Enterobacter cloacae outbreak and emergence of quinolone resistance gene in Dutch hospital

• Published in: Emerging infectious diseases Vol. 12; no. 5; pp. 807 - 812
• Main Authors: Paauw, Armand, Fluit, Ad C, Verhoef, Jan, Leverstein-van Hall, Maurine A
• Format: Journal Article
• Language: English
• Published: United States U.S. National Center for Infectious Diseases 01-05-2006; Centers for Disease Control and Prevention
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Base Sequence; Cluster Analysis; Communicable Diseases, Emerging - epidemiology; Communicable Diseases, Emerging - genetics; Conjugation, Genetic; Disease Outbreaks; Dispatch; Drug Resistance, Bacterial - genetics; Electrophoresis, Gel, Pulsed-Field; Enterobacter; Enterobacter cloacae; Enterobacter cloacae - classification; Enterobacter cloacae - drug effects; Enterobacter cloacae - genetics; Enterobacteriaceae; Enterobacteriaceae infections; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - epidemiology; Epidemics; fluoroquinolones; Gene Amplification; Genetic aspects; Genotype; Humans; integron; Microbial Sensitivity Tests; Molecular Sequence Data; Netherlands; Netherlands - epidemiology; Phylogeny; plasmid-mediated; Plasmids; qnr; qnrA; Quinolones - pharmacology; Species Specificity; Netherlands
• ISSN: 1080-6040; 1080-6059
• DOI: 10.3201/eid1205.050910

An outbreak of Enterobacter cloacae infections with variable susceptibility to fluoroquinolones occurred in the University Medical Center Utrecht in the Netherlands in 2002. Our investigation showed that a qnrA1 gene was present in 78 (94%) of 83 outbreak isolates and that a qnrA1-encoding plasmid transferred to other strains of the same species and other species. The earliest isolate carrying this same plasmid was isolated in 1999. qnrA1 was located in a complex integron consisting of the intI1, aadB, qacEDelta1, sul1, orf513, qnrA1, ampR, qacEDelta1, and sul1 genes that were not described previously. On the same plasmid, 2 other class 1 integrons were present. One was a new integron associated with the bla(CTX-M-9) extended-spectrum beta-lactamase.