Keywords
Fluoroquinolones
ESBLs
Clinical specimens
How to Cite
Abstract
The treatment of Klebsiella pneumoniae infections has become more difcult due to the emergence of multidrug-resistant strains. Fluoroquinolones have been widely used to treat respiratory tract infections and urinary tract infections caused by different bacteria. Therefore, this study aimed to evaluate fluoroquinolones resistance and detect ESBL producers in various clinical samples in Duhok Province, Iraq. K. pneumoniae was identied from different clinical samples by conventional microbiological tests. In addition, antibiotic susceptibility was detected by the KirbyBauer disc diffusion method. Out of 120 K. pneumoniae isolates, 73.3% were causing urinary tract infections, in most cases, 74.2% were among females and 25.8% among males, and among those 120 isolates, 76.7% of isolates were from outpatients, and 23.3% were inpatients. The resistance rate among all samples was 52.5%, 36.7%, 33.3%, 33.3%, ciprofloxacin, levofloxacin, norfloxacin, and ofloxacin, respectively in urine samples, the resistance to nalidixic acid was 22.5%. Among 120 samples, only 12 isolates were hypermucoviscosity. About 25% of ciprofloxacin and 17.5% of levofloxacin resistances were ESBL producers simultaneously. According to this study, K. pneumoniae is more susceptible to norfloxacin, ofloxacin, and nalidixic acid than ciprofloxacin and levofloxacin. Additionally, this study establishes a link between ESBL and fluoroquinolone resistance.
References
Abd Al-Mayahi, F.S., Abd Al-Hamed, Z.A. (2021). Antibiogram Of Klebsiella Pneumoniae That Isolated from Clinical and Environmental Samples in Al-Diwaniyah Hospitals. Al-Qadisiyah Journal of Pure Science, 26 (2), 44-54.
Abdulrazzaq, R.H., Faisal, R.M. (2022). Efficiency of Hichrome Enterococcus Faecium Agar in The Isolation of Enterococcus Spp. And Other Associated Bacterial Genera from Water. Journal of Life and Bio-Sciences Research, 3 (1). 1-6.
Alheib, O., Kayali, R., Abajy, M.Y. (2015). Prevalence of Plasmid-Mediated Quinolone Resistance (PMQR) Determinants Among Extended Spectrum Beta-Lactamases (ESBL)-Producing Isolates of Escherichia Coli And Klebsiella Pneumoniae in Aleppo. Syria. Archives of Clinical Infectious Diseases, 10 (3).
Al-Marzooq, F., Yusof, M.Y.M., Tay, S.T. (2014). Molecular Analysis of Ciprofloxacin Resistance Mechanisms in Malaysian ESBL-Producing Klebsiella Pneumoniae Isolates and Development of Mismatch Amplification Mutation Assays (MAMA) For Rapid Detection of Gyra And Parc Mutations. Biomed Research International. 2014, 601630.
Aminul, P. Anwar, S., Molla M.A., Miah, R.A. (2021). Evaluation of Antibiotic Resistance Patterns in Clinical Isolates of Klebsiella Pneumoniae in Bangladesh. Biosafety aznd Health, 3 (6), 301-306.
Bouchakour, M., Zerouali, K., Claude J.D.P.G., Amarouch, H., El Mdaghri, N., Courvalin, P., Timinouni, M. (2010). Plasmid-Mediated Quinolone Resistance in Expanded Spectrum Beta Lactamase Producing Enterobacteriaceae in Morocco. Journal of Infection in Developing Countries. 4 (12), 779803.
Centers of Diseases Control and Prevention (CDC) (2010). Klebsiella Pneumoniae in Healthcare Settings. March, 19, 2022, Https://Www.Cdc.Gov/Hai/Organisms/Klebsiella/Klebsiella.Html.
Centers of Diseases Control and Prevention (CDC) (2010). Klebsiella Pneumoniae in Healthcare Settings. March, 19, 2022, Https://Www.Cdc.Gov/Hai/Organisms/Klebsiella/Klebsiella.Html.
