The cyclohexane tolerance and Phe-Arg-β-naphtylamide susceptibility of multidrug-resistant Enterobacter cloacae clinical isolates, and the predominance of one PFGE clone in Hungary

K. Glatz, A. Tóth, J. Pászti

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4 Citations (Scopus)

Abstract

The report concerns the molecular epidemiology, cyclohexane tolerance and Phe-Arg-β-naphtylamide (PAβN) susceptibility of multidrug-resistant Enterobacter cloacae isolates, with high-level fluoroquinolone resistance collected from healthcare facilities in a nationwide survey. A total of 113 multidrug-resistant E. cloacae isolates (recovered in 1997-2005) were subjected to disc diffusion tests, ERIC-PCR and XbaI PFGE. Representatives of the ERIC-types (n=67) were tested further with cyclohexane and PAβN, using ciprofloxacin as the substrate. Forty-four per cent of the isolates were derived from the urinary tract, 19% from the bloodstream, 17% from the respiratory tract, and 15% from wound infections. Four ERIC-types (A, B, C and D) were distinguished, but 109 isolates were found to belong to a single, epidemic ERIC type: A. PFGE results suggested that the epidemic-type isolates were of monoclonal origin. Forty-two patients were involved in four outbreaks caused by the epidemic-type strains. Eighty-one cases were found to be nosocomial. At least fourfold reduction in ciprofloxacin MICs was found in the presence of PAβN in 79% of representative isolates (representing types A, C and D); an eightfold or greater reduction in ciprofloxacin MICs in the presence of PAβN (PAβN+) was found in 37% of representative isolates, representing types A and C. Eighty-five per cent of the representative isolates were found to be cyclohexane-tolerant, representing types A, C and D. This is the first report of a wide distribution of cyclohexane-tolerant or PAβN+ strains of E. cloacae. These feature-indicators of adaptive mechanisms that help bacteria to survive in hospital wards may have contributed to the nationwide spread of type A strains.

Original languageEnglish
Pages (from-to)1254-1261
Number of pages8
JournalClinical Microbiology and Infection
Volume17
Issue number8
DOIs
Publication statusPublished - Aug 2011

Fingerprint

phenylalanylarginine
Enterobacter cloacae
Hungary
Clone Cells
Ciprofloxacin
Molecular Epidemiology
Fluoroquinolones
Wound Infection
Urinary Tract
Respiratory System
Disease Outbreaks
Cyclohexane
Bacteria
Delivery of Health Care
Polymerase Chain Reaction

Keywords

  • Cyclohexane tolerance
  • Enterobacter cloacae
  • ESBL
  • Molecular epidemiology
  • Multidrug resistance

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

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title = "The cyclohexane tolerance and Phe-Arg-β-naphtylamide susceptibility of multidrug-resistant Enterobacter cloacae clinical isolates, and the predominance of one PFGE clone in Hungary",
abstract = "The report concerns the molecular epidemiology, cyclohexane tolerance and Phe-Arg-β-naphtylamide (PAβN) susceptibility of multidrug-resistant Enterobacter cloacae isolates, with high-level fluoroquinolone resistance collected from healthcare facilities in a nationwide survey. A total of 113 multidrug-resistant E. cloacae isolates (recovered in 1997-2005) were subjected to disc diffusion tests, ERIC-PCR and XbaI PFGE. Representatives of the ERIC-types (n=67) were tested further with cyclohexane and PAβN, using ciprofloxacin as the substrate. Forty-four per cent of the isolates were derived from the urinary tract, 19{\%} from the bloodstream, 17{\%} from the respiratory tract, and 15{\%} from wound infections. Four ERIC-types (A, B, C and D) were distinguished, but 109 isolates were found to belong to a single, epidemic ERIC type: A. PFGE results suggested that the epidemic-type isolates were of monoclonal origin. Forty-two patients were involved in four outbreaks caused by the epidemic-type strains. Eighty-one cases were found to be nosocomial. At least fourfold reduction in ciprofloxacin MICs was found in the presence of PAβN in 79{\%} of representative isolates (representing types A, C and D); an eightfold or greater reduction in ciprofloxacin MICs in the presence of PAβN (PAβN+) was found in 37{\%} of representative isolates, representing types A and C. Eighty-five per cent of the representative isolates were found to be cyclohexane-tolerant, representing types A, C and D. This is the first report of a wide distribution of cyclohexane-tolerant or PAβN+ strains of E. cloacae. These feature-indicators of adaptive mechanisms that help bacteria to survive in hospital wards may have contributed to the nationwide spread of type A strains.",
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AB - The report concerns the molecular epidemiology, cyclohexane tolerance and Phe-Arg-β-naphtylamide (PAβN) susceptibility of multidrug-resistant Enterobacter cloacae isolates, with high-level fluoroquinolone resistance collected from healthcare facilities in a nationwide survey. A total of 113 multidrug-resistant E. cloacae isolates (recovered in 1997-2005) were subjected to disc diffusion tests, ERIC-PCR and XbaI PFGE. Representatives of the ERIC-types (n=67) were tested further with cyclohexane and PAβN, using ciprofloxacin as the substrate. Forty-four per cent of the isolates were derived from the urinary tract, 19% from the bloodstream, 17% from the respiratory tract, and 15% from wound infections. Four ERIC-types (A, B, C and D) were distinguished, but 109 isolates were found to belong to a single, epidemic ERIC type: A. PFGE results suggested that the epidemic-type isolates were of monoclonal origin. Forty-two patients were involved in four outbreaks caused by the epidemic-type strains. Eighty-one cases were found to be nosocomial. At least fourfold reduction in ciprofloxacin MICs was found in the presence of PAβN in 79% of representative isolates (representing types A, C and D); an eightfold or greater reduction in ciprofloxacin MICs in the presence of PAβN (PAβN+) was found in 37% of representative isolates, representing types A and C. Eighty-five per cent of the representative isolates were found to be cyclohexane-tolerant, representing types A, C and D. This is the first report of a wide distribution of cyclohexane-tolerant or PAβN+ strains of E. cloacae. These feature-indicators of adaptive mechanisms that help bacteria to survive in hospital wards may have contributed to the nationwide spread of type A strains.

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