title: High prevalence of plasmid-mediated quinolone resistance determinants in Enterobacter cloacae isolated from hospitals of the Qazvin, Alborz, and Tehran provinces, Iran.
abstract: BACKGROUND
  Plasmid-mediated quinolone resistance (PMQR) is a growing clinical concern worldwide. The main aims of this study were to detect qnr-encoding genes and to evaluate the clonal relatedness of qnr-positive Enterobacter cloacae isolates.
  
  
  METHODS
  A total of 116 E. cloacae isolates that were not susceptible to quinolone were obtained from seven hospitals in Tehran, five hospitals in Qazvin, and two hospitals in Karaj (Iran). Bacterial identification was performed using standard laboratory methods and API 20E strips. Quinolone resistance was determined using the Kirby-Bauer disk diffusion method according to the Clinical Laboratory Standards Institute (CLSI) guidelines. PCR and sequencing were employed to detect qnrA, qnrB, and qnrS genes, and clonal relatedness was assessed using the enterobacterial repetitive intergenic consensus (ERIC)-PCR method.
  
  
  RESULTS
  In total, 45 (38.8%) and 71 (61.2%) of isolates showed high- and low-level quinolone resistance, respectively, and qnr-encoding genes were detected in 70 (60.3%) of them. qnrB1 [45 (38.8%) isolates] was the most commonly detected gene, followed by qnrS1 [28 (24.1%) isolates] and qnrB4 [18 (15.5%) isolates] either alone or in combination with other genes. The results of the ERIC-PCR revealed that 53 (75.7%) qnr-positive isolates were genetically unrelated.
  
  
  CONCLUSIONS
  This study describes, for the first time, the high prevalence of the qnrB1, qnrS1, and qnrB4 genes among E. cloacae isolates in Iran. The detection of qnr genes emphasizes the need for establishing tactful policies associated with infection control measures in hospital settings in Iran.
authors.affiliation: Celular e Molecular Research Center, Qazvin Universidade de Ciências Médicas, Qazvin, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Peymani
authors.affiliation: Celular e Molecular Research Center, Qazvin Universidade de Ciências Médicas, Qazvin, Iran.
authors.forename: Taghi Naserpour
authors.initials: TN
authors.lastname: Farivar
authors.affiliation: Celular e Molecular Research Center, Qazvin Universidade de Ciências Médicas, Qazvin, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Najafipour
authors.affiliation: Celular e Molecular Research Center, Qazvin Universidade de Ciências Médicas, Qazvin, Iran.
authors.forename: Samaneh
authors.initials: S
authors.lastname: Mansouri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D016972:Enterobacter cloacae / Q000187:drug effects* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010957:Plasmids / Q000235:genetics; D015995:Prevalence; D015363:Quinolones / Q000494:pharmacology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015363:Quinolones