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A new QepA4 variant was detected in an O86:H28 ST156- fimH38 Escherichia coli , showing a multidrug-resistance phenotype. PAβN inhibition of  qepA4- harboring transconjugant resulted in increase of nalidixic acid accumulation. The  qepA4  and  catA1  genes were clustered in a 26.0-kp contig matching an IncF-type plasmid, and containing a Tn21-type transposon with multiple mobile genetic elements. This QepA variant is worrisome because these determinants might facilitate the selection of higher-level resistance mutants, playing a role in the development of resistance, and/or confer higher-level resistance to fluoroquinolones in association with chromosomal mutations.

Genetic Background and Expression of the New qepA4 Gene Variant Recovered in Clinical TEM-1- and CMY-2-Producing Escherichia coli