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Plasmid-mediated quinolone resistance in Enterobacteriaceae: a systematic review with a focus on Mediterranean
B Yanat1,2, J-M Rodríguez-Martínez2,3, A Touati4
1Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, 06000, Bejaia, Algeria.
Abstract:
Quinolones are a family of synthetic broad-spectrum antimicrobial drugs. These molecules have been widely prescribed to treat various infectious diseases and have been classified into several generations based on their spectrum of activity. Quinolones inhibit bacterial DNA synthesis by interfering with the action of DNA gyrase and topoisomerase IV. Mutations in the genes encoding these targets are the most common mechanisms of high-level fluoroquinolone resistance. Moreover, three mechanisms for plasmid-mediated quinolone resistance (PMQR) have been discovered since 1998 and include Qnr proteins, the aminoglycoside acetyltransferase AAC(6')-Ib-cr, and plasmid-mediated efflux pumps QepA and OqxAB. Plasmids with these mechanisms often encode additional antimicrobial resistance (extended spectrum beta-lactamases [ESBLs] and plasmidic AmpC [pAmpC] ß-lactamases) and can transfer multidrug resistance. The PMQR determinants are disseminated in Mediterranean countries with prevalence relatively high depending on the sources and the regions, highlighting the necessity of long-term surveillance for the future monitoring of trends in the occurrence of PMQR genes.
Insights
Fluoroquinolone resistance emerges from target mutations and plasmid-mediated mechanisms like Qnr proteins. Monitoring these plasmid-mediated quinolone resistance (PMQR) genes in Mediterranean countries is crucial due to their high prevalence and association with multidrug resistance.
Area of Science:
- Microbiology
- Pharmacology
- Genetics
Background:
- Quinolones are broad-spectrum synthetic antimicrobials used for infectious diseases.
- They function by inhibiting bacterial DNA gyrase and topoisomerase IV, essential for DNA synthesis.
- Resistance often arises from mutations in these target genes.
Purpose of the Study:
- To review the mechanisms of quinolone resistance, focusing on plasmid-mediated quinolone resistance (PMQR).
- To highlight the prevalence and dissemination of PMQR determinants in Mediterranean countries.
- To emphasize the need for ongoing surveillance of PMQR genes.
Main Methods:
- Literature review of quinolone resistance mechanisms.
- Analysis of reported prevalence data for PMQR determinants in Mediterranean regions.
- Discussion of the genetic basis of PMQR and associated resistance genes.
Main Results:
- High-level fluoroquinolone resistance is commonly linked to target gene mutations.
- Three main PMQR mechanisms (Qnr proteins, AAC(6')-Ib-cr, QepA/OqxAB efflux pumps) have been identified.
- PMQR determinants are prevalent in Mediterranean countries and often co-occur with other resistance genes (ESBLs, pAmpC), facilitating multidrug resistance spread.
Conclusions:
- Plasmid-mediated quinolone resistance poses a significant threat due to its association with multidrug resistance.
- The dissemination of PMQR genes in Mediterranean countries necessitates continuous surveillance.
- Long-term monitoring is essential for understanding and managing trends in PMQR gene occurrence.
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