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Detection of Chromosomal and Plasmid-Mediated Quinolone Resistance Among Escherichia coli Isolated from Urinary Tract Infection Cases; Zagazig University Hospitals, Egypt

Authors Esmaeel NE, Gerges MA, Hosny TA, Ali AR, Gebriel MG

Received 25 November 2019

Accepted for publication 11 January 2020

Published 11 February 2020 Volume 2020:13 Pages 413—421

DOI https://doi.org/10.2147/IDR.S240013

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony


Noura E Esmaeel, 1 Marian A Gerges, 1 Thoraya A Hosny, 2 Ahmed R Ali, 3 Manar G Gebriel 1

1Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; 2Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; 3Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

Correspondence: Marian A Gerges
Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, 44519, Egypt
Tel +20 1003819530
Email maromicro2006@yahoo.com

Introduction: Resistance to fluoroquinolones (FQ) in uropathogenic Escherichia coli (UPEC) has emerged as a growing problem. Chromosomal mutations and plasmid-mediated quinolone resistance (PMQR) determinants have been implicated. Data concerning the prevalence of these determinants in UPEC in our hospital are quite limited.
Purpose: To investigate the occurrence and genetic determinants of FQ resistance in UPEC isolated from urinary tract infection (UTI) cases in Zagazig University Hospitals.
Patients and Methods: Following their isolation, the identification and susceptibility of UPEC isolates were performed by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometer (MALDI-TOF MS). FQ resistance was detected by the disc diffusion method. Ciprofloxacin minimal inhibitory concentration (MIC) was determined using E-test. Chromosomal mutations in the gyrA gene were detected using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and for detection of PMQR, a couple of multiplex PCR reactions were used.
Results: Among a total of 192 UPEC isolates, 46.9% (n=90) were FQ resistant. More than half of the isolates (57.8%) exhibited high-level ciprofloxacin resistance (MIC > 32 μg/mL). Mutations in gyrA were detected in 76.7% of isolates, with 34.4% having mutations at more than one site. PMQR determinants were detected in 80.1% of UPEC isolates, with aac(6ʹ)-Ib-cr gene being the most frequent found in 61.1% of isolates.
Conclusion: There is a high prevalence of both gyrA mutations and PMQR determinants among UPEC isolates in our hospital which contribute to high-level ciprofloxacin resistance, a finding that may require the revision of the antibiotics used for empirical treatment of UTI.

Keywords: gyrA mutations, qnr determinants, uropathogenic E. coli, ciprofloxacin resistance

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