Centers of Diseases Control and Prevention (CDC) (2019). 2019 AR Threats Report. Marth, 19, 2022, https://www.cdc.gov/hai/organisms/klebsiella/klebsiella.html.
Choby, J.E., Howard-Anderson, J., Weiss, D.S. (2020). Hypervirulent Klebsiella pneumoniae - Clinical and Molecular Perspectives. Journal of Internal Medicine, 287 (3), 283300.
Clinical and Laboratory Standards Institute (2021). M100 Performance Standards for Antimicrobial Susceptibility Testing. 31thed. Wayne, Pennsylvania, USA.
Correia, S., Poeta, P., Hebraud, M., Capelo, J.L., Igrejas, G. (2017). Mechanisms of Quinolone Action and Resistance: Where Do We Stand?. Journal of Medical Microbiology. 66 (5), 551-559.
Cremet, L., Caroff, N., Dauvergne, S., Reynaud, A., Lepelletier, D., Corvec, S. (2011). Prevalence of Plasmid-Mediated Quinolone Resistance Determinants in ESBL Enterobacteriaceae Clinical Isolates Over A 1-Year Period in A French Hospital. Pathologie Biologie. 59 (3), 151-156.
Czajkowski, K. Bro-Konopielko, M., Teliga-Czajkowska, J. (2021). Urinary Tract Infection in Women. Przeglad Menopauzalny. 20 (1), 4047.
Drieux, L. Brossier, F. Sougakoff, W., Jarlier, V. (2008). Phenotypic Detection of Extended-Spectrum Beta-Lactamase Production in Enterobacteriaceae: Review and Bench Guide. Clinical Microbiology and Infection. 14 (1), 90103. https://doi.org/10.1111/j.1469-0691.2007.01846.x
Eftekhar, F., Seyedpour, S.M. (2015). Prevalence of Qnr and Aac(6')-Ib-Cr Genes in Clinical Isolates of Klebsiella pneumoniae from Imam Hussein Hospital in Tehran. Iranian Journal of Medical Sciences. 40 (6), 515521.
Fuhrmeister, A.S., Jones, R.N. (2019). The Importance of Antimicrobial Resistance Monitoring Worldwide and The Origins of SENTRY Antimicrobial Surveillance Program. Open Forum Infectious Diseases. 6 (1), 14.
Ghadiri, K., Akya1, A., Elahi, A. Jafari, S., Chegenelorestani, R. (2019). Evaluation of Resistance To Ciprofloxacin and Identification of Mutations in Topoisomerase Genes in Escherichia coli and Klebsiella pneumonia Isolated From Pediatric Urinary Tract Infections. Journal of Pediatr Research. 6 (4), 322-328.
Goudarzi, M., Azad, M., Seyedjavadi, S.S. (2015). Prevalence of Plasmid-Mediated Quinolone Resistance Determinants and Oqxab Efflux Pumps Among Extended-Spectrum -Lactamase Producing Klebsiella Pneumoniae Isolated From Patients With Nosocomial Urinary Tract Infection in Tehran, Iran. Scientifica, 518167.
Hagiya, H., Watanabe, N., Maki, M., Murase, T., Otsuka, F. (2014). Clinical Utility of String Test As A Screening Method For Hypermucoviscosity-Phenotype Klebsiella pneumoniae. Acute Medicine & Surgery. 1 (4), 245246.
Hasan, S.A., Raheem, T.F., Abdulla H.M. (2021). Phenotypic, Antibiotyping, and Molecular Detection of Klebsiella pneumoniae Isolates from Clinical Specimens in Kirkuk, Iraq. Archives of Razi Institute. 76 (4), 10611067.
Hooper, D.C., Jacoby, G.A. (2015). Mechanisms of Drug Resistance: Quinolone Resistance. Annals of The New York Academy of Sciences. 1354 (1), 1231.
