Yıl: 2020 Cilt: 5 Sayı: 2 Sayfa Aralığı: 101 - 106 Metin Dili: İngilizce DOI: 10.5152/cjms.2020.1406 İndeks Tarihi: 10-12-2020

Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection

Öz:
BACKGROUND/AIMSEscherichia coli (E. coli) is responsible for the vast majority of uncomplicated bacterial urinary tract infection (UTI) cases in women. The high ability of the isolates to develop antimicrobial resistance makes the treatment difficult. In this study, we investigated the presence of plasmid-mediated quinolone resistance (PMQR) genes in E. coli isolates and their relationship with extended-spectrum beta-lactamases (ESBL).MATERIAL and METHODSA total of 300 E. coli isolates from urine specimens of women, including 108 ESBL producers and 192 non-ESBL producers, were analyzed. The ESBL production was examined using the E-test ESBL strips, and the carbapenemase activity was examined using the CarbaNP test. The presence of PMQR genes (qnrA, qnrB, qnrS, and aac (6´)-Ib) among urine isolates was investigated using polymerase chain reaction. Conjugation experiments were performed to detect the horizontal transferability of the PMQR-positive plasmid.RESULTSAmong the ESBL-EC isolates, ciprofloxacin resistance was determined at 69%. Eight isolates were resistant to carbapenems. The aac(6’)-Ib-cr variant was found in 40% of ciprofloxacin-resistant E. coli isolates. None of the isolates harbored the qnrA, qnrB, or qnrS gene. The transferability was 14% for aac(6’)-Ib-cr. The MICs of transconjugants showed increased resistance to fluoroquinolones compared with the recipient E. coli J53AzR.CONCLUSION: This study showed that the frequency of PMQR genes in ESBL-producing superbug E. coli isolates reduced therapeutic options for treating community-acquired UTIs in affected women and that a careful use of antibiotics is very important.
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  • 1. Kranz J, Schmidt S, Lebert C, Schneidewind L, Schmiemann G, Wagenlehner F. Uncomplicated bacterial community acquired urinary tract infection in adults. Dtsch Arztebl Int 2017; 114: 866-73. [Crossref]
  • 2. Nordmann P, Poirel L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect 2014; 20: 821-30. [Crossref]
  • 3. Strahilevitz J, Jacoby GA, Hooper DC, Robicsek A. Plasmid-Mediated Quinolone Resistance: A Multifaceted Threat. Clin Microbiol Rev 2009; 22: 664-89. [Crossref]
  • 4. Martinez-Martinez L, Eliecer Cano M, Manuel Rodríguez-Martínez J, Calvo J, Pascual A. Plasmid-mediated quinolone resistance. Expert Rev Anti Infect Ther 2008; 6: 685-711. [Crossref]
  • 5. Redgrave LS, Sutton SB, Webber MA, Piddock LJ. Fluoroquinolone resistance: mechanisms, impact on bacteria, and role in evolutionary success. Trends Microbiol 2014; 22: 438-45. [Crossref]
  • 6. Garoff L, Yadav K, Hughes D. Increased expression of Qnr is sufficient to confer clinical resistance to ciprofloxacin in Escherichia coli. J Antimicrob Chemother 2018; 73: 348-52. [Crossref]
  • 7. 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: 818-22. [Crossref]
  • 8. Poirel L, Rodriguez-Martinez JM, Mammeri H, Liard A, Nordmann P. Origin of plasmid-mediated quinolone resistance determinant QnrA. Antimicrob Agents Chemother 2005; 49: 3523-5. [Crossref]
  • 9. Jiang X, Li J, Zhang Y, Yan H, Wang Y, Shi L, et al. Detection of plasmid-mediated quinolone resistance determinants and qnrS expression in Enterobacteriaceae clinical isolates. J Infect Dev Ctries 2014; 8: 1625-9. [Crossref]
  • 10. Grundmann H, Livermore DM, Giske CG, Canton R, Rossolini GM, Campos J, et al. Carbapenem-non-susceptible Enterobacteriaceae in Europe: conclusions from a meeting of national experts. Euro Surveill 2010; 15: 1-13. [Crossref]
  • 11. Matthews PC, Barrett LK, Warren S, Stoesser N, Snelling M, Matthew Scarborough M, et al. Oral fosfomycin for treatment of urinary tract infection: a retrospective cohort study. BMC Infect Dis 2016; 16: 556. [Crossref]
  • 12. Concia E, Bragantini D, Mazzaferri F. Clinical evaluation of guidelines and therapeutic approaches in multi drug-resistant urinary tract infections. J Chemotherapy 2017; 29(S1): 19-28. [Crossref]
  • 13. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonehritis in women: A 2010 update by the IDSA and European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011; 52: e103-20. [Crossref]
  • 14. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 9.0, 2019.
