Open AccessIncrease in the Prevalence of Resistance Determinants to Trimethoprim/Sulfamethoxazole in Clinical Stenotrophomonas maltophilia Isolates in China
Author(s) -
Lintao Hu,
Guosheng Chen,
Qinxiang Kong,
Liping Gao,
Xi Chen,
Ying Yan,
Jiabin Li
Publication year - 2016
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0157693
Subject(s) - sulfamethoxazole , biology , stenotrophomonas maltophilia , trimethoprim , microbiology and biotechnology , stenotrophomonas , integron , gene cassette , antibiotic resistance , genetics , antibiotics , bacteria , pseudomonas , pseudomonas aeruginosa
Aims This study was carried to reveal the genetic mechanisms of trimethoprim/sulfamethoxazole (SXT) resistance. Methods Among 300 clinical Stenotrophomonas maltophilia isolates from China, resistance determinants such as sul and dfrA genes, integrons and transposase were examined using PCR, DNA sequencing and thermal asymmetric interlaced PCR (TAIL-PCR). Data were analyzed using SPSS 20.0. Results Of the 300 isolates, 116 (38.7%) were resistant to SXT. An alarming trend of increased resistance to SXT were found over the 10-year period. The positive rates of sul and class 1 integrase ( intI1 ) increased gradually with the development of SXT resistance over the 10-year period. Multiple logistic regression analyses indicated that the genes of qacEΔ1-sul1 (81% vs 46.2%, p = 0.000), sul2 (50.9% vs 9.8%, p = 0.000), intI1 (83.6% vs 65.8%, p = 0.000), dfrA12 (25% vs 3.3%, p = 0.000), dfrA17 (15.5% vs 3.8%, p = 0.000) and dfrA27 (4.3% vs 1.6%, p = 0.01) were more prevalent in SXT-resistant isolates than SXT-susceptible isolates except dfrA1 ( p = 0.83) and dfrA5 ( p = 0.18). Sequencing data revealed 12 types of resistance gene cassettes ( aar-3 - dfrA27 , dfrA12 – aadA2 , dfrA17 – aadA5 , cmlA1 , aacA4 , aadA5 , arr-3-aacA4 , aadA1 , aadB–aadA4 , aacA4 – catB8 – aadA1 , aadB – aac(6 ′ )-II – bla CARB-8 and aac(6 ′ )-II – bla CARB-8 ) located in the class 1 integron in 163 isolates (87% SXT-resistant vs 33.7% SXT-susceptible isolates, p = 0.000). A novel finding was the aar-3 - dfrA27 (KC748137) gene cassette. The gene of sul2 linked to transposase in 50 SXT- resistant and 7 SXT- susceptible isolates was detected by TAIL-PCR. Conclusions The findings demonstrated a higher prevalence of sul , dfrA , intI1 and resistance gene cassettes in class 1 integron in SXT-resistant clinical S . maltophilia isolates in China. The sul1 and dfrA genes located in integrons and the sul2 linked to transposase may imply wide and rapid dissemination of resistance gene in bacteria.