title: Fluoroquinolone Resistance Mechanisms and population structure of Enterobacter cloacae non-susceptible to Ertapenem in North-Eastern France.
abstract: Fluoroquinolone (FQ) agents are a potential resort to treat infection due to Enterobacteriaceae producing extended spectrum β-lactamase and susceptible to FQ. In a context of increase of non-susceptibility to carbapenems among Enterobacteriaceae, we characterized FQ resistance mechanisms in 75 Enterobacter cloacae isolates non-susceptible to ertapenem in North-Eastern France in 2012 and describe the population structure by pulsed field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Among them, 14.7% (12/75) carried a carbapenemase-encoding gene. Except one isolate producing VIM-1, the carbapenemase-producing isolates carried the well-known IncL/M pOXA48a plasmid. Most of the isolates (59/75) harbored at least a FQ-R determinant. qnr genes were predominant (40%, 30/75). The MLST study revealed that E. cloacae isolates' clonality was wide [24 different sequence types (STs)]. The more widespread STs were ST74, ST101, ST110, ST114, and ST133. Carbapenem MICs were higher for E. cloacae ST74 than for other E. cloacae isolates. Plasmid-mediated quinolone resistance determinants were more often observed in E. cloacae ST74 isolates. These findings showed that (i) pOXA-48a is spreading in North-Eastern France, (ii) qnr is preponderant in E. cloacae, (iii) E. cloacae comprised a large amount of lineages spreading in North-Eastern France, and (iv) FQ as an alternative to β-lactams to treat ertapenem non-susceptible Enterobacteriaceae are compromised.
authors.affiliation: Laboratoire de Bactériologie-Virologie-Hygiène, Hôpital Robert Debré, CHU Reims Reims, France ; Structure Fédérative de Recherche CAP-Santé, UFR Médecine, Université de Reims Champagne-Ardenne Reims, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Guillard
authors.affiliation: Service d'Hygiène Hospitalière, CHRU Besançon Besançon, France ; UMR 6249 Chrono-environnement, Université de Franche-Comté Besançon, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Cholley
authors.affiliation: Laboratoire de Bactériologie-Virologie-Hygiène, Hôpital Robert Debré, CHU Reims Reims, France ; Structure Fédérative de Recherche CAP-Santé, UFR Médecine, Université de Reims Champagne-Ardenne Reims, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Limelette
authors.affiliation: Service d'Hygiène Hospitalière, CHRU Besançon Besançon, France ; UMR 6249 Chrono-environnement, Université de Franche-Comté Besançon, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Hocquet
authors.affiliation: Laboratoire de Bactériologie-Virologie-Hygiène, Hôpital Robert Debré, CHU Reims Reims, France ; Structure Fédérative de Recherche CAP-Santé, UFR Médecine, Université de Reims Champagne-Ardenne Reims, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Matton
authors.affiliation: UMR 6174 CNRS, Département d'Informatique des Systèmes Complexes, Université de Franche-Comté Belfort, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Guyeux
authors.affiliation: Structure Fédérative de Recherche CAP-Santé, UFR Médecine, Université de Reims Champagne-Ardenne Reims, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Lebreil
authors.affiliation: Laboratoire de Bactériologie-Virologie-Hygiène, Hôpital Robert Debré, CHU Reims Reims, France ; Structure Fédérative de Recherche CAP-Santé, UFR Médecine, Université de Reims Champagne-Ardenne Reims, France.
authors.forename: Odile
authors.initials: O
authors.lastname: Bajolet
authors.affiliation: Laboratoire de Bactériologie-Virologie-Hygiène, Hôpital Robert Debré, CHU Reims Reims, France ; Structure Fédérative de Recherche CAP-Santé, UFR Médecine, Université de Reims Champagne-Ardenne Reims, France.
authors.forename: Lucien
authors.initials: L
authors.lastname: Brasme
authors.affiliation: Laboratoire de Bactériologie-Virologie-Hygiène, Hôpital Robert Debré, CHU Reims Reims, France.
authors.forename: Janick
authors.initials: J
authors.lastname: Madoux
authors.affiliation: Laboratoire de Bactériologie-Virologie-Hygiène, Hôpital Robert Debré, CHU Reims Reims, France ; Structure Fédérative de Recherche CAP-Santé, UFR Médecine, Université de Reims Champagne-Ardenne Reims, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Vernet-Garnier
authors.affiliation: Centre de Recherche et d'Investigation Clinique, Hôpital Robert Debré, CHU Reims Reims, France.
authors.forename: Coralie
authors.initials: C
authors.lastname: Barbe
authors.affiliation: Service d'Hygiène Hospitalière, CHRU Besançon Besançon, France ; UMR 6249 Chrono-environnement, Université de Franche-Comté Besançon, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bertrand
authors.affiliation: Laboratoire de Bactériologie-Virologie-Hygiène, Hôpital Robert Debré, CHU Reims Reims, France ; Structure Fédérative de Recherche CAP-Santé, UFR Médecine, Université de Reims Champagne-Ardenne Reims, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: de Champs On Behalf Of CarbaFrEst Group
keywords: Carbapenem; Enterobacter cloacae; Fluoroquinolones; MLST; PMQR; QRDR