Hudzicki, J. (2009). Kirby-Bauer Disk Diffusion Susceptibility Test Protocol. American Society For Microbiology, April, 11, 2022, Https://Asm.Org/Protocols/Kirby-Bauer-Disk-Diffusion-Susceptibility-Test-Pro.
Jacoby, G.A. (2005) Mechanisms of Resistance to Quinolones. Clinical Infectious Diseases. 41 (2), 120126.
Jamshidi, M.R.M., Zandi, H., Eftekhar, F. (2019). Correlation Of Quinolone-Resistance, Qnr Genes and Integron Carriage in Multidrug-Resistant Community Isolates of Klebsiella Spp. Iranian Journal of Basic Medical Sciences. 22 (12), 13871391.
Johnson, A.P. (2015). Surveillance of Antibiotic Resistance. Philosophical Transactions of The Royal Society of London. Series B, Biological Sciences, 370(1670),
Karampela, I., Dalamaga, M. (2020). Could Respiratory Fluoroquinolones, Levofloxacin and Moxifloxacin, Prove to be Beneficial as an Adjunct Treatment in COVID-19?. Archives of Medical Research. 51(7), 741-742.
Khalid, H.M. Yousif, S.Y., Jubrael, J.S. (2013). Bacteriological and Molecular Characterization of Extended Spectrum -Lactamases in Clinical Isolates of Klebsiella pneumoniae Isolated from Kurdistan Region, Iraq. SJUOZ. (1)1. 158-163.
Kim, H.B., Park, C.H., Kim, C.J., Kim. E.C., Jacoby, G.A., Hooper, D.C. (2009). Prevalence of Plasmid-Mediated Quinolone Resistance Determinants Over A 9-Year Period. Antimicrobial Agents and Chemotherapy. 53 (2), 639645.
Liu, C., Guo, J. (2019). Hypervirulent Klebsiella pneumoniae (Hypermucoviscous and Aerobactin Positive) Infection Over 6 Years In The Elderly In China: Antimicrobial Resistance Patterns, Molecular Epidemiology and Risk Factor. Annals of Clinical Microbiology and Antimicrobials. 18 (1), 4.
Mahon, C.R., Lehman, D.C., Manuselis, G. (2019). Textbook of Diagnostic Microbiology.5th ed. Chine. Elsevier. 869.
Martin, R.M., Bachman, M.A. (2018). Colonization, Infection, and The Accessory Genome of Klebsiella pneumoniae. Frontiers in Cellular and Infection Microbiology. 8, 4.
Martinez-Martinez, L., Pascual, A., Jacoby, G.A. (1998). Quinolone Resistance from A Transferable Plasmid. Lancet. 351 (9105), 797-9.
Metlay, J.P., Waterer, G.W. (2019). Treatment of Community-Acquired Pneumonia During The Coronavirus Disease 2019 (COVID-19) Pandemic. Ann Intern Med. 173 (4), 304-305.
Mike, L.A., Stark, A.J., Forsyth,V.S., Vornhagen, J., Smith, S.N., Bachman, M.A., Mobley, H. (2021). A Systematic Analysis of Hypermucoviscosity and Capsule Reveals Distinct and Overlapping Genes That Impact Klebsiella Pneumoniae Fitness. Plos Pathogens. 17 (3), E1009376.
Mohammed, H.H., Saadi, A.T., Yaseen.N.A. (2019). Detection Of Carbapenem Antibiotic Resistance In Klebsiella Pneumonia In Duhok City/Kurdistan Region/Iraq. Duhok Medical Journal. 14 (1), 28-42.
Naqid. I.A., Hussein, N.R., Balatay, A.A., Saeed, K.A., Ahmad, H.A. (2021). The Antimicrobial Resistance Pattern of Klebsiella Pneumonia Isolated From The Clinical Specimens in Duhok City in Kurdistan Region of Iraq. Journal of Kermanshah University Medical Science. 24 (2), e106135.
