title: Enterobacter cloacae outbreak and emergence of quinolone resistance gene in Dutch hospital.
abstract: An outbreak of Enterobacter cloacae infections with variable susceptibility to fluoroquinolones occurred in the University Medical Center Utrecht in the Netherlands in 2002. Our investigation showed that a qnrA1 gene was present in 78 (94%) of 83 outbreak isolates and that a qnrA1-encoding plasmid transferred to other strains of the same species and other species. The earliest isolate carrying this same plasmid was isolated in 1999. qnrA1 was located in a complex integron consisting of the intI1, aadB, qacEDelta1, sul1, orf513, qnrA1, ampR, qacEDelta1, and sul1 genes that were not described previously. On the same plasmid, 2 other class 1 integrons were present. One was a new integron associated with the bla(CTX-M-9) extended-spectrum beta-lactamase.
authors.affiliation: Eijkman-Winkler Institute for Microbiology, Infectious Diseases and Inflammation, University Medical Center Utrecht, 3508 GA Utrecht, the Netherlands. A.Paauw@umcutrecht.nl
authors.forename: Armand
authors.initials: A
authors.lastname: Paauw
authors.forename: Ad C
authors.initials: AC
authors.lastname: Fluit
authors.forename: Jan
authors.initials: J
authors.lastname: Verhoef
authors.forename: Maurine A
authors.initials: MA
authors.lastname: Leverstein-van Hall
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001483:Base Sequence; D016000:Cluster Analysis; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000235:genetics; D003227:Conjugation, Genetic; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D016521:Electrophoresis, Gel, Pulsed-Field; D016972:Enterobacter cloacae / Q000145:classification / Q000187:drug effects* / Q000235:genetics*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000453:epidemiology; D005784:Gene Amplification; D005838:Genotype; D006801:Humans; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D009426:Netherlands / Q000453:epidemiology; D010802:Phylogeny; D010957:Plasmids; D015363:Quinolones / Q000494:pharmacology*; D013045:Species Specificity
chemical_list: D000900:Anti-Bacterial Agents; D015363:Quinolones