Phenotypic and genotypic evaluation of fluoroquinolones resistance in Klebsiella pneumoniae isolates from urinary tract infections in Bojnourd city

Document Type : Research Paper


1 Mashhad Branch, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Mashhad, Iran.

2 Master of Bacteriology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran.


Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections, accounting for a significant proportion of hospital clients (about 30-40%). The emergence of resistance to cephalosporins, fluoroquinolones and trimethoprim-sulfamethoxazole which were often used to treat general and nosocomial infections, delayed effective treatment of these diseases and subsequently resulted in increased infections and mortality of patients.
Methods: In this study, 30 specimens of positive cultures of urinary tract infection which were referred to Imam Reza Hospital laboratory in Bojnourd were studied. The resistance and susceptibility of the isolates were determined by disc diffusion method. The presence of QnrA gen was assessed by molecular methods with specific primers.
Results: The phenotypic resistance of isolates to nalidixic acid, levofloxacin and ciprofloxacin were 43.33%, 26.66% and 40%, respectively. Also, genotypic analysis of the isolates showed 6.66% of the studied genes.
Conclusion: Based on the results of the present study, it can be said that resistance to antibiotics belonging to the fluoroquinolones is not yet widely high.


  1. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms
    of infection and treatment options. Nature Reviews Microbiology. 2015;13(5):269-84.
    2. Lin JC, Chang FY, Fung CP, Xu JZ, Cheng HP, Wang JJ, et al. High prevalence of phagocytic-resistant
    capsular serotypes of Klebsiella pneumoniae in liver abscess. Microbes Infect.2004;6(13):1191-8.
    3. shikh-bardsiri H, shakibaie MR. Antibiotic resistance pattern among biofilm producing and non producing
    Proteus strains isolated from hospitalized patients; matter of hospital hygiene and antimicrobial stewardshi,
    Pakistan Journal of Biological Sciences, 2013;16(22):1496-1502.
    4. Amiri M, Jajarmi M, Ghanbarpour R. Prevalence of Resistance to Quinolone and Fluoroquinolone Antibiotics
    and Screening of qnr Genes Among Escherichia coli Isolates From Urinary Tract Infection. Int J Enteric
    Pathog. 2017, 5(4):100-105.
    5. Kim HB, Park CH, Kim CJ, Kim EC, Jacoby GA, Hooper DC. Prevalence of plasmid-mediated quinolone
    resistance determinants over a 9-year period. Antimicrob Agents Chemother. 2009;53(2):639-645
    6. Sahm DF,Thomsberry C, Mayfiell DC, Jones ME, Karlowsky JA. Multidrug-resistant urinary tract isolates of
    Escherchia Coli: prevalence and patient demographics in the United State in 2000. Antimicrob Agent and
    chemother 2001; 45(5):1402-6.
    7. Ito CA, Gales AC, Tognim MC, Munerato P, Dalla Costa LM. Quinolone-resistant Escherichia coli. Brazilian
    Journal of Infectious Diseases. 2008;12(1):5-9.
    8. Soleimani-Asl Y, Zibaei M, Firoozeh F. Detection of qnrA gene among quinolone-resistant Escherichia coli
    isolated from urinary tract infections in Khorram Abad during 2011-2012. Feyz Journal of Kashan University
    of Medical Sciences. 2013 1;17(5).
    9. Robicsek A, Jacoby GA, Hooper DC. The worldwide emergence of plasmid-mediated quinolone resistance.
    The Lancet infectious diseases. 2006 1;6(10):629-40.
    10. Vakili B, Khorvash F, Fazeli H, Khaleghi M. Detection of quinolone-resistance mutations of parC gene in
    clinical isolates of Acinetobacter baumannii in Iran. J Res Med Sci 2014; 19(6): 567-70.
    11. Ghanbarpour R, Daneshdoost S. Identification of shiga toxin and intimin coding genes in Escherichia coli
    isolates from pigeons (Columba livia) in relation to phylotypes and antibiotic resistance patterns. Trop Anim
    Health Prod. 2012;44(2):307-12.
    12. Clinical and Laboratory Standards Institute (2016) Performance standards for antimicrobial susceptibility
    testing: twenty-second informational supplement. CLSI document M100–S22. Wayne, PA, USA.
    13. Askari Badouei M, Jajarmi M, Mirsalehian A. Virulence profiling and genetic relatedness of Shiga toxinproducing Escherichia coli isolated from humans and ruminants. Comp Immunol Microbiol Infect Dis.
    14. Naderi Z, Ghanbarpour R, Sami M. Antimicrobial resistance characteristics and phylogenetic groups of
    Escherichia coli isolated from diarrheic calves in southeast of Iran. Int J Enteric Pathog. 2016; 4(4):537-548
    15. Cattoir V, Poirel L, Rotimi V, Soussy C-J, Nordmann P. Multiplex PCR for detection of plasmid-mediated
    quinolone resistance qnr genes in ESBL-producing enterobacterial isolates. Journal of antimicrobial
    chemotherapy. 2007;60(2):394-7.
    16. Adib, N., Ghanbarpour, R., Solatzadeh, H., & Alizade, H. Antibiotic resistance profile and virulence genes of
    uropathogenic Escherichia coli isolates in relation to phylogeny. Trop Biomed.2014;31(1): 17-25.
    17. Tavakol M, MomtazH. Determination of antibiotic resistance profile in Klebsiella pneumonia strains isolated
    from urinary tract infections of patients hospitalized in Peyambaran hospital (Tehran-Iran). Feyz Journal.2017;
    21 (1) :74-82
    18. Shin JH, Jung HJ, Lee JY, Kim HR, Lee JN, Chang CL. High rates of plasmid-mediated quinolone resistance
    QnrB variants among ciprofloxacin-resistant Escherichia coli and Klebsiella pneumoniae from urinary tract
    infections in Korea. Microbial Drug Resistance. 2008;14(3):221-6.
  2. 19. Robicsek A, Strahilevitz J, Sahm D, Jacoby G, Hooper D. qnr prevalence in ceftazidime-resistant
    Enterobacteriaceae isolates from the United States. Antimicrobial agents and chemotherapy. 2006;50(8):2872-
    20. Moghadasi M, Mirzaee M, Mehrabi M. Frequency of Quinolone Resistance and qnrB and qnrC Genes in
    Clinical Isolates of Klebsiella pneumonia. J Med Bacteriol.2016;5(6):39-45.
    21. C.Manikandan and A.Amsath. Antibiotic susceptibility pattern of Klebsiella pneumoniae isolated from urine