title: Plasmid-mediated quinolone resistance determinants in urinary isolates of Escherichia coli and Klebsiella pneumoniae in a large Singapore hospital.
abstract: BACKGROUND
  At the time of the study, 3 plasmid-borne qnr determinants (qnrA, qnrB and qnrS) and 1 plasmid-borne aminoglycoside-modifying enzyme determinant that confers quinolone resistance (aac(6')-Ib-cr) had been described in the literature.
  
  
  METHODS
  We studied the prevalence of the 3 qnr determinants in a total of 117 nalidixic acid-resistant urinary isolates of Klebsiella pneumoniae (61 isolates) and Escherichia coli (56 isolates) using multiplex polymerase chain reaction (PCR). Further, a subset of the original strains (comprising 14 E. coli and 38 K. pneumoniae) showing reduced susceptibility to the aminoglycosides underwent PCR for aac(6')-Ib, followed by restriction digestion with BtsCI to detect the variant aac(6')-Ib-cr.
  
  
  RESULTS
  Twenty-eight of 61 (45.9%) Klebsiella isolates were found to possess at least 1 qnr determinant. Only 1/56 (1.8%) E. coli isolates were found to possess a qnr determinant. Two of the Klebsiella isolates possessed 2 qnr determinants each (qnrB and qnrS). The predominant determinant was qnrB (19 isolates). There were 11 isolates harbouring qnrS, and only 1 with qnrA. 1/14 (7.1%) E. coli and 35/38 K. pneumoniae (92.1%) were found to possess aac(6')-Ib-cr. There was pairwise association between each of qnr, aac(6')-Ib-cr and the presence of an extended-spectrum beta-lactamase.
  
  
  CONCLUSIONS
  A high prevalence of plasmid-mediated quinolone resistance determinants [i.e., qnrS, qnrB and aac(6')-Ib-cr] was found in quinolone-resistant K. pneumoniae isolated in a large hospital in Singapore.
authors.affiliation: Department of Pathology, Singapore General Hospital, Singapore. deepak.rama.narayana@sgh.com.sg
authors.forename: Rama Narayana
authors.initials: RN
authors.lastname: Deepak
authors.forename: Tse Hsien
authors.initials: TH
authors.lastname: Koh
authors.forename: Kian Sing
authors.initials: KS
authors.lastname: Chan
mesh_terms: D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D006761:Hospitals; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008969:Molecular Sequence Data; D015363:Quinolones / Q000494:pharmacology*; D011815:R Factors; D012846:Singapore; D014556:Urine / Q000382:microbiology
chemical_list: D015363:Quinolones