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J Med Microbiol 53 (2004), 85-86; DOI: 10.1099/jmm.0.05339-0
© 2004 Society for General Microbiology
ISSN 0022-2615

Molecular epidemiology of emerging reduced susceptibility to fluoroquinolones in Escherichia coli

Feng-Jui Chen, Tsai-Ling Lauderdale, L. Clifford McDonald, Pei-Chen Chen, Hsiao-Chuan Yin, Monto Ho and Hsiu-Jung Lo

Division of Clinical Research, National Health Research Institutes, 128 Yen-Chiu-Yuan Rd, Sec. 2, Taipei 11529, Taiwan, ROC

Correspondence: Hsiu-Jung Lo (hjlo{at}nhri.org.tw)


The fluoroquinolones are potent antimicrobial agents used for the treatment of infections caused by Gram-negative organisms. With the increased use of quinolones, increasing incidences of ciprofloxacin resistance have been reported (Garau et al., 1999). We previously collected 1203 Escherichia coli isolates from 44 hospitals through Taiwan Surveillance of Antimicrobial Resistance I (TSAR I). Of these, 136 (11.3 %), 211 (17.5 %) and 856 (71.2 %) isolates were respectively resistant, reduced-susceptible and susceptible to ciprofloxacin, based upon demonstration of disk diffusion zones of inhibition (Chen et al., 2001; McDonald et al., 2001).

Restriction patterns of chromosomal DNA were analysed by pulsed-field gel electrophoresis (PFGE) to determine the relatedness of 63 E. coli isolates obtained from three hospitals in Taiwan. These isolates consisted of 9, 29 and 25 ciprofloxacin-resistant, -reduced-susceptible and -susceptible isolates, respectively. According to cluster analysis, there was no predominate clone among these 63 isolates and no close relatedness was found among resistant isolates. A total of seven groups (A–G) of isolates possessing more than 80 % relatedness (a difference of fewer than three bands) in DNA patterns were identified (Fig. 1). These seven genetically related groups consisted of 12 ciprofloxacin-reduced-susceptible isolates and four susceptible isolates. All groups consisted of two isolates except group C, which consisted of four isolates. There were three groups (groups B, C and F) with distinct, indistinguishable DNA patterns, and no direct or epidemiological linkage among them could be demonstrated. Group C consisted of four ciprofloxacin-reduced-susceptible strains that were isolated from four outpatients at the same hospital with a greater than 90 % relatedness (a difference of fewer than two bands). Two of these isolates had the same DNA patterns and antibiograms. Two reduced-susceptible isolates (strains 0816 and 0886) of group D also had greater than 90 % relatedness and similar antibiograms and were isolated 1 month apart from two outpatients at the same hospital.



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  		Fig. 1. Dendrogram of 63 clinical E. coli isolates based on PFGE results. Strains were clustered by UPGMA. Correlation: Bands, Jaccard (tolerance 1.0 %, optimization value 0.5 %, minimal surface area of a band 0.0 %). Susceptibility of strains to ciprofloxacin is indicated by R (resistant), S (susceptible) or RS (reduced susceptible).

 

The potential for food-borne transmission of resistance in E. coli and Salmonella enterica serotype Choleraesuis has been reported (Chiu et al., 2002; Garau et al., 1999). Moreover, McDonald et al. (2000) found that a large proportion of retail chicken carcasses purchased in markets in Taiwan were contaminated with E. coli having reduced susceptibility to fluoroquinolones. Our finding of close relatedness in fluoroquinolone-reduced-susceptible isolates but not in resistant isolates supports the hypothesis that frequent exposure of humans to common clones of bacteria possessing reduced susceptibility to fluoroquinolone in the food supply may be another route of transmission among outpatients.


   References
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 References
 

  • Chen, F. J., McDonald, L. C., Ho, M. & Lo, H. J. (2001). Identification of reduced fluoroquinolone susceptibility in Escherichia coli: a herald for emerging resistance. J Antimicrob Chemother 48, 936–938.[Free Full Text]

  • Chiu, C. H., Wu, T. L., Su, L. H., Chu, C., Chia, J. H., Kuo, A. J., Chien, M. S. & Lin, T. Y. (2002). The emergence in Taiwan of fluoroquinolone resistance in Salmonella enterica serotype choleraesuis. N Engl J Med 346, 413–419.[Abstract/Free Full Text]

  • Garau, J., Xercavins, M., Rodriguez-Carballeira, M., Gomez-Vera, J. R., Coll, I., Vidal, D., Llovet, T. & Ruiz-Bremon, A. (1999). Emergence and dissemination of quinolone-resistant Escherichia coli in the community. Antimicrob Agents Chemother 43, 2736–2741.[Abstract/Free Full Text]

  • McDonald, L. C., Lauderdale, T. L. & Ho, M. (2000). Reduced susceptibility to fluoroquinolones of E. coli and Salmonella spp. isolated from retail chicken carcasses and emerging human resistance in Taiwan. In Abstracts of the 100th General Meeting of the American Society for Microbiology, Los Angeles, CA, p. 682, abstract Y-7.

  • McDonald, L. C., Chen, F. J., Lo, H. J., Yin, H. C., Lu, P. L., Huang, C. H., Chen, P., Lauderdale, T. L. & Ho, M. (2001). Emergence of reduced susceptibility and resistance to fluoroquinolones in Escherichia coli in Taiwan and contributions of distinct selective pressures. Antimicrob Agents Chemother 45, 3084–3091.[Abstract/Free Full Text]




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