  • 15. Nordmann P, Dortet L, Poirel L. Rapid detection of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2012; 18: 1503-7. [Crossref]
  • 16. Mushi MF, Mshana SE, Imirzalioglu C, Bwanga F. Carbapenemase genes among multidrug resistant gram-negative clinical isolates from a tertiary hospital in Mwanza, Tanzania. Biomed Res Int 2014; 1-6. 303104. [Crossref]
  • 17. Maynard C, Bekal S, Sanschagrin F, Levesque RC, Brousseau R, Masson L, et al. Heterogeneity among virulence and antimicrobial resistance gene profiles of extraintestinal Escherichia coli isolates of animal and human origin. J Clin Microbiol 2004; 42: 5444-52. [Crossref]
  • 18. Robicsek A, Jacoby GA, Hooper DC. The worldwide emergence of plasmid mediated quinolone resistance. Lancet Infect Dis 2006; 6: 629-40. [Crossref]
  • 19. Wang M, Tran JH, Jacoby GA, Zhang Y, Wang F, Hooper DC. Plasmid-mediated quinolone resistance in clinical isolates of Escherichia coli from Shanghai, China. Antimicrob Agents Chemother 2003; 47: 2242-8. [Crossref]
  • 20. Martinez-Martinez L, Pascual A, Jacoby GA. Quinolone resistance from a transferable plasmid. Lancet 1998; 351: 797-9. [Crossref]
  • 21. European Centre for Disease Prevention and Control (ECDC). Antimicrobial resistance surveillance in Europe 2012, Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm, Sweden, ECDC; 2013.
  • 22. European Antimicrobial Resistance Surveillance System. EARSS Annual Report 2008; EARSS: Bilthoven, The Netherland, 2009.
  • 23. Balode A, Punda-Polic V, Dowzicky MJ. Antimicrobial susceptibility of gram-negative and gram-positive bacteria collected from countries in Eastern Europe: Results from the Tigecycline Evaluation and Surveillance Trial (T.E.S.T.) 2004-2010. Int J Antimicrob Agents 2013; 41: 527-35. [Crossref]
  • 24. Koksal F, Ak K, Kucukbasmaci O, Samasti M. Prevalence of antimicrobial resistance patterns of extended-spectrum beta-lactamase producing E. coli and K. pneumoniae isolated blood cultures in an Istanbul University Hospital. Chemother 2009; 55: 293-7. [Crossref]
  • 25. Guillard T, Cambau E, Chau F, Massias L, de Champs C, Fantin B. Ciprofloxacin Treatment Failure in a Murine Model of Pyelonephritis Due to an AAC(6’)-Ib-cr-Producing Escherichia coli Strain Susceptible to Ciprofloxacin In Vitro. Antimicrob Agents Chemother 2013; 57: 5830-5. [Crossref]
  • 26. Longhi C, Conte MP, Marazzato M, Iebba V, Totino V, Santangelo F, et al. Plasmid-mediated fluoroquinolone resistance determinants in Escherichia coli from community uncomplicated urinary tract infection in an area of high prevalence of quinolone resistance. Eur J Clin Microbiol Infect Dis 2012; 31: 1917-21. [Crossref]
  • 27. Volcao LM, Lacava JP, Gewehr MF, Leal VL, Ramis IB, Ramos DF, et al. High frequency of the aac(6’)-Ib-cr gene associated with double mutations in gyrA and parC in Escherichia coli isolates from patients with urinary tract infections. J Glob Antimicrob Resist 2018; 13: 180-3. [Crossref]
  • 28. Goudarzi M, Fazeli M. Quinolone Resistance Determinants qnr, qep, and aac(6’)-Ib-cr in Extended-Spectrum B-Lactamase Producing Escherichia coli Isolated From Urinary Tract Infections in Tehran, Iran. Shiraz E-Med J 2017; 18: e44498. [Crossref]
  • 29. Oktem IM, Gulay Z, Bicmen M, Gur D. HITIT Project Study Group: qnrA prevalence in extended-spectrum beta-lactamase-positive Enterobacteriaceae isolates from Turkey. Jpn J Infect Dis 2008; 61: 13-7.
  • 30. Nazik H, Bektöre B, Ongen B, Ilktac M, Ozyurt M, Kuvat N, et al. Plasmid-Mediated Quinolone Resistance Genes in Escherichia coli Urinary Isolates from Two Teaching Hospitals in Turkey: Coexistence of TEM, SHV, CTX-M and VEB-1 Type-lactamases. Trop J Pharm Res 2011; 10: 325-33. [Crossref]
  • 31. Aktepe OC, Aşık G, Cetinkol Y, Biçmen M, Gülay Z. Investigation of plasmid-mediated quinolone resistance in Escherichia coli strains. Mikrobiyol Bul 2012; 46: 9-16.
