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Master's Dissertation
DOI
https://doi.org/10.11606/D.6.2014.tde-27032014-091736
Document
Author
Full name
Rafaela Rogério Floriano de Sousa
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2014
Supervisor
Committee
Matte, Glavur Rogerio (President)
Huenuman, Nilton Erbet Lincopan
Silva, Rodrigo Cayô da
Title in Portuguese
Pesquisa de genes de resistência a quinolonas em bacilos Gram negativos de origem clínica e ambiental
Keywords in Portuguese
Fluoroquinolonas
Genes de Resistência a Quinolonas
Plasmídeos Mediadores de Resistência a Quinolonas (PMQR)
Resistência Bacteriana
Abstract in Portuguese
Introdução. Quinolonas são antimicrobianos sintéticos que inibem as enzimas DNA-girase e topoisomerase IV resultando na morte bacteriana. São altamente eficazes no tratamento de infecções bacterianas, especialmente causadas por bactérias Gram negativas, e portanto amplamente utilizados na medicina humana e veterinária, na qual também são empregados como profiláticos. Porém, o uso indiscriminado e inadequado levou ao aumento de bactérias resistentes a estes compostos. Esta resistência pode ocorrer devido a mutações nas enzimas DNA-girase e topoisomerase IV, e também por genes contidos em plasmídeos. Estes últimos são os principais responsáveis pela disseminação e circulação da resistência entre o meio ambiente e o ambiente hospitalar. Objetivos. Pesquisar genes de resistência a antimicrobianos do grupo das quinolonas em bactérias Gram negativas de origem clínica e ambiental que apresentam resistência fenotípica a este grupo. Material e Métodos. 73 cepas de Enterobacteriaceae e Aeromonas sp. de origem clínica e ambiental foram selecionadas para o estudo, e avaliadas quanto à sensibilidade aos antimicrobianos do grupo das quinolonas e à pesquisa de genes de resistência a este mesmo grupo e mutações no gene que codifica a enzima DNA-girase por meio de PCR e sequenciamento. Resultados. Das 73 cepas previamente selecionadas para compor o estudo, 65 foram utilizadas, devido à exclusão de perfis clonais similares. Nestas, foram observados os genes, qnrS1 (1,5 por cento ), qnrS2 (26,2 por cento ), qnrB1 (3,1 por cento ), qnrB19 (12,3 por cento ), qnrD1 (1,5 por cento ), aac(6)-Ib-cr (10,8 por cento ), oqxA (43,1 por cento ) e oqxB (41,5 por cento ), e duas variantes determinadas qnrB-like (3,1 por cento ) e qnrB69-like (1,5 por cento ). Os genes qnrA, qnrC e qepA não foram identificados. Mutações na enzima DNA-girase foram observadas em 97,9 por cento das cepas positivas para algum dos genes pesquisados. Em 4 cepas foi possível estabelecer a associação do gene aac(6)-Ib-cr com integron de classe 1. Foi realizado sequenciamento e caracterização do plasmídeo completo onde estava inserido o gene qnrD1. Conclusões. Este estudo relata pela primeira vez no Brasil a ocorrência dos genes qnrS2, oqxA e oqxB, a associação entre o elemento genético integron de classe 1 e o gene aac(6)-Ib-cr, e o gene qnrD1 e a caracterização do plasmídeo completo onde este estava inserido. Os genes qnrB1, qnrB19, e aac(6)-Ib-cr, anteriormente apenas relatados em cepas clínicas, foram observados em cepas ambientais. Os resultados deste estudo mostram alta frequência de genes de resistência a quinolonas tanto em isolados clínicos quanto em isolados ambientais, alertando quanto à disseminação da resistência entre fontes diferentes, e possível manutenção destes genes por cepas ambientais.
Title in English
Research for genes of quinolone resistance in Gram negative bacilli from clinical and environmental origin
Keywords in English
Bacterial Resistance
Fluoroquinolones
Plasmid-Mediated Quinolone Resistance (PMQR)
Quinolone-Resistance Genes
Abstract in English
Introduction. Quinolones are synthetic antimicrobial agents that inhibit DNA gyrase and topoisomerase IV enzymes resulting in bacterial death. They are highly effective in the treatment of bacterial infections, especially the ones caused by Gram negative bacteria, as well as for prophylaxy. Therefore they are widely used in human and veterinary medicine. However, indiscriminate and improper use led to an increase of bacteria resistance to these compounds. This resistance can be due to mutations in DNA gyrase and topoisomerase IV enzymes and also by genes contained in plasmids, which are mainly responsible for the spread and transmission of resistance between the environment and the hospital set. Objectives. To search for genes of resistance to quinolone antimicrobial agents in Gram-negative bacteria from clinical and environmental strains that present phenotypic resistance to this group. Material and Methods. 73 strains of Enterobacteriaceae and Aeromonas spp., from clinical and environmental origin, were selected for this study, and evaluated for antimicrobial susceptibility of quinolone and search of resistance genes in this same group and also for mutations in the gene encoding the enzyme DNA gyrase by PCR and sequencing. Results. Of the 73 strains previously selected to compose this study, 65 were used, due to the exclusion of similar clonal profiles. In these, genes qnrS1 (1.5 per cent ), qnrS2 (26.2 per cent ) qnrB1 (3.1 per cent ), qnrB19 (12.3 per cent ) qnrD1 (1.5 per cent ) aac(6')-Ib-cr (10.8 per cent ) oqxA (43.1 per cent ) and oqxB (41.5 per cent ) were observed, and two variants were named as qnrB-like (3.1 per cent ) and qnrB69-like (1.5 per cent ). The qnrA, qnrC and qepA genes were not identified. Mutations in DNA gyrase enzyme were observed in 97.9 per cent of the positive strains for at least one of the genes studied. It was possible to establish the association of aac(6')-Ib-cr with class 1 integron gene in four strains. Complete sequencing and characterization of plasmid qnrD1, where the gene was inserted, was performed. Conclusions. This study reports, for the first time in Brazil, the occurrence of qnrS2, oqxA and oqxB genes, the association between genetic element integron class 1 gene and the aac (6 ')-Ib-cr, and qnrD1 gene and the characterization of the complete plasmid where this was inserted. qnrB1, qnrB19, and aac(6')-Ib-cr genes, previously only reported in clinical strains, were observed in environmental strains. The results of this study show a high frequency of quinolone-resistance genes for both clinical and environmental isolates, warning about the spread of resistance through different sources, and the possible maintenance of these genes by environmental strains.
 
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Publishing Date
2014-04-23
 
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