Detection Of Plasmid Mediated Quinolone Resistance Among Isolates From Cirrhotic Patients With Spontaneous Bacterial Peritonitis In A University Hospital
European Journal of Molecular & Clinical Medicine,
2020, Volume 7, Issue 6, Pages 2068-2081
AbstractIntroduction:Spontaneous bacterial peritonitis in advanced liver cirrhosis and its treatment have a global burden in healthcare management especially in our locality. Fluoroquinolones are widely used as prophylaxis in that group of patients. Data concerning the prevalence of PMQR determinants in SBP are quite limited.
Purpose: To study prevalence of PMQR determinants in isolates from ascetic fluid of cirrhoticpatients with SBP and the relation to ESBL production.
Patients and Methods:Ascetic fluid culture was performed; Identification and antimicrobial susceptibility of isolates weredone by conventional methods. FQ resistant isolate are subjected to double disc synergy test for phenotypic detection of ESBL and Polymerase chain reaction for detection of PMQR determinants.
Results:Among total of145 Ecoli, 21 Klebsiella pneumonia and 31 gram positive cocci,we found that 70 Ecoli (48.2%), 10 K pneumonia (47.6%) and 10 (32.2%) Gram positive isolates were FQ-resistant. All tested FQ-Resistant Gram negative isolates (100%) harbored at least one of studied PMQR genes.acc6`-Ib-cr is most frequent (87.5%) followed by qnrS(81.2%), while qnrB frequency was 12.5% and qepAwas detected in 10% of gram negative bacilli. In Gram positive cocci 6 isolates showed PMQR (acc6`-Ib-cr&qnrSonly). A statistically significant association was found between ESBL producers and acc6`-Ib-cr gene, an association was also found with qnrS gene.
Conclusion:PMQR determinants and ESBLs prevalence is high among FQ-resistant isolates from acetic fluid of cirrhotic patients diagnosed with spontaneous bacterial peritonitis. The PMQR genes and their association with ESBL-producing plasmids have a great effect on multidrug resistance spread, thusmight lead to serious problems. Judicious use of quinolones as prophylaxis in SBP patients is essential.
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