Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 12, Number 5—May 2006
Dispatch

Enterobacter cloacae Outbreak and Emergence of Quinolone Resistance Gene in Dutch Hospital

Armand Paauw*Comments to Author , Ad C. Fluit*, Jan Verhoef*, and Maurine A. Leverstein-van Hall*
Author affiliations: *University Medical Center, Utrecht, the Netherlands

Main Article

Figure 1

Schematic presentation of integrons on pQC compared with previously described integrons (5,9,19,21,22). The black double-pointed arrows indicate the product amplified with an Expand Long Template PCR system (Roche, Woerden, the Netherlands), demonstrating a link between the qnrA and blaCTX-M-9 genes and their respective integrons.

Figure 1. Schematic presentation of integrons on pQC compared with previously described integrons (5,9,19,21,22). The black double-pointed arrows indicate the product amplified with an Expand Long Template PCR system (Roche, Woerden, the Netherlands), demonstrating a link between the qnrA and blaCTX-M-9 genes and their respective integrons.

Main Article

References
  1. Martínez-Martínez  L, Pascual  A, Jacoby  GA. Quinolone resistance from a transferable plasmid. Lancet. 1998;351:797–9. DOIPubMedGoogle Scholar
  2. Nordmann  P, Poirel  L. Emergence of plasmid-mediated resistance to quinolones in Enterobacteriaceae. J Antimicrob Chemother. 2005;56:463–9. DOIPubMedGoogle Scholar
  3. Jacoby  GA, Chow  N, Waites  KB. Prevalence of plasmid-mediated quinolone resistance. Antimicrob Agents Chemother. 2003;47:559–62. DOIPubMedGoogle Scholar
  4. Rodríguez-Martínez  JM, Pascual  A, García  I, Martínez-Martínez  L. Detection of the plasmid-mediated quinolone resistance determinant qnr among clinical isolates of Klebsiella pneumoniae producing AmpC-type beta-lactamase. J Antimicrob Chemother. 2003;52:703–6. DOIPubMedGoogle Scholar
  5. 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. DOIPubMedGoogle Scholar
  6. Wang  M, Sahm  DF, Jacoby  GA, Hooper  DC. Emerging plasmid-mediated quinolone resistance associated with the qnr gene in Klebsiella pneumoniae clinical isolates in the United States. Antimicrob Agents Chemother. 2004;48:1295–9. DOIPubMedGoogle Scholar
  7. Poirel  L, Van De  LM, Mammeri  H, Nordmann  P. Association of plasmid-mediated quinolone resistance with extended-spectrum β-lactamase VEB-1. Antimicrob Agents Chemother. 2005;49:3091–4. DOIPubMedGoogle Scholar
  8. Jonas  D, Biehler  K, Hartung  D, Spitzmüller  B, Daschner  FD. Plasmid-mediated quinolone resistance in isolates obtained in German intensive care units. Antimicrob Agents Chemother. 2005;49:773–5. DOIPubMedGoogle Scholar
  9. Mammeri  H, Van De  LM, Poirel  L, Martínez-Martínez  L, Nordmann  P. Emergence of plasmid-mediated quinolone resistance in Escherichia coli in Europe. Antimicrob Agents Chemother. 2005;49:71–6. DOIPubMedGoogle Scholar
  10. Leverstein-van Hall  MA, Blok  HE, Paauw  A, Fluit  AC, Troelstra  A, Mascini  EM, Extensive hospital-wide spread of a multidrug-resistant Enterobacter cloacae clone, with late detection due to a variable antibiogram and frequent patient transfer. J Clin Microbiol. 2006;44:518–24. DOIPubMedGoogle Scholar
  11. Leverstein-van Hall  MA, Blok  HEM, Donders  ART, Paauw  A, Fluit  AC, Verhoef  J. Multidrug resistance among Enterobacteriaceae is strongly associated with the presence of integrons and is independent of species or isolate origin. J Infect Dis. 2003;187:251–9. DOIPubMedGoogle Scholar
  12. Clinical and Laboratory Standards Institute. (formerly NCCLS). Performance standards for antimicrobial susceptibility testing: fourteenth international supplement. NCCLS Document M100-S14. Wayne (PA): The Institute; 2004.
  13. Leverstein-van Hall  MA, Fluit  AC, Blok  HE, Box  AT, Peters  ED, Weersink  AJ, Control of nosocomial multiresistant Enterobacteriaceae using a temporary restrictive antibiotic agent policy. Eur J Clin Microbiol Infect Dis. 2001;20:785–91. DOIPubMedGoogle Scholar
