [DOI:10.1007/s10156-010-0120-2]
6. Firoozeh F, Zibaei M, Soleimani-Asl Y. Detection of plasmid-mediated qnr genes among the quinolone-resistant Escherichia coli isolates in Iran. J Infect Dev Ctries. 2014; 8(7):818-22.[DOI:10.3855/jidc.3746] [PMID] [DOI:10.3855/jidc.3746]
7. Martínez-Martínez L, Eliecer Cano M, Manuel Rodríguez-Martínez J, Calvo J, Pascual A. Plasmid-mediated quinolone resistance. Expert Rev Anti Infect Ther. 2008; 6(5):685-711.[DOI:10.1586/14787210.6.5.685] [PMID] [DOI:10.1586/14787210.6.5.685]
8. Park YJ, Yu JK, Lee S, Oh EJ, Woo GJ. Prevalence and diversity of qnr alleles in AmpC-producing Enterobacter cloacae, enterobacter aerogenes, citrobacter freundii and serratia marcescens: A multicentre study from Korea. J Antimicrob Chemother. 2007; 60(4):868-71. [DOI:10.1093/jac/dkm266] [PMID] [DOI:10.1093/jac/dkm266]
9. Zhang R, Ichijo T, Huang YL, Cai JC, Zhou HW, Yamaguchi N, et al. High prevalence of qnr and aac(6')-Ib-cr genes in both water-borne environmental bacteria and clinical isolates of Citrobacter freundii in China. Microbes Environ. 2012; 27(2):158-63. [DOI:10.1264/jsme2.ME11308] [PMID] [PMCID] [DOI:10.1264/jsme2.ME11308]
10. Leski TA, Taitt CR, Bangura U, Stockelman MG, Ansumana R, Cooper WH 3rd, et al. High prevalence of multidrug resistant Enterobacteriaceae isolated from outpatient urine samples but not the hospital environment in Bo, Sierra Leone. BMC Infect Dis. 2016; 16:167. [DOI:10.1186/s12879-016-1495-1] [PMID] [DOI:10.1186/s12879-016-1495-1]
11. Fauci S, Braunwald E, Kasper DL, Hauser S, Longo D, Jameson J, et al. Harrison's principles of internal medicine. USA: McGraw-Hill; 2008. [Link]
12. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Wayne: Clinical and Laboratory Standards Institute; 2017. [Link]
13. Kang HY, Tamang MD, Seol SY, Kim ES. Dissemination of plasmid-mediated qnr, aac(6')-Ib-cr, and qepA Genes among 16S rRNA Methylase producing enterobacteriaceae in Korea. J Bacteriol Virol. 2009; 39(3):173-82. [DOI:10.4167/jbv.2009.39.3.173] [DOI:10.4167/jbv.2009.39.3.173]
14. Robicsek A, Strahilevitz J, Sahm DF, Jacoby GA, Hooper DC. qnr prevalence in ceftazidime-resistant Enterobacteriaceae isolates from the United States. Antimicrob Agents Chemother. 2006; 50(8):2872-4. [DOI:10.1128/AAC.01647-05] [PMID] [PMCID] [DOI:10.1128/AAC.01647-05]
15. Park CH, Robicsek A, Jacoby GA, Sahm D, Hooper DC. Prevalence in the United States of aac(6')-Ib-cr encoding a ciprofloxacin-modifying enzyme. Antimicrob Agents Chemother. 2006; 50(11):3953-5. [DOI:10.1128/AAC.00915-06] [PMID] [DOI:10.1128/AAC.00915-06]
16. Metri BC, Jyothi P. Antibiotic sensivity pattern of citrobacter spp. isolated from patients with urinary tract infections in tertiary care hospital in south india. Int J Pharm Pharm Sci. 2015; 7(1):252-4. [Link]
17. Stewart ZE, Shaker M, Baxter JD. Urinary tract infection caused by citrobacter koseri in a patient with Spina Bifida, an ileal conduit and renal caluli progressing to peri-nephric abscess and empyema. Urol Case Rep. 2017; 11:22-4. [DOI:10.1016/j.eucr.2016.11.013] [PMID] [DOI:10.1016/j.eucr.2016.11.013]
18. Gill MA, Schutze GE. Citrobacter urinary tract infections in children. Pediatr Infect Dis J. 1999; 18(10):889-92.[DOI:10.1097/00006454-199910000-00010] [PMID] [DOI:10.1097/00006454-199910000-00010]
