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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 23, Issue 3, Pages e60-e64
Original Article

Mechanisms of Reduced Susceptibility to Ciprofloxacin in Escherichia coli Isolates from Canadian Hospitals

Patricia J Baudry-Simner,1,2 Amanpreet Singh,1 James A Karlowsky,1,2 Daryl J Hoban,1,2 George G Zhanel,1,2 and Canadian Antimicrobial Resistance Alliance

1Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Canada
2Department of Clinical Microbiology, Health Sciences Centre, Winnipeg, Manitoba, Canada

Copyright © 2012 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


OBJECTIVE: To determine whether plasmid-mediated quinolone resistance (PMQR) determinants play a role in the increasing resistance to fluoroquinolones among Escherichia coli isolates in Canadian hospitals, and to determine the mechanisms of reduced susceptibility to ciprofloxacin in a recent collection of 190 clinical E coli isolates.

METHODS: E coli isolates (n=1702) were collected as part of the 2007 Canadian Hospital Ward Antibiotic Resistance Surveillance (CANWARD) study. Antimicrobial susceptibility testing was performed by Clinical and Laboratory Standards Institute (CLSI) broth microdilution. Using a representative subset of isolates (n=190), the mechanisms of reduced susceptibility to ciprofloxacin were detected by polymerase chain reaction and sequencing of the quinolone resistance-determining regions (QRDR) of chromosomal gyrA and parC genes, and by polymerase chain reaction for the PMQR genes: qnr, aac(6) Ib-cr and qepA.

RESULTS: 2.1% and 1.1% of E coli harboured aac(6)Ib-cr and qnrB, respectively. Single amino acid substitutions in the QRDR of gyrA were observed among isolates with ciprofloxacin minimum inhibitory concentrations as low as 0.12 μg/mL. As the ciprofloxacin minimum inhibitory concentration increased to 1 μg/mL (which is still considered to be susceptible by the CLSI), the vast majority of isolates demonstrated both gyrA and parC mutations.

CONCLUSION: PMQR determinants and QRDR mutants among clinical E coli isolates with reduced susceptibility to ciprofloxacin demonstrates the need for increased surveillance and the need to re-evaluate the current CLSI breakpoints to prevent further development of fluoroquinolone resistance.