  14. Cantón  R, Oliver  A, Coque  TM, Varela  MD, Pérez-Díaz  JC, Baquero  F. Epidemiology of extended-spectrum beta-lactamase-producing Enterobacter isolates in a Spanish hospital during a 12-year period. J Clin Microbiol. 2002;40:1237–43. DOIPubMedGoogle Scholar
  15. Lévesque  C, Piché  L, Larose  C, Roy  PH. PCR mapping of integrons reveals several novel combinations of resistance genes. Antimicrob Agents Chemother. 1995;39:185–91.PubMedGoogle Scholar
  16. Steward  CD, Rasheed  JK, Hubert  SK, Biddle  JW, Raney  PM, Anderson  GJ, Characterization of clinical isolates of Klebsiella pneumoniae from 19 laboratories using the National Committee for Clinical Laboratory Stands extended-spectrum beta-lactamase detection methods. J Clin Microbiol. 2001;39:2864–72. DOIPubMedGoogle Scholar
  17. Nijssen  S, Florijn  A, Top  J, Willems  R, Fluit  A, Bonten  M. Unnoticed outbreaks of integron-carrying Enterobacteriaceae in an ICU. Clin Infect Dis. 2005;41:1–9. DOIPubMedGoogle Scholar
  18. Pérez-Pérez  FJ, Hanson  ND. Detection of plasmid-mediated AmpC β-lactamase genes in clinical isolates by using multiplex PCR. J Clin Microbiol. 2002;40:2153–62. DOIPubMedGoogle Scholar
  19. Parsons  Y, Hall  RM, Stokes  HW. A new trimethoprim resistance gene, dhfrX, in the In7 integron of plasmid pDGO100. Antimicrob Agents Chemother. 1991;35:2436–9.PubMedGoogle Scholar
  20. Stokes  HW, Tomaras  C, Parsons  Y, Hall  RM. The partial 3´-conserved segment duplications in the integrons In6 from pSa and In7 from pDGO100 have a common origin. Plasmid. 1993;30:39–50. DOIPubMedGoogle Scholar
  21. Sabaté  M, Navarro  F, Miró  E, Campoy  S, Mirelis  B, Barbé  J, Novel complex sul1-type integron in Escherichia coli carrying blaCTX-M-9. Antimicrob Agents Chemother. 2002;46:2656–61. DOIPubMedGoogle Scholar
  22. Ahmed  AM, Shimamoto  T. A plasmid-encoded class 1 integron carrying sat, a putative phosphoserine phosphatase gene and aadA2 from enterotoxigenic Escherichia coli O159 isolated in Japan. FEMS Microbiol Lett. 2004;235:243–8. DOIPubMedGoogle Scholar
  23. Leverstein-van Hall  MA, Box  AT, Blok  HE, Paauw  A, Fluit  AC, Evidence of extensive interspecies transfer of integron-mediated antimicrobial resistance genes among multidrug-resistant Enterobacteriaceae in a clinical setting. J Infect Dis. 2002;186:49–56. DOIPubMedGoogle Scholar
  24. Verdet  C, Arlet  G, Barnaud  G, Lagrange  PH, Philippon  A. A novel integron in Salmonella enterica serovar Enteritidis, carrying the bla(DHA-1) gene and its regulator gene ampR, originated from Morganella morganii. Antimicrob Agents Chemother. 2000;44:222–5. DOIPubMedGoogle Scholar
  25. Robicsek  A, Sahm  DF, Strahilevitz  J, Jacoby  GA, Hooper  DC. Broader distribution of plasmid-mediated quinolone resistance in the United States. Antimicrob Agents Chemother. 2005;49:3001–3. DOIPubMedGoogle Scholar
  26. Jeong  JY, Yoon  HJ, Kim  ES, Lee  Y, Choi  SH, Kim  NJ, Detection of qnr in clinical isolates of Escherichia coli from Korea. Antimicrob Agents Chemother. 2005;49:2522–4. DOIPubMedGoogle Scholar
  27. Nazic  H, Poirel  L, Nordmann  P. Further identification of plasmid-mediated quinolone resistance determinant in Enterobacteriaceae in Turkey. Antimicrob Agents Chemother. 2005;49:2146–7. DOIPubMedGoogle Scholar
  28. Tran  JH, Jacoby  GA. Mechanism of plasmid-mediated quinolone resistance. Proc Natl Acad Sci U S A. 2002;99:5638–42. DOIPubMedGoogle Scholar
  29. Martínez-Martínez  L, Pascual  A, García  I, Tran  J, Jacoby  GA. Interaction of plasmid and host quinolone resistance. J Antimicrob Chemother. 2003;51:1037–9. DOIPubMedGoogle Scholar

Main Article

Page created: January 12, 2012
Page updated: January 12, 2012
Page reviewed: January 12, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external