19. Metri BC, Jyothi P, Peerapur BV. Antibiotic resistance in citrobacter spp. isolated from urinary tract infection. Urol Ann. 2013; 5(4):312-3. [DOI:10.4103/0974-7796.120295] [PMID] [DOI:10.4103/0974-7796.120295]
20. Ranjan KP, Ranjan N. Citrobacter: An emerging health care associated urinary pathogen. Urol Ann. 2013; 5(4):313-4. [PMID] [PMCID] [DOI:10.4103/0974-7796.120297]
21. Metri BC, Jyothi P, Peerapur BV. Anti-microbial resistance profile of Citrobacter species in a tertiary care hospital of Southern India. Indian J Med Sci. 2011; 65(10):429-35.[DOI:10.4103/0019-5359.109259] [PMID] [DOI:10.4103/0019-5359.109259]
22. Kim PW, Harris AD, Roghmann MC, Morris JG Jr, Strinivasan A, Perencevich EN. Epidemiological risk factors for isolation of ceftriaxone-resistant versus -susceptible citrobacter freundii in hospitalized patients. Antimicrob Agents Chemother. 2003; 47(9):2882-7. [DOI:10.1128/AAC.47.9.2882-2887.2003] [PMID] [DOI:10.1128/AAC.47.9.2882-2887.2003]
23. Soleimani-Asl Y, Zibaei M, Firoozeh F. [Detection of qnrA gene among quinolone-resistant Escherichia coli isolated from urinary tract infections in Khorram Abad during 2011-2012 (Persian)]. Feyz. 2013; 17(5):488-94. [Link]
24. Yang H, Chen H, Yang Q, Chen M, Wang H. High prevalence of plasmid-mediated quinolone resistance genes qnr and aac(6')-Ib-cr in clinical isolates of Enterobacteriaceae from nine teaching hospitals in China. Antimicrob Agents Chemother. 2008; 52(12):4268-73. [DOI:10.1128/AAC.00830-08] [PMID] [DOI:10.1128/AAC.00830-08]
25. Halová D, Papousek I, Jamborova I, Masarikova M, Cizek A, Janecko N, et al. Plasmid-mediated quinolone resistance genes in Enterobacteriaceae from American crows: High prevalence of bacteria with variable qnrB genes. Antimicrob Agents Chemother. 2014; 58(2):1257-8. [DOI:10.1128/AAC.01849-13] [PMID] [DOI:10.1128/AAC.01849-13]
26. Bouchakour M, Zerouali K, Gros Claude JD, Amarouch H, El Mdaghri N, Courvalin P, et al. Plasmid-mediated quinolone resistance in expanded spectrum beta lactamase producing enterobacteriaceae in Morocco. J Infect Dev Ctries. 2010; 4(12):779-803. [DOI:10.3855/jidc.796] [PMID] [DOI:10.3855/jidc.796]
27. Shao Y, Xiong Z, Li X, Hu L, Shen J, Li T, et al. Prevalence of plasmid-mediated quinolone resistance determinants in Citrobacter freundii isolates from Anhui province, PR China. J Med Microbiol. 2011; 60(Pt 12):1801-5. [DOI:10.1099/jmm.0.034082-0] [PMID] [DOI:10.1099/jmm.0.034082-0]
28. Cruz GR, Radice M, Sennati S, Pallecchi L, Rossolini GM, Gutkind G, et al. Prevalence of plasmid-mediated quinolone resistance determinants among oxyiminocephalosporin-resistant Enterobacteriaceae in Argentina. Mem Inst Oswaldo Cruz. 2013; 108(7):924-7. [DOI:10.1590/0074-0276130084] [PMID] [DOI:10.1590/0074-0276130084]
29. Robicsek A, Jacoby GA, Hooper DC. The worldwide emergence of plasmid-mediated quinolone resistance. Lancet Infect Dis. 2006; 6(10):629-40. [DOI:10.1016/S1473-3099(06)70599-0] [PMID] [DOI:10.1016/S1473-3099(06)70599-0]
30. Karah N, Poirel L, Bengtsson S, Sundqvist M, Kahlmeter G, Nordmann P, et al. Plasmid-mediated quinolone resistance determinants qnr and aac(6')-ib-cr in escherichia coli and Klebsiella spp. from Norway and Sweden. Diagn Microbiol Infect Dis. 2010; 66(4):425-31. [DOI:10.1016/j.diagmicrobio.2009.12.004] [PMID] [DOI:10.1016/j.diagmicrobio.2009.12.004]

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