J. M. Rodríguez-Martínez

Origin of Plasmid-Mediated Quinolone Resistance Determinant QnrA

ABSTRACT Plasmid-mediated resistance to quinolones is increasingly reported in studies of Enterobacteriaceae. Using a PCR-based strategy, a series of gram-negative species were screened for qnrA-like genes. Shewanella algae, an environmental species from marine and fresh water, was identified as its reservoir. This is a one of the very few examples of progenitor identification of an acquired antibiotic resistance gene.

Plasmid-mediated quinolone resistance: an update

In 1998, the first plasmid-mediated gene involved in quinolone resistance (currently named qnrA1) was reported. Extra qnr-like plasmid-mediated genes (qnrB, qnrS, qnrC, qnrD) and their chromosomal homologues have also been characterized. These genes code for a pentapeptide repeat protein that protects type II topoisomerases from quinolones. Since then, there have been reports of two other plasmid-mediated resistance mechanisms: the modification of quinolones with a piperazinyl substituent by the acetyltransferase, Aac(6′)-Ib-cr; and active efflux by QepA and OqxAB, pumps related to major facilitator superfamily (MFS) transporters. These genes have a wide geographic distribution (mainly in Enterobacteriaceae). Because of the difficulties of phenotypic detection of this type of resistance, its real prevalence is only partially known. One important point is that although these mechanisms cause only low-level resistance, they favor and complement the selection of other resistance mechanisms.

Molecular Epidemiology and Mechanisms of Carbapenem Resistance in Pseudomonas aeruginosa

ABSTRACT The contributions of different mechanisms of resistance to carbapenems among a collection of imipenem- and meropenem-nonsusceptible Pseudomonas aeruginosa isolates were investigated. This screening included the recently reported extended-spectrum cephalosporinases (ESACs) weakly hydrolyzing carbapenems. Eighty-seven percent of the studied isolates were resistant to imipenem. Genes encoding metallo-β-lactamases or carbapenem-hydrolyzing oxacillinases were not identified. The main mechanism associated with imipenem resistance was the loss of outer membrane protein OprD. Identification of overexpressed ESACs and loss of OprD were observed for 65% of the isolates, all being fully resistant to imipenem. Resistance to meropenem was observed in 78% of the isolates, with all but one also being resistant to imipenem. Overexpression of the MexAB-OprM, MexXY-OprM, or MexCD-OprJ efflux systems was observed in 60% of the isolates, suggesting the contribution of efflux mechanisms in resistance to meropenem. The loss of porin OprD and the overproduction of ESACs were observed in 100% and 92% of the meropenem-resistant isolates, respectively. P. aeruginosa can very often accumulate different resistance mechanisms, including ESAC production, leading to carbapenem resistance.

Extended-Spectrum Cephalosporinases in Pseudomonas aeruginosa

ABSTRACT The characterization of AmpC-type β-lactamases was performed in a collection of 32 clinical Pseudomonas aeruginosa isolates with intermediate susceptibility or resistance to imipenem and ceftazidime. Twenty-one out of those 32 isolates overexpressed AmpC β-lactamase, and the MICs of ceftazidime and imipenem were reduced after cloxacillin addition. Cloning and sequencing identified 10 AmpC β-lactamase variants. Reduced susceptibility to imipenem, ceftazidime, and cefepime was observed only with recombinant P. aeruginosa strains expressing an AmpC β-lactamase that had an alanine residue at position 105. The catalytic efficiencies (kcat/Km) of the AmpC variants possessing this residue were increased against oxyiminocephalosporins and imipenem. In addition, we show here that those AmpC variants constitute a favorable background for the in vitro selection of imipenem-resistant strains. This report identified a novel resistance mechanism that may contribute to imipenem resistance in P. aeruginosa.

In Vivo Selection of Fluoroquinolone-Resistant Escherichia coli Isolates Expressing Plasmid-Mediated Quinolone Resistance and Expanded-Spectrum β-Lactamase

ABSTRACT A ciprofloxacin-resistant Escherichia coli isolate, isolate 1B, was obtained from a urinary specimen of a Canadian patient treated with norfloxacin for infection due to a ciprofloxacin-susceptible isolate, isolate 1A. Both isolates harbored a plasmid-encoded sul1-type integron with qnrA1 and blaVEB-1 genes. Isolate 1B had amino acid substitutions in gyrase and topoisomerase.

Plasmid-mediated quinolone resistance.

