بررسی مقاومت به فلوروکینولون ها در کلبسیلا ایزوله های پنومونیه از بیماران مراجعه کننده به بیمارستان های وابسته به دانشگاه علوم پزشکی اردبیل، 1399-1400

عنوان انگليسی

Investigation of resistance to fluoroquinolones among Klebsiella pneumoniae isolates recovered from patients referred to hospitals affiliated to Ardabil University of Medical Sciences, 2020-2021

خلاصه انگلیسی

BACKGROUND AND OBJECTIVES Klebsiella pneumoniae is one of the important causes of nosocomial infection and leading causes of ventilator-associated pneumonia. Apart from pneumonia, this bacterium can cause a wide range of infections such as wound infection, cholecystitis, meningitis, septicemia, osteomyelitis, diarrhea, and urinary infection. Antibiotic resistance is one of the most important challenges in treating infections caused by bacteria, such as Klebsiella pneumoniae. This study was designed to investigate the antibiotic resistance of clinical isolates of Klebsiella pneumoniae to fluoroquinolones used to treat the disease in Ardabil hospitals. MATERIALS AND METHODS In this descriptive, cross-sectional study, 100 isolates of Klebsiella pneumoniae were recovered from patients referred to hospitals affiliated to Ardabil University of Medical Sciences between 2020-2021. Biochemical and molecular methods were used to identification of the isolates. The antibiotic resistance pattern was done using disc diffusion method based on CLSI guidelines. The minimum inhibitory concentration (MIC) of ciprofloxacin was determined by agar dilution method and mutations in gyrA and parC genes and the presence of resistance genes such as accA, qnr, and qepA were investigated using PCR method. RESULTS AND DISCUSSION In this study, 49% of the isolates were MDR strains, and the highest rate of resistance to cefazolin (66%) and cefotaxime (66%) was observed. Meropenem and amikacin with 76% and 69% sensitivity were the most effective antimicrobial agents against Klebsiella pneumoniae. accA resistance gene was detected in 10 isolates (10%), while qepA and qnr resistance genes were not observed in any of the isolates. The MIC range of ciprofloxacin was between 0.5 and above 1024, with 4 isolates having a MIC above 1024. These isolates were examined for mutations in gyrA and parC genes. In the investigation of mutation in gyrA, an amino acid substitution from serine to isoleucine was observed at position 83, while no mutation was observed in parC gene. CONCLUSION Ciprofloxacin is an effective drug against complicated urinary infections, pyelonephritis, wound infection, and respiratory infections. In this study, a high frequency of aac (6')-Ib-cr gene was reported. Since this gene is located on a plasmid, it can easily transfer between Klebsiella pneumoniae strains in hospital settings, leading to the spread of resistance to fluoroquinolones

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