Prevalence of Plasmid-Mediated Quinolone Resistance Genes in Pseudomonas aeruginosa Clinical Strains in Northwest Iran

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Nazari Maryam; Saeli Nilofar; Arzanlou Mohsen; Jafari Ramedani Saghar; Mirzanejad Asl Hafez; Khademi Farzad; Alinezhad Aida

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Journal: Journal of Ardabil University of Medical Sciences Year:2024 | Volume: | Issue: Page(s): 46-57

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Title

Prevalence of Plasmid-Mediated Quinolone Resistance Genes in Pseudomonas aeruginosa Clinical Strains in Northwest Iran

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Keywords

Pseudomonas aeruginosaQ4

PlasmidQ4

Abstract

2Background: Antibiotic resistance represents a critical global concern within the medical community, posing significant challenges in the treatment of infections caused by drug-resistant pathogens. Over the years, broad-spectrum fluoroquinolones have been extensively used to treat infections caused by both Gram-positive and Gram-negative bacteria, including Pseudomonas aeruginosa. In this study, we decided to assess the prevalence of Plasmid-mediated quinolone resistance mechanisms among clinical isolates of P. aeruginosa in Ardabil hospitals. Methods: We analyzed a total of 200 clinical isolates of P. aeruginosa, collected between June 2019 and May 2023. The antibiotic resistance profiles of these strains against various fluoroquinolone antibiotics were determined using the disk diffusion method. Additionally, we investigated the presence of qnrA, qnrB, qnrC, qnrD, and qnrS genes through polymerase chain reaction (PCR) analysis. Furthermore, we assessed the expression levels of efflux pump genes and outer membrane porin genes using the quantitative reverse transcription PCR (qRT-PCR) in fluoroquinolone-resistant P. aeruginosa strains. Results: Our findings revealed that 69% of P. aeruginosa strains were resistant to fluoroquinolones. The resistance rates for different fluoroquinolones were as follows: ciprofloxacin 55.5%, ofloxacin 62%, norfloxacin 53.5%, lomefloxacin 55.3%, and levofloxacin 55.5%. Notably, 78.9% of these strains exhibited multidrug resistance (MDR). Among the qnr genes, qnrB was the most prevalent (2.9%). No other qnr genes were identified. Interestingly, 75% of P. aeruginosa strains carrying the qnrB gene showed overexpression of efflux pump genes, while 100% exhibited down-regulation of the oprD gene. Conclusion: Given the high prevalence of fluoroquinolone-resistant P. aeruginosa clinical isolates in Ardabil hospitals and the multifactorial nature of resistance, continuous monitoring of antibiotic resistance trends and understanding the underlying resistance mechanisms are crucial for selecting appropriate treatment strategies.

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