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Front Microbiol. 2015 Oct 23;6:1186. doi: 10.3389/fmicb.2015.01186. eCollection 2015.

Fluoroquinolone Resistance Mechanisms and population structure of Enterobacter cloacae non-susceptible to Ertapenem in North-Eastern France.

Author information

1
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.
2
Service d'Hygiène Hospitalière, CHRU Besançon Besançon, France ; UMR 6249 Chrono-environnement, Université de Franche-Comté Besançon, France.
3
UMR 6174 CNRS, Département d'Informatique des Systèmes Complexes, Université de Franche-Comté Belfort, France.
4
Structure Fédérative de Recherche CAP-Santé, UFR Médecine, Université de Reims Champagne-Ardenne Reims, France.
5
Laboratoire de Bactériologie-Virologie-Hygiène, Hôpital Robert Debré, CHU Reims Reims, France.
6
Centre de Recherche et d'Investigation Clinique, Hôpital Robert Debré, CHU Reims Reims, 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.

KEYWORDS:

Carbapenem; Enterobacter cloacae; Fluoroquinolones; MLST; PMQR; QRDR

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