RESEARCH ARTICLE


PMQR Determinants Expression in Gram-negative Uropathogens Clinically Isolated from Hospitalized Patients with Pyelonephritis in Kharkiv, Ukraine



Olga Chub1, *, Aleksandr V. Bilchenko2, Igor Teslenko3
1 Kharkiv Medical Academy for Postgraduate Education, department of Internal Medicine and Nephrology, Kharkiv, Ukraine
2 Head of Department, Kharkiv Medical Academy for Postgraduate Education, Kharkiv, Ukraine
3 Kharkiv Medical Academy for Postgraduate Education, Kharkiv, Ukraine


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© 2017 Chub et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Kharkiv Medical Academy for Postgraduate Education, department of Internal Medicine and Nephrology, Kharkiv, Ukraine; Tel: +380953545759; E-mail: o.chub@mail.ru


Abstract

Background:

Resistance to beta-lactams and fluoroquinolones has been increasing in the treatment of urinary tract infections (UTIs), worldwide. Recent studies in Europe and the United States have demonstrated that steady increase in the rate of uropathogen’s resistance to commonly prescribed antibiotics is associated with plasmid-mediated resistance genes existence. According to the published data, acquirеd rеsistance to quinolones is predоminantly mediated by plasmid-mediated quinolone resistance determinants (PMQR) that cоmpromise the efficаcу of the first, second and third generation quinolones.

The objective of this study was to determine the prevalence of PMQR genes among uropathogens from hospitalized patients with pyelonephritis and to identify the presence of genes involved in the resistance, specifically - aac(6')-Ib-cr, QnrA and efflux pump QepA.

Methods:

A cross-sectional study of 105 patients with pyelonephritis, treated in Kharkiv City Clinical Emergency Hospital, Ukraine was carried out. Bacterial isolates were collected, antimicrobial susceptibility of isolates was determined by the Kirby Bauer disk diffusion method and screening for the presence of aac(6')-Ib-cr, QnrA and efflux pump QepA PMQR genes was performed by polymerase chain reaction.

Results:

Among 81 isolated gram negative bacterial strains, 39 (48.1%) were identified to carry different types of plasmid-mediated resistance determinants, among which 27 (69.2%) were found to be extended spectrum beta-lactamases producers, and 12 (30.8%) – were positive for plasmid-mediated quinolone resistance genes. Most of the identified genes were found in P. mirabilis, E. coli and Serratia spp. strains with its prevalence of 62.5%, 52.8% and 50%, respectively. Most common isolated gene was efflux pump QepA. In this study, 100% of the PMQR producing isolates are identified as meropenem susceptible. Global resistance to fluoroquinolones was ≥ 20% among isolated gram-negative strains. Treatment by fluoroquinolones demonstrated the best favorable clinical response in the patients infected with ESBL-producing organisms, whereas cephalosporins were the most effective in patients infected with fluoroquinolone resistance uropathogens.

Conclusion:

Therapeutic alternatives for the treatment of UTI patients with resistant uropathogens, particularly in hospitalized patients, are limited. Rational use of antibiotics in practice and/or the proper detection of plasmid-mediated resistance genes among the bаcteria in cоmmunitiеs arе crucial for further prevention of antimicrobial resistance development.

Keywords: Quinolones, Pyelonephritis, Uropathogens, Plasmids, Resistance, Genes.