PHENOTYPIC AND GENOTYPIC CHARACTERIZATION OF FLUOROQUINOLONE DRUG RESISTANCE AMONG STAPHYLOCOCCUS AUREUS IN A TERTIARY CARE HOSPITAL

  • SHELINA NAMEIRAKPAM Department of Microbiology, Saveetha Medical College, Chennai, Tamil Nadu, India.
  • UMA MAGESWARI SSM Department of Microbiology, Saveetha Medical College, Chennai, Tamil Nadu, India.
  • KALYANI M Department of Microbiology, Saveetha Medical College, Chennai, Tamil Nadu, India.

Abstract

Objective: The objective of the study was to determine whether recent use of topical fluoroquinolones is a risk factor for in vitro fluoroquinolone resistance in Staphylococcus aureus ocular isolates. Fluoroquinolone antibiotics such as ciprofloxacin (CIP) are useful drugs against infections caused by Staphylococcus aureus and mutations in deoxyribonucleic acid (DNA) gyrase which control bacterial DNA topology, can be one of the reasons of occurrence resistance to this class of antibiotics. Therefore, finding new mutations and study of the quinolone interaction with mutated GyrA can provide important issues for explanation resistance.


Methods: Bacterial identification was confirmed by appropriate morphological, cultural, and biochemical tests. The antibiotic susceptibility pattern was determined for all isolates. The possible involvement of efflux pumps in mediating fluoroquinolone resistance as well as changes in the quinolone resistance-determining region (QRDR) of gyrA gene was investigated.


Results: Differences in methicillin resistance among staphylococci were observed based on patient age, with higher rates observed in older patients (p<0.0001). Out of 91 isolates, 77 (84.61%) were resistant to CIP and 47 (51.65%) were resistant to ofloxacin (OF). Confirmation with agar dilution test showed that 57 samples were resistant to CIP, 38 samples were resistant to OF, and 29 samples were resistant to both CIP and OF. By polymerase chain reaction (PCR) testing, gyrA genes in resistance strains were amplified. All the five resistant isolates were found to be positive for the presence of a fluoroquinolones resistance gene (gyrA gene) and the two sensitive isolates were found to be negative. Resistance among CIP and OF in isolated harboring a mutation GyrA was of statistical significance among S. aureus (p<0.001).


Conclusion: The result of this study will be useful to update the antibiotic policy in our hospital set up and controlling the irrational use of antibiotics among health care workers. The information obtained will provide a baseline data that can be used to design further research for prevention of drug resistance caused by Staphylococcus aureus.

Keywords: Fluoroquinolones, Staphylococcus aureus, gyrA gene, Ciprofloxacin, Ofloxacin and polymerase chain reaction

