Prevalence of plasmid-mediated quinolone resistance and aminoglycoside resistance determinants among carbapeneme non-susceptible Enterobacter cloacae

PLoS One. 2012;7(10):e47636. doi: 10.1371/journal.pone.0047636. Epub 2012 Oct 23.


Background: Simultaneous resistance to aminoglycosides and fluoroquinolones in carbapeneme non-susceptible (CNS) isolates will inevitably create problems. The present study was performed to characterize the prevalence of the plasmid-mediated quinolone resistance determinants (QRDs) and aminoglycoside resistance determinants (ARDs) among the CNS Enterobacter cloacae (E. cloacae) isolates in a Chinese teaching hospital, and to acquire their molecular epidemiological characteristics.

Methods: The β-lactamases genes (including class A carbapenemase genes bla(KPC) and bla(SME), metallo-β-lactamase genes (MBLs) bla(IMP), bla(VIM) and bla(NDM), and extended spectrum β-lactamases (ESBLs),bla(CTX-M), bla(TEM) and bla(SHV)), QRDs (including qnrA, qnrB, qnrS and aac(6')-Ib-cr) and ARDs (including aac(6')-Ib, armA and rmtB) of these 35 isolates were determined by PCR and sequenced bidirectionally. The clonal relatedness was investigated by pulsed-field gel electrophoresis (PFGE).

Results: Of the 35 isolates, 9 (25.7%) harbored a carbapenemase gene; 23 (65.7%) carried ESBLs; 24 (68.6%) were QRD positive; and 27 (77.1%) were ARD positive. Among the 5 bla(IMP-8) positive strains, 4 (80%) contained both ESBL and QRD genes, and all the 5 (100%) harbored ARD genes. Of the 23 ESBLs positive isolates, 6 (26.1%) were carbapenemase positive, 14 (60.9%) were QRD positive, and 18 (78.3%) were ARD positive. PFGE revealed genetic diversity among the 35 isolates, indicating that the high prevalence of CNS E. cloacae isolates was not caused by clonal dissemination.

Conclusion: QRD and ARD genes were highly prevalent among the CNS E. cloacae isolates. Multiple resistant genes were co-expressed in the same isolates. The CNS E. cloacae isolate co-expressing bla(NDM-1), bla(IMP-26), qnrA1 and qnrS1 was first reported.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aminoglycosides / pharmacology*
  • Anti-Bacterial Agents / pharmacology*
  • Carbapenems / pharmacology*
  • Drug Resistance, Multiple, Bacterial / genetics
  • Enterobacter cloacae / drug effects*
  • Enterobacter cloacae / genetics*
  • Plasmids / genetics*
  • Quinolones / pharmacology*


  • Aminoglycosides
  • Anti-Bacterial Agents
  • Carbapenems
  • Quinolones

Grant support

This work was supported in part by the National Science Foundation of China (Grant No. 81071621 and No.30973378; The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.