Paterson, D.L., Mulazimoglu, L., Casellas, J.M., Ko, W.C. Goossens, H., Gottberg, A.V., Mohapatra, S., Trenholme, G.M., Klugman, K.P., Mccormack, J.G., Yu, V.L. (2000). Epidemiology of Ciprofloxacin Resistance and Its Relationship To Extended-Spectrum Beta-Lactamase Production in Klebsiella Pneumoniae Isolates Causing Bacteremia. Clinical Infectious Diseases. 30 (3), 473478.
Poirel, L., Villa, L. ,Bertini, A., Pitout, J.D., Nordmann, P., Carattoli, A. (2007). Expanded-Spectrum Beta-Lactamase and Plasmid-Mediated Quinolone Resistance. Emerging Infectious Diseases, 13 (5), 803805.
Priyadarshini, B., Mahalakshmi, K., Kumar, V.N., (2019). Mutant Prevention Concentration of Ciprofloxacin Against Klebsiella Pneumoniae Clinical Isolates: An Ideal Prognosticator in Treating Multidrug-Resistant Strains. International Journal of Microbiology, 6850108.
Russo, T.A. Marr, C.M. (2019). Hypervirulent Klebsiella Pneumoniae. Clinical Microbiology Reviews. 32 (3), E00001-19.
Shahraki, S.H. Mohammadzadeh-Rostami, F., Haddadi-Feishani, M., Mohagheghifard, A., Majidiani, H. (2014). Evaluation of Quinolone-Resistant Strains of Klebsiella pneumoniae in Clinical Specimens Obtained From Patients Referred To Zahedan Educational Hospitals. Zahedan Journal of Research in Medical Sciences. 17 (8). 12-15.
Shahram, S.H., Farzaneh, M.R., Mehdi, H.F., Hossein, M.A., Somayeh, J., Hamidreza, M. (2015). Evaluation of Quinolone-Resistant Strains of Klebsiella pneumoniae in Clinical Specimens Obtained From Patients Referred To Zahedan Educational Hospitals. Zahedan Journal of Research in Medical Sciences. 17 (8).
Sharma, P.C., Jain, A., Jain, S. (2009). Fluoroquinolone Antibacterials: A Review on Chemistry, Microbiology and Therapeutic Prospects. Acta Pol Pharm. 66 (6), 587-604.
Shon, A.S., Bajwa, R.P., Russo, T.A. (2013). Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae: A New and Dangerous Breed. Virulence. 4 (2), 107118.
Standards for Microbiology Investigations (UK SMI) (2018). Motility Test. April, 2022, 4, Https://Www.Gov.Uk/Government/Collections/Standards-For-Microbiology-Investigations-Smi.
Stojowska-Swdrzyska. K., upkowska, A., Kuczyska-Winik, D., Laskowska, E. (2021). Antibiotic Heteroresistance in Klebsiella pneumoniae. International Journal of Molecular Sciences. 23 (1), 449.
The European Committee on Antimicrobial Susceptibility Testing (2021). Breakpoint Tables for Interpretation of Mics and Zone Diameters, Version 10.0., 1, 2022 Https://Www.Eucast.Org/Clinical_Breakpoints/.
Wang, G., Zhao, G., Chao, X., Xie, L., Wang, H. (2020). The Characteristic of Virulence, Biofilm and Antibiotic Resistance of Klebsiella pneumoniae. International Journal of Environmental Research and Public Health.17(17), 6278.
Wiener, E.S., Heil, E.L., Hynicka, L.M., Johnson, J.K. (2016). Are Fluoroquinolones Appropriate for The Treatment of Extended-Spectrum -Lactamase-Producing Gram-Negative Bacilli? The Journal of Pharmacy Technology. 32 (1), 1621.
World Health Organization (2017). WHO Publishes List Of Bacteria For Which New Antibiotics Are Urgently Needed [Cited 19 Marth 2022] Available From: https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed.
Yacouba, A., Olowo-Okere, A., Yunusa, I. Repurposing Of Antibiotics For Clinical Management Of COVID-19: A Narrative Review. Ann Clin Microbiol Antimicrob. 20 (1), 37.
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