The first plasmid-mediated gene involved in quinolone resistance (qnrA1) was reported in 1998. It codes for a pentapeptide-repeat protein that protects type II topoisomerases from quinolones. Additional related plasmid-mediated genes (qnrB, qnrS and qnrC) and chromosomal homologs of them have also been discovered. Two other plasmid-mediated resistance mechanisms were later reported: modification of quinolones with a piperazinyl substituent by the acetyltransferase Aac(6´)-Ib-cr and active efflux by QepA, a pump related to the major facilitator superfamily transporters. These genes have a wide geographical distribution (essentially in enterobacteria), although their real prevalence is only partially known because of the difficulty of phenotypic detection of this type of resistance. Although these mechanism cause low-level resistance, they favor and complement the selection of additional mechanisms of resistance.

Mutant Prevention Concentrations of Fluoroquinolones for Enterobacteriaceae Expressing the Plasmid-Carried Quinolone Resistance Determinant qnrA1

ABSTRACT The influence of qnrA1 on the development of quinolone resistance in Enterobacteriaceae was evaluated by using the mutant prevention concentration parameter. The expression of qnrA1 considerably increased the mutant prevention concentration compared to strains without this gene. In the presence of qnrA1, mutations in gyrA and parC genes were easily selected to produce high levels of quinolone resistance.

Characterization of DIM-1, an Integron-Encoded Metallo-β-Lactamase from a Pseudomonas stutzeri Clinical Isolate in the Netherlands

ABSTRACT A carbapenem-resistant Pseudomonas stutzeri strain isolated from a Dutch patient was analyzed in detail. This isolate produced a metallo-β-lactamase (MBL) whose gene, with 43.5% GC content, was cloned and expressed in Escherichia coli. β-Lactamase DIM-1 (for Dutch imipenemase) was weakly related to other Ambler class B β-lactamases, sharing <52% amino acid identity with the most closely related MBL, GIM-1, and 45% identity with IMP-type MBLs. The β-Lactamase DIM-1 significantly hydrolyzed broad-spectrum cephalosporins and carbapenems and spared aztreonam. This MBL gene was embedded in a class 1 integron containing two other gene cassettes, encoding resistance to aminoglycosides and disinfectants, that was located on a 70-kb plasmid.

Qnr-like pentapeptide repeat proteins in Gram-positive bacteria

OBJECTIVES To study the role of Qnr-like pentapeptide repeat proteins (PRPs) from several gram-positive species with quinolone resistance in vitro. METHODS A PCR-based strategy was used to clone and express genes coding for Qnr-like PRPs in Enterococcus faecalis, Enterococcus faecium, Listeria monocytogenes, Clostridium perfringens, C. difficile, Bacillus cereus and B. subtilis in Escherichia coli DH10B. MIC values of nalidixic acid and fluoroquinolones were determined for reference strains and E. coli DH10B harbouring recombinant plasmids containing genes coding for PRPs. RESULTS Amino acid identity of Qnr-like PRPs in gram-positive strains compared with that of the plasmid-mediated quinolone resistance determinants QnrA1, QnrB1 and QnrS1 was in the range of 16% to 22%. Recombinant plasmids coding for Qnr-like PRPs conferred reduced susceptibility to fluoroquinolones (in the range of 0.016 to 0.064 mg/L for ciprofloxacin) and nalidixic acid (from 6 to 12 mg/L), depending on the antimicrobial agent and PRP. The PRP from B. subtilis showed no protective effect. CONCLUSIONS The PRPs analysed conferred a reduced susceptibility phenotype in E. coli; the data provide further evidence of the possible roles in quinolone resistance of PRPs from different gram-positive species. These gram-positive species may constitute a reservoir for Qnr-like quinolone resistance proteins.

VIM-19, a Metallo-β-Lactamase with Increased Carbapenemase Activity from Escherichia coli and Klebsiella pneumoniae

ABSTRACT Two carbapenem-resistant isolates, one Escherichia coli isolate and one Klebsiella pneumoniae isolate, recovered from an Algerian patient expressed a novel VIM-type metallo-β-lactamase (MBL). The identified blaVIM-19 gene was located on a ca. 160-kb plasmid and located inside a class 1 integron in both isolates. VIM-19 differed from VIM-1 by the Asn215Lys and Ser228Arg substitutions, increasing its hydrolytic activity toward carbapenems. Site-directed mutagenesis experiments showed that both substitutions were necessary for the increased carbapenemase activity of VIM-19. This study indicates that MBLs with enhanced activity toward carbapenems may be obtained as a result of very few amino acid substitutions.