References

1. Brumfitt W, Hamilton-Miller JM. The worldwide problem of methicillin-resistant Staphylococcus aureus. Drugs Exp Clin Res 1990;16:205-14.
2. Emaneini M, Taherikalani M, Eslampour MA, Sedaghat H, Aligholi M, Jabalameli F, et al. Phenotypic and genotypic evaluation of aminoglycoside resistance in clinical isolates of staphylococci in Tehran, Iran. Microb Drug Resist 2009;15:129-32.
3. Nicholas BD, Bhargave G, Hatipoglu A, Heffelfinger R, Rosen M, Pribitkin EA. Preoperative prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in patients undergoing intranasal surgery. Med Sci Monit 2010;16:CR365-8.
4. Chambers HF. Methicillin resistance in staphylococci: Molecular and biochemical basis and clinical implications. Clin Microbiol Rev 1997;10:781-91.
5. Hooper DC. Fluoroquinolone resistance among gram-positive cocci. Lancet Infect Dis 2002;2:530-8.
6. Schmitz FJ, Higgins PG, Mayer S, Fluit AC, Dalhoff A. Activity of quinolones against gram-positive cocci: Mechanisms of drug action and bacterial resistance. Eur J Clin Microbiol Infect Dis 2002;21:647-59.
7. Horii T, Suzuki Y, Takeshita A, Maekawa M. Molecular characterization of 8-methoxyfluoroquinolone resistance in a clinical isolate of methicillin-resistant Staphylococcus aureus. Chemotherapy 2007;53:104-9.
8. Tanaka M, Wang T, Onodera Y, Uchida Y, Sato K. Mechanism of quinolone resistance in Staphylococcus aureus. J Infect Chemother 2000;6:131-9.
9. Tanaka M, Onodera Y, Uchida Y, Sato K. Quinolone resistance mutations in the GrlB protein of Staphylococcus aureus. Antimicrob Agents Chemother 1998;42:3044-6.
10. Iihara H, Suzuki T, Kawamura Y, Ohkusu K, Inoue Y, Zhang W, et al. Emerging multiple mutations and high-level fluoroquinolone resistance in methicillin-resistant Staphylococcus aureus isolated from ocular infections. Diagn Microbiol Infect Dis 2006;56:297-303.
11. Noguchi N, Okihara T, Namiki Y, Kumaki Y, Yamanaka Y, Koyama M, et al. Susceptibility and resistance genes to fluoroquinolones in methicillin-resistant Staphylococcus aureus isolated in 2002. Int J Antimicrob Agents 2005;25:374-79.
12. Blumberg HM, Rimland D, Carroll DJ, Terry P, Wachsmuth IK. Rapid development of ciprofloxacin resistance in methicillin-susceptible and-resistant Staphylococcus aureus. J Infect Dis 1991;163:1279-85.
13. Mahon CR, Lehman DC, Manuselis G. Text Book of Diagnostic Microbiology. 3rd ed. Philadelphia, PA, USA: Saunders; 2007.
14. Bhooshan S, Prasad J, Dutta A, Ke V, Mukhopadhyay C. Reduced susceptibility of mrsa to vancomycin. Int J Pharm Pharm Sci 2016;8:321-2.
15. Fatholahzadeh B, Emaneini M, Gilbert G, Udo E, Aligholi M, Modarressi MH, et al. Staphylococcal cassette chromosome mec (SCCmec) analysis and antimicrobial susceptibility patterns of methicillin-resistant Staphylococcus aureus (MRSA) isolates in Tehran, Iran. Microb Drug Resist 2008;14:217-20.
16. Reisner SB, Woods GL, Thomson RP. Specimen collection. In: Murray PR, Baron EJ, Pfaller MA, editors. Manual of Clinical Microbiology. 7th ed. Washington, DC: American Society for Microbiology; 1999. p. 64-76.
17. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. Twenty-first Informational Supplement. United States: Clinical and Laboratory Standards Institute; 2011. p. 31.
18. Fatholahzadeh B, Emaneini M, Aligholi M, Gilbert G, Taherikalani M, Jonaidi N, et al. Molecular characterization of methicillin-resistant Staphylococcus aureus clones from a teaching hospital in Tehran. Jpn J Infect Dis 2009;62:309-11.
19. Horii T, Suzuki Y, Monji A, Morita M, Muramatsu H, Kondo Y, et al. Detection of mutations in quinolone resistance-determining regions in levofloxacin-and methicillin-resistant Staphylococcus aureus: Effects of the mutations on fluoroquinolone MICs. Diagn Microbiol Infect Dis 2003;46:139-45.
20. Schmitz FJ, Jones ME, Hofmann B, Hansen B, Scheuring S, Lückefahr M, et al. Characterization of grlA, grlB, gyrA, and gyrB mutations in 116 unrelated isolates of Staphylococcus aureus and effects of mutations on ciprofloxacin MIC. Antimicrob Agents Chemother 1998;42:1249-52.
21. Emaneini M, Aligholi M, Hashemi FB, Jabalameli F, Shahsavan S, Dabiri H, et al. Isolation of vancomycin resistant Staphylococcus aureus in a teaching hospital in Tehran. J Hosp Infect 2007;66:92-3.
22. Marangon FB, Miller D, Muallem MS, Romano AC, Alfonso EC. Ciprofloxacin and levofloxacin resistance among methicillin-sensitive Staphylococcus aureus isolates from keratitis and conjunctivitis. Am J Ophthalmol 2004;137:453-8.
23. Coskun-Ari FF, Bosgelmez-Tinaz G. grlA and gyrA mutations and antimicrobial susceptibility in clinical isolates of ciprofloxacin-methicillin resistant Staphylococcus aureus. Eur J Med Res 2008;13:366-70.
24. Takahata M, Yonezawa M, Kurose S, Futakuchi N, Matsubara N, Watanabe Y, et al. Mutations in the gyrA and grlA genes of quinolone-resistant clinical isolates of methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother 1996;38:543-6.
25. Yoon EJ, Lee CY, Shim MJ, Min YH, Kwon AR, Lee J, et al. Extended spectrum of quinolone resistance, even to a potential latter third-generation agent, as a result of a minimum of two GrlA and two GyrA alterations in quinolone-resistant Staphylococcus aureus. Chemotherapy 2010;56:153-7.
26. Wang T, Tanaka M, Sato K. Detection of grlA and gyrA mutations in 344 Staphylococcus aureus strains. Antimicrob Agents Chemother 1998;42:236-40.
27. Touaitia R, Bektache S, Boutefnouchet N, Djahoudi A, Bachtarzi M. Molecular characterization of methicillin-resistant Staphylococcus aureus isolated from clinical cases in east Algeria. Asian J Pharm Clin Res 2017;10:59-61.
Statistics
42 Views | 43 Downloads
Citatons
How to Cite
NAMEIRAKPAM, S., U. M. SSM, and K. M. “PHENOTYPIC AND GENOTYPIC CHARACTERIZATION OF FLUOROQUINOLONE DRUG RESISTANCE AMONG STAPHYLOCOCCUS AUREUS IN A TERTIARY CARE HOSPITAL”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 13, no. 8, May 2020, pp. 87-91, doi:10.22159/ajpcr.2020.v13i8.38033.
Section
Original Article(s)