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Antimicrobial Agents and Chemotherapy, February 2009, p. 639-645, Vol. 53, No. 2
0066-4804/09/$08.00+0     doi:10.1128/AAC.01051-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Prevalence of Plasmid-Mediated Quinolone Resistance Determinants over a 9-Year Period {triangledown}

Hong Bin Kim,1,2,4 Chi Hye Park,4 Chung Jong Kim,2 Eui-Chong Kim,3 George A. Jacoby,5 and David C. Hooper4*

Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea,1 Department of Internal Medicine,2 Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea,3 Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts,4 Lahey Clinic, Burlington, Massachusetts5

Received 4 August 2008/ Returned for modification 13 October 2008/ Accepted 30 November 2008

Recently, several plasmid-mediated quinolone resistance (PMQR) genes conferring low levels of quinolone resistance have been discovered. To evaluate the temporal change in the prevalence of PMQR genes over a decade in a tertiary hospital in the Republic of Korea, we selected every fifth isolate of Escherichia coli and Klebsiella pneumoniae and every third isolate of Enterobacter cloacae between 1998 and 2001 and between 2005 and 2006 from a collection of blood isolates. Six PMQR genes [qnrA, qnrB, qnrC, qnrS, aac(6')-Ib-cr, and qepA] were screened by multiplex PCR and then confirmed by direct sequencing, and the aac(6')-Ib-positive PCR products were digested with BtsCI to identify the aac(6')-Ib-cr variant. Of 461 isolates, 37 (8%) had one of the six PMQR genes; 13 (5%) of 261 E. coli strains, 13 (10%) of 135 K. pneumoniae strains, and 11 (17%) of 65 E. cloacae strains. qnrB was the most common PMQR gene and was found as early as 1998, whereas qnrS, aac(6')-Ib-cr, and qepA emerged after 2000. None of the isolates carried qnrA or qnrC. Ciprofloxacin resistance increased over time (P < 0.001), and the overall prevalence of PMQR genes tended to increase (P = 0.20). PMQR-positive isolates had significantly higher ciprofloxacin resistance and multidrug resistance rates (P = 0.005 and P < 0.001, respectively). The increasing frequency of ciprofloxacin resistance in Enterobacteriaceae was associated with an increasing prevalence of PMQR genes, and this change involved an increase in the diversity of the PMQR genes and also an increase in the prevalence of the mutations in gyrA, parC, or both in PMQR-positive strains but not PMQR-negative strains.

* Corresponding author. Mailing address: Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2696. Phone: (617) 726-3812. Fax: (617) 726-7416. E-mail: dhooper{at}partners.org

{triangledown} Published ahead of print on 8 December 2008.

Antimicrobial Agents and Chemotherapy, February 2009, p. 639-645, Vol. 53, No. 2
0066-4804/09/$08.00+0     doi:10.1128/AAC.01051-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Strahilevitz, J., Jacoby, G. A., Hooper, D. C., Robicsek, A. (2009). Plasmid-Mediated Quinolone Resistance: a Multifaceted Threat. Clin. Microbiol. Rev. 22: 664-689 [Abstract] [Full Text]  
  • Kim, H. B., Wang, M., Park, C. H., Kim, E.-C., Jacoby, G. A., Hooper, D. C. (2009). oqxAB Encoding a Multidrug Efflux Pump in Human Clinical Isolates of Enterobacteriaceae. Antimicrob. Agents Chemother. 53: 3582-3584 [Abstract] [Full Text]  
  • Jacoby, G. A., Gacharna, N., Black, T. A., Miller, G. H., Hooper, D. C. (2009). Temporal Appearance of Plasmid-Mediated Quinolone Resistance Genes. Antimicrob. Agents Chemother. 53: 1665-1666 [Abstract] [Full Text]  


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