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Background   Klebsiella pneumoniae  is one of the most important opportunistic pathogens causing serious complications in patients in hospitals and community. The clinical significance of  K. pneumoniae  is mainly due to its ability to acquire multiple antibiotic resistance genes. In this study we report the findings of a survey of plasmid mediated quinolone resistance in Extended-Spectrum β-lactamase (ESBL)-producing  K. pneumoniae  in Kuwait.    Methods  Clinical samples were collected from the microbiology laboratories of three major hospitals. Isolates were confirmed as ESBL-producers by disc diffusion method and PCR for the presence of  bla  genes. Antimicrobial susceptibility testing and genetic analysis were performed to detect the presence of a number of genes conferring resistance to β-lactam and fluoroquinolone antimicrobial agents including  bla  SHV ,  bla  TEM ,  aac  (6')- Ib-cr ,  qnrA ,  qnrB  and  qnrS . Pulsed-field gel electrophoresis (PFGE) was used for typing the isolates.    Results  In total 173 ESBL-producing  K. pneumoniae  were detected.  qnr  genes were identified in 27 (15.6 %) isolates and  aac(6′)-Ib Ib-cr  gene in 26 (96 %). One (3.7 %) contained  qnrA 2, 21 harbored  qnrB 1 (78 %) and 5 (18.5 %) contained  qnrS . Twenty one (78 %) isolates contained all three  bla  genes. PFGE showed diverse profiles.    Conclusion  We identified for the first time the emergence of the mobile fluoroquinolone resistance  qnrA 2 in a clinical isolate in the middle east and also showed the dissemination of  aac  (6')- Ib-cr ,  qnr B, and  qnr S genes among ESBL-producing  K. pneumoniae  in Kuwait. The abundance of plasmid mediated resistance to fluoroquinolones among ESBL-producing  K. pneumoniae  is alarming as it facilitates therapy failure. Preventing the spread of these isolates is crucial if we are to sustain the effectiveness of the limited choices we have left in antimicrobial therapy.

The emergence of plasmid mediated quinolone resistance qnrA2 in extended spectrum β-lactamase producing Klebsiella pneumoniae in the Middle East