title: Molecular epidemiology of endemic ciprofloxacin-susceptible and -resistant Enterobacteriaceae.
abstract: OBJECTIVE
  To elucidate the epidemiology of widespread ciprofloxacin resistance in our Veterans Affairs medical center using whole cell DNA analysis.
  
  
  METHODS
  In vitro study of ciprofloxacin resistant and susceptible Enterobacteriaceae isolated during the course of a clinical epidemiologic study of quinolone resistance.
  
  
  METHODS
  Veterans Affairs Medical Center with acute care and long-term care divisions.
  
  
  RESULTS
  We examined 40 ciprofloxacin-resistant strains of Serratia marcescens, Proteus mirabilis, and Providencia stuartii using restriction endonuclease analysis of whole cell DNA and compared them with concomitantly isolated ciprofloxacin sensitive strains. We sought to determine whether resistant strains were identical to susceptible strains, indicating in vivo emergence of resistant strains from susceptible strains, and whether resistant strains were shared among patients. All 26 ciprofloxacin-resistant S marcescens isolates shared a single ecoRI restriction pattern. Multiple patterns were seen in the ciprofloxacin-susceptible S marcescens isolates; however, several isolates had a pattern matching that of the resistant isolates. Similar results were seen among the P mirabilis isolates. Three different ecoRI patterns were found among the ciprofloxacin-resistant P stuartii isolates; none matched those found among the susceptible isolates. The frequency of spontaneous emergence of ciprofloxacin resistance in susceptible S marcescens strains with restriction pattern matching that of the resistant strains was significantly higher than that of nonmatching strains.
  
  
  CONCLUSIONS
  Ciprofloxacin-resistant strains of Enterobacteriaceae became widespread within a short period of time. Resistant strains of S marcescens and P mirabilis arose from endemic susceptible strains. The resistant strain of S marcescens appeared to arise from a susceptible strain with a relatively high frequency of spontaneous ciprofloxacin resistance.
authors.affiliation: Special Pathogens Laboratory, Veterans Affairs Medical Center, Pittsburgh, PA.
authors.forename: Y C
authors.initials: YC
authors.lastname: Yee
authors.forename: R R
authors.initials: RR
authors.lastname: Muder
authors.forename: M H
authors.initials: MH
authors.lastname: Hsieh
authors.forename: T C
authors.initials: TC
authors.lastname: Lee
mesh_terms: D016022:Case-Control Studies; D002939:Ciprofloxacin / Q000494:pharmacology*; D004262:DNA Restriction Enzymes / Q000235:genetics; D004269:DNA, Bacterial / Q000235:genetics*; D004352:Drug Resistance, Microbial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000235:genetics; D006787:Hospitals, Veterans; D006801:Humans; D008826:Microbial Sensitivity Tests; D012706:Serratia marcescens / Q000187:drug effects / Q000235:genetics
chemical_list: D004269:DNA, Bacterial; D002939:Ciprofloxacin; D004262:DNA Restriction Enzymes