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Background  Quinolone resistance in  Enterobacteriaceae  results mainly from mutations in type II DNA topoisomerase genes and/or changes in the expression of outer membrane and efflux pumps. Several recent studies have indicated that plasmid-mediated resistance mechanisms also play a significant role in fluoroquinolone resistance, and its prevalence is increasing worldwide. In China, the presence of the  qnr  gene in the clinical isolates of  Enterobacteriaceae  has been reported, but this transmissible quinolone resistance gene has not been detected in strains isolated singly from pediatric patients. Because quinolones associated with a variety of adverse side effects on children, they are not authorized for pediatric use. This study therefore aimed to investigate the presence of the  qnr  gene in clinical isolates of  E. coli  and  K. pneumoniae  from pediatric patients in China.    Methods  A total 213 of non-repetitive clinical isolates resistant to ciprofloxacin from  E. coli  and  K. pneumoniae  were collected from hospitalized patients at five children's hospital in Beijing, Shanghai, Guangzhou, and Chongqing. The isolates were screened for the plasmid-mediated quinolone resistance genes of  qnrA ,  qnrB , and  qnrS  by PCR. Transferability was examined by conjugation with the sodium azide-resistant  E. coli  J53. All  qnr -positive were analyzed for clonality by enterobacterial repetitive intergenic consensus (ERIC)-PCR.    Results  The study found that 19 ciprofloxacin-resistant clinical isolates of  E. coli  and  K. pneumoniae  were positive for the  qnr  gene, and most of the  qnr  positive strains were ESBL producers. Conjugation experiments showed that quinolone resitance could be transferred to recipients. Apart from this, different DNA banding patterns were obtained by ERIC-PCR from positive strains, which means that most of them were not clonally related.    Conclusion  This report on transferable fluoroquinolone resistance due to the  qnr  gene among  E. coli  and  K. pneumoniae  strains indicated that plasmid-mediated quinolone resistance has emerged in pediatric patients in China.

Presence of qnr gene in Escherichia coli and Klebsiella pneumoniae resistant to ciprofloxacin isolated from pediatric patients in China