The molecular mechanisms of fluoroquinolone resistance found in rectal swab isolates of Enterobacterales from men undergoing a transrectal prostate biopsy: the rationale for targeted prophylaxis.

Autor: Piekarska K; Department of Bacteriology, National Institute of Public Health NIH - National Research Institute, Chocimska 24, 00-791, Warsaw, Poland. kpiekarska@pzh.gov.pl., Zacharczuk K; Department of Bacteriology, National Institute of Public Health NIH - National Research Institute, Chocimska 24, 00-791, Warsaw, Poland., Wołkowicz T; Department of Bacteriology, National Institute of Public Health NIH - National Research Institute, Chocimska 24, 00-791, Warsaw, Poland., Mokrzyś M; Department of Urology, St. Anna Hospital, A. Mickiewicza 39, 05-500, Piaseczno, Poland.; Department of Urology, Centre of Postgraduate Medical Education, 01-813, Warsaw, Poland., Wolaniuk N; Department of Bacteriology, National Institute of Public Health NIH - National Research Institute, Chocimska 24, 00-791, Warsaw, Poland., Nowakowska M; Department of Bacteriology, National Institute of Public Health NIH - National Research Institute, Chocimska 24, 00-791, Warsaw, Poland., Szempliński S; Department of Urology, Centre of Postgraduate Medical Education, 01-813, Warsaw, Poland., Dobruch J; Department of Urology, St. Anna Hospital, A. Mickiewicza 39, 05-500, Piaseczno, Poland.; Department of Urology, Centre of Postgraduate Medical Education, 01-813, Warsaw, Poland., Gierczyński R; Department of Bacteriology, National Institute of Public Health NIH - National Research Institute, Chocimska 24, 00-791, Warsaw, Poland.
Jazyk: angličtina
Zdroj: Annals of clinical microbiology and antimicrobials [Ann Clin Microbiol Antimicrob] 2021 Dec 07; Vol. 20 (1), pp. 81. Date of Electronic Publication: 2021 Dec 07.
DOI: 10.1186/s12941-021-00487-y
Abstrakt: Background: Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) is considered an essential urological procedure for the histological diagnosis of prostate cancer. It is, however, considered a "contaminated" procedure which may lead to infectious complications. Recent studies suggest a significant share of fluoroquinolone-resistant rectal flora in post-biopsy infections.
Methods: The molecular mechanisms of fluoroquinolone resistance, including PMQR (plasmid-mediated quinolone resistance) as well as mutation in the QRDRs (quinolone-resistance determining regions) of gyrA, gyrB, parC and parE, among Enterobacterales isolated from 32 of 48 men undergoing a prostate biopsy between November 2015 and April 2016 were investigated. Before the TRUS-Bx procedure, all the patients received an oral antibiotic containing fluoroquinolones.
Results: In total, 41 Enterobacterales isolates were obtained from rectal swabs. The MIC of ciprofloxacin and the presence of common PMQR determinants were investigated in all the isolates. Nine (21.9%) isolates carried PMQR with qnrS as the only PMQR agent detected. DNA sequencing of the QRDRs in 18 Enterobacterales (E. coli n = 17 and E. cloacae n = 1) isolates with ciprofloxacin MIC ≥ 0.25 mg/l were performed. Substitutions in the following codons were found: GyrA-83 [Ser → Leu, Phe] and 87 [Asp → Asn]; GyrB codon-605 [Met → Leu], ParC codons-80 [Ser → Ile, Arg] and 84 [Glu → Gly, Met, Val, Lys], ParE codons-458 [Ser → Ala], 461 [Glu → Ala] and 512 [Ala → Thr]. Six isolates with ciprofloxacin MIC ≥ 2 mg/l had at least one mutation in GyrA together with qnrS.
Conclusions: This study provides information on the common presence of PMQRs among Enterobacterales isolates with ciprofloxacin MIC ≥ 0.25 mg/l, obtained from men undergoing TRUS-Bx. This fact may partially explain why some men develop post-TRUS-Bx infections despite ciprofloxacin prophylaxis.
(© 2021. The Author(s).)
Databáze: MEDLINE
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