The molecular mechanisms of fluoroquinolone resistance found in rectal swab isolates of Enterobacterales from men undergoing a transrectal prostate biopsy: the rationale for targeted prophylaxis

Annals of Clinical Microbiology and Antimicrobials

Natalia Wolaniuk¹  Katarzyna Piekarska¹  Tomasz Wołkowicz¹  Rafał Gierczyński¹  Katarzyna Zacharczuk¹  Magdalena Nowakowska¹  Stanisław Szempliński²  Mateusz Mokrzyś³  Jakub Dobruch³ 

[1] Department of Bacteriology, National Institute of Public Health NIH – National Research Institute, Chocimska 24, 00-791, Warsaw, Poland;Department of Urology, Centre of Postgraduate Medical Education, 01-813, Warsaw, Poland;Department of Urology, St. Anna Hospital, A. Mickiewicza 39, 05-500, Piaseczno, Poland;Department of Urology, Centre of Postgraduate Medical Education, 01-813, Warsaw, Poland;

关键词: Prostate biopsy;    Post-biopsy infections;    Enterobacteriaceae;    Fluoroquinolone resistance;    PMQR and mutations;   

DOI  :  10.1186/s12941-021-00487-y

来源: Springer

【 摘 要 】

BackgroundTransrectal ultrasound-guided prostate biopsy (TRUS-Bx) is considered an essential urological procedure for the histological diagnosis of prostate cancer. It is, however, considered a “contaminated” procedure which may lead to infectious complications. Recent studies suggest a significant share of fluoroquinolone-resistant rectal flora in post-biopsy infections.MethodsThe molecular mechanisms of fluoroquinolone resistance, including PMQR (plasmid-mediated quinolone resistance) as well as mutation in the QRDRs (quinolone-resistance determining regions) of gyrA, gyrB, parC and parE, among Enterobacterales isolated from 32 of 48 men undergoing a prostate biopsy between November 2015 and April 2016 were investigated. Before the TRUS-Bx procedure, all the patients received an oral antibiotic containing fluoroquinolones.ResultsIn total, 41 Enterobacterales isolates were obtained from rectal swabs. The MIC of ciprofloxacin and the presence of common PMQR determinants were investigated in all the isolates. Nine (21.9%) isolates carried PMQR with qnrS as the only PMQR agent detected. DNA sequencing of the QRDRs in 18 Enterobacterales (E. coli n = 17 and E. cloacae n = 1) isolates with ciprofloxacin MIC ≥ 0.25 mg/l were performed. Substitutions in the following codons were found: GyrA—83 [Ser → Leu, Phe] and 87 [Asp → Asn]; GyrB codon—605 [Met → Leu], ParC codons—80 [Ser → Ile, Arg] and 84 [Glu → Gly, Met, Val, Lys], ParE codons—458 [Ser → Ala], 461 [Glu → Ala] and 512 [Ala → Thr]. Six isolates with ciprofloxacin MIC ≥ 2 mg/l had at least one mutation in GyrA together with qnrS.ConclusionsThis study provides information on the common presence of PMQRs among Enterobacterales isolates with ciprofloxacin MIC ≥ 0.25 mg/l, obtained from men undergoing TRUS-Bx. This fact may partially explain why some men develop post-TRUS-Bx infections despite ciprofloxacin prophylaxis.

【 授权许可】

CC BY