  • 32. Pitout JD, Wei Y, Church DL, Gregson DB. Surveillance for plasmid-mediated quinolone determinants in Enterobacteriacea within the Calgary Health Region, Canada: the emergence of aac(6’)-Ib-cr. J Antimicrob Chemother 2008; 61: 999-1002. [Crossref]
  • 33. Yang HY, Nam YS, Lee HJ. Prevalence of plasmid-mediated quinolone resistance genes among ciprofloxacin-non susceptible Escherichia coli and Klebsiella pneumoniae isolated from blood cultures in Korea. Can J Infect Dis Med Microbiol 2014; 25: 163-9. [Crossref]
  • 34. Bouchillon SK, Badal RE, Hoban DJ, Hawser SP. Antimicrobial susceptibility of inpatient urinary tract isolates of gram-negative bacilli in the United States: results from the study for monitoring antimicrobial resistance trends (SMART) program: 2009-2011. Clin Ther 2013; 35: 872-7. [Crossref]
  • 35. Thadena JT, Pogueb JM, Kayec KS. Role of newer and re-emerging older agents in the treatment of infections caused by carbapenem-resistant Enterobacteriaceae. Virulence 2017; 8: 403-16. [Crossref]
  • 36. Boucher HW, Talbot GH, Benjamin DK, Bradley J, Guidos RJ, Jones RN, et al. 10×20 Progress-Development of New Drugs Active Against Gram-Negative Bacilli: An Update From the Infectious Diseases Society of America (IDSA Public Policy). Clin Infect Dis 2013; 56: 1685-94. [Crossref]
  • 37. Neuner EA, Sekeres J, Hall GS, van Duin D. Experience with Fosfomycin for Treatment of Urinary Tract Infections Due to Multidrug-Resistant Organisms. Antimicrob Agents Chemother 2012; 56: 5744. [Crossref]
  • 38. Karlowsky JA, Denisuik AJ, Lagacé-Wiensa PRS, Adam HJ, Baxter MR, Hoban DJ, et al. In Vitro Activity of Fosfomycin against Escherichia coli Isolated from Patients with Urinary Tract Infections in Canada as Part of the CANWARD Surveillance Study. Antimicrob Agents Chemother 2014; 58: 1252-6. [Crossref]
  • 39. Tandogdu Z, Wagenlehner FM. Global epidemiology of urinary tract infections. Curr Opin Infect Dis 2016; 29: 73-9. [Crossref]
APA Özdemir s, Aydoğan O, Ozbek A, ÇIFTCI I, Koksal Cakirlar F (2020). Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection. , 101 - 106. 10.5152/cjms.2020.1406
Chicago Özdemir sinem,Aydoğan Okan,Ozbek Ahmet,ÇIFTCI IHSAN HAKKI,Koksal Cakirlar Fatma Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection. (2020): 101 - 106. 10.5152/cjms.2020.1406
MLA Özdemir sinem,Aydoğan Okan,Ozbek Ahmet,ÇIFTCI IHSAN HAKKI,Koksal Cakirlar Fatma Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection. , 2020, ss.101 - 106. 10.5152/cjms.2020.1406
AMA Özdemir s,Aydoğan O,Ozbek A,ÇIFTCI I,Koksal Cakirlar F Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection. . 2020; 101 - 106. 10.5152/cjms.2020.1406
Vancouver Özdemir s,Aydoğan O,Ozbek A,ÇIFTCI I,Koksal Cakirlar F Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection. . 2020; 101 - 106. 10.5152/cjms.2020.1406
IEEE Özdemir s,Aydoğan O,Ozbek A,ÇIFTCI I,Koksal Cakirlar F "Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection." , ss.101 - 106, 2020. 10.5152/cjms.2020.1406
ISNAD Özdemir, sinem vd. "Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection". (2020), 101-106. https://doi.org/10.5152/cjms.2020.1406
APA Özdemir s, Aydoğan O, Ozbek A, ÇIFTCI I, Koksal Cakirlar F (2020). Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection. Cyprus Journal of Medical Sciences, 5(2), 101 - 106. 10.5152/cjms.2020.1406
Chicago Özdemir sinem,Aydoğan Okan,Ozbek Ahmet,ÇIFTCI IHSAN HAKKI,Koksal Cakirlar Fatma Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection. Cyprus Journal of Medical Sciences 5, no.2 (2020): 101 - 106. 10.5152/cjms.2020.1406
MLA Özdemir sinem,Aydoğan Okan,Ozbek Ahmet,ÇIFTCI IHSAN HAKKI,Koksal Cakirlar Fatma Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection. Cyprus Journal of Medical Sciences, vol.5, no.2, 2020, ss.101 - 106. 10.5152/cjms.2020.1406
AMA Özdemir s,Aydoğan O,Ozbek A,ÇIFTCI I,Koksal Cakirlar F Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection. Cyprus Journal of Medical Sciences. 2020; 5(2): 101 - 106. 10.5152/cjms.2020.1406
Vancouver Özdemir s,Aydoğan O,Ozbek A,ÇIFTCI I,Koksal Cakirlar F Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection. Cyprus Journal of Medical Sciences. 2020; 5(2): 101 - 106. 10.5152/cjms.2020.1406
IEEE Özdemir s,Aydoğan O,Ozbek A,ÇIFTCI I,Koksal Cakirlar F "Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection." Cyprus Journal of Medical Sciences, 5, ss.101 - 106, 2020. 10.5152/cjms.2020.1406
ISNAD Özdemir, sinem vd. "Hidden Danger: Superbug Escherichia coli Isolated from Urine Isolates of Outpatient Women with Uncomplicated Urinary Tract Infection". Cyprus Journal of Medical Sciences 5/2 (2020), 101-106. https://doi.org/10.5152/cjms.2020.1406