Quinolone Resistance among Extended-Spectrum β-Lactamases Producing Klebsiella Pneumoniae in Sohag University Hospital, Upper Egypt

Abstract

Background: Extended-spectrum β-lactamases (ESBLs) production is the major resistance mechanism to β-lactam antibiotics in Enterobacteriaceae. Moreover, the emergence of quinolone resistance in ESBLs-producing isolates had become a global threat for treatment of infections caused by these bacteria. Objectives: We investigated the association between ESBLs production and quinolone resistance in Klebsiella pneumoniae isolates. Methodology: A total of 148 isolates of K. pneumoniae collected from Sohag University Hospital over the period of 10 months between June 2014 and April 2015. Identification of Klebsiella pneumoniae was performed with the Vitek 2 system (bioMerieux, France). Screening for extended spectrum beta lactamases (ESBLs) production was done with the Vitek 2 system (bioMerieux, France) and confirmed using the combined disk diffusion test (CDDT) .The ESBL’s genotype was then analyzed by multiplex PCR of bla TEM , bla SHV and bla CTX-M genes. Also multiplex PCR was used for detection of quinolone resistance determinant genes qnrA, qnrB and qnrS among ESBLs-producing K. pneumonia isolates. Results : In our study we found that among the 148 K. pneumoniae isolates; 121 (81.7%) were ESBLs producers according to CDDT results, bla TEM was found in 44% of them, while bla CTX-M found in 6%, bla TEM and bla CTX-M together found in 39% of the isolates, but in 7% bla TEM , bla SHV were found together, the three genes bla TEM , bla SHV and bla CTX-M were found in 4% but none of the isolates carried bla SHV gene alone or with bla CTX-M . 113(93%) of the 121 ESBLs producing isolates were found to carry one or more of quinolone resistance (QNR) genes qnrA, qnrB, qnrS. The three genes together were found in (53.9%) of the isolates, while qnrS was found in (29.1%), qnrA in (11%) of the isolates and (6%) carried both qnr B and S. Conclusions: Our results showed coexistence of ESBLs production and quinolone resistance in the majority of the K. pneumoniae isolates suggesting that more care should be taken for the choice of antibiotic therapy beside strict application of infection control policies to prevent dissemination of the multidrug resistant strains.