Abstract
Fitness cost associated with resistance to fluoroquinolones was recently shown to vary across clones of methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase-producing Klebsiella pneumoniae. The resulting dissimilar fitness should have influenced the clonal dynamics and thereby the rates of resistance for these pathogens. Moreover, a similar mechanism was recently proposed for the emergence of the H30 and H30R lineages of ESBL-producing E. coli and the major international clone (ribotype 027) of Clostridium difficile. Furthermore, several additional international clones of various multiresistant bacteria are suspect to have been selected by an analogous process. An ability to develop favorable mutations in the gyrase and topoisomerase IV genes seems to be a prerequisite for pathogens to retain fitness while showing high-level resistance to fluoroquinolones. Since, the consumption of other “non-fluoroquinolone” groups of antibiotics have also contributed to the rise in resistance rates a more judicious use of antibiotics in general and of fluoroquinolones in particular could ameliorate the international resistance situation.
Highlights
Though, clonal spread has always been a hallmark of many serious pathogens it is striking and remains enigmatic why the clonal spectra of several multiresistant bacteria have undergone a reduction at some point during the last three decades
Though, varying fitness cost associated with resistance to fluoroquinolones was obviously influencing the clonal dynamics of methicillin-resistant Staphylococcus aureus (MRSA) in the hospital setting we have demonstrated an even more pronounced difference between minor clone and major clone strains in ESBL-producing K. pneumoniae
An additional strong argument for the influence of fluoroquinolone consumption on the clonal dynamics of C. difficile is the well-established fact that the incidence of the ribotype 027 strains remains significantly lower in pediatric units compared with adult ward (McFarland et al, 2016) which is in agreement with our finding with the major clones of ESBLproducing K. pneumoniae in Hungary (Szilágyi et al, 2010) and should reflect the differing use of fluoroquinolones in the two departments
Summary
Clonal spread has always been a hallmark of many serious pathogens it is striking and remains enigmatic why the clonal spectra of several multiresistant bacteria have undergone a reduction at some point during the last three decades. Though, varying fitness cost associated with resistance to fluoroquinolones was obviously influencing the clonal dynamics of MRSA in the hospital setting we have demonstrated an even more pronounced difference between minor clone and major clone strains in ESBL-producing K. pneumoniae.
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