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The purpose of this study was to determine the prevalence and molecular characterization of plasmid-mediated quinolone resistance (PMQR) genes ( qnrA, qnrB, qnrS, aac(6′)-Ib-cr , and  qepA ) among ESBL-producing  Klebsiella pneumoniae  isolates in Kashan, Iran. A total of 185  K. pneumoniae  isolates were tested for quinolone resistance and ESBL-producing using the disk diffusion method and double disk synergy (DDST) confirmatory test. ESBL-producing strains were further evaluated for the  bla   CTX-M  genes. The PCR method was used to show presence of plasmid-mediated quinolone resistance genes and the purified PCR products were sequenced. Eighty-seven ESBL-producing strains were identified by DDST confirmatory test and majority (70, 80.5%) of which carried  bla   CTX-M  genes including CTX-M-1 (60%), CTX-M-2 (42.9%), and CTX-M-9 (34.3%). Seventy-seven ESBL-producing  K. pneumoniae  isolates harbored PMQR genes, which mostly consisted of  aac(6′)-Ib-cr  (70.1%) and  qnrB  (46.0%), followed by  qnrS  (5.7%). Among the 77 PMQR-positive isolates, 27 (35.1%) and 1 (1.3%) carried 2 and 3 different PMQR genes, respectively. However,  qnrA  and  qepA  were not found in any isolate. Our results highlight high ESBL occurrence with CTX-M type and high frequency of plasmid-mediated quinolone resistance genes among ESBL-producing  K. pneumoniae  isolates in Kashan.

journal of pathogens

Prevalence of Plasmid-Mediated Quinolone Resistance Genes among Extended-Spectrumβ-Lactamase-ProducingKlebsiella pneumoniaeHuman Isolates in Iran