title: Ciprofloxacin-resistant Escherichia coli in Central Greece: mechanisms of resistance and molecular identification.
abstract: BACKGROUND
  Fluoroquinolone resistant E. coli isolates, that are also resistant to other classes of antibiotics, is a significant challenge to antibiotic treatment and infection control policies. In Central Greece a significant increase of ciprofloxacin-resistant Escherichia coli has occurred during 2011, indicating the need for further analysis.
  
  
  METHODS
  A total of 106 ciprofloxacin-resistant out of 505 E. coli isolates consecutively collected during an eight months period in a tertiary Greek hospital of Central Greece were studied. Antimicrobial susceptibility patterns and mechanisms of resistance to quinolones were assessed, whereas selected isolates were further characterized by multilocus sequence typing and β-lactamase content.
  
  
  RESULTS
  Sequence analysis of the quinolone-resistance determining region of the gyrA and parC genes has revealed that 63% of the ciprofloxacin-resistant E. coli harbored a distinct amino acid substitution pattern (GyrA:S83L + D87N; ParC:S80I + E84V), while 34% and 3% carried the patterns GyrA:S83L + D87N; ParC:S80I and GyrA:S83L + D87N; ParC:S80I + E84G respectively. The aac (6')-1b-cr plasmid-mediated quinolone resistance determinant was also detected; none of the isolates was found to carry the qnrA, qnrB and qnrS.Genotyping of a subset of 35 selected ciprofloxacin-resistant E. coli by multilocus sequence typing has revealed the presence of nine sequence types; ST131 and ST410 were the most prevalent and were exclusively correlated with hospital and health care associated infections, while strains belonging to STs 393, 361 and 162 were associated with community acquired infections. The GyrA:S83L + D87N; ParC:S80I + E84V substitution pattern was found exclusively among ST131 ciprofloxacin-resistant E. coli. Extended-spectrum β-lactamase-positive ST131 ciprofloxacin-resistant isolates produced CTX-M-type enzymes; eight the CTX-M-15 and one the CTX-M-3 variant. CTX-M-1 like and KPC-2 enzymes were detected in five and four ST410 ciprofloxacin-resistant E. coli isolates, respectively.
  
  
  CONCLUSIONS
  Our findings suggest that, ST131 and ST410 predominate in the ciprofloxacin resistant E. coli population.
authors.affiliation: Department of Microbiology, University Hospital of Larissa, Larissa, Greece.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Mavroidi
authors.forename: Vivi
authors.initials: V
authors.lastname: Miriagou
authors.forename: Apostolos
authors.initials: A
authors.lastname: Liakopoulos
authors.forename: Εva
authors.initials: Ε
authors.lastname: Tzelepi
authors.forename: Angelos
authors.initials: A
authors.lastname: Stefos
authors.forename: George N
authors.initials: GN
authors.lastname: Dalekos
authors.forename: Efthymia
authors.initials: E
authors.lastname: Petinaki
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D002939:Ciprofloxacin / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000382:microbiology; D024841:Fluoroquinolones / Q000494:pharmacology; D005838:Genotype; D006115:Greece / Q000453:epidemiology; D006801:Humans; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D002939:Ciprofloxacin; D001618:beta-Lactamases