Background: Klebsiella pneumoniae is one of the most important opportunistic pathogens causing serious complications\nin patients in hospitals and community. The clinical significance of K. pneumoniae is mainly due to its ability to acquire\nmultiple antibiotic resistance genes. In this study we report the findings of a survey of plasmid mediated quinolone\nresistance in Extended-Spectrum �²-lactamase (ESBL)-producing K. pneumoniae in Kuwait.\nMethods: Clinical samples were collected from the microbiology laboratories of three major hospitals. Isolates were\nconfirmed as ESBL-producers by disc diffusion method and PCR for the presence of bla genes. Antimicrobial\nsusceptibility testing and genetic analysis were performed to detect the presence of a number of genes conferring\nresistance to �²-lactam and fluoroquinolone antimicrobial agents including blaSHV, blaTEM, aac (6')-Ib-cr, qnrA, qnr B\nand qnrS. Pulsed-field gel electrophoresis (PFGE) was used for typing the isolates.\nResults: In total 173 ESBL-producing K. pneumoniae were detected. qnr genes were identified in 27 (15.6 %) isolates and\naac(6â�²)-Ib Ib-cr gene in 26 (96 %). One (3.7 %) contained qnr A2, 21 harbored qn rB1 (78 %) and 5 (18.5 %) contained qnrS.\nTwenty one (78 %) isolates contained all three bla genes. PFGE showed diverse profiles.\nConclusion: We identified for the first time the emergence of the mobile fluoroquinolone resistance qnr A2 in a clinical\nisolate in the middle east and also showed the dissemination of aac (6')-Ib-cr, qnr B, and qnrS genes among\nESBL-producing K. pneumoniae in Kuwait. The abundance of plasmid mediated resistance to fluoroquinolones\namong ESBL-producing K. pneumoniae is alarming as it facilitates therapy failure. Preventing the spread of these\nisolates is crucial if we are to sustain the effectiveness of the limited choices we have left in antimicrobial therapy.
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