Molecular Analysis of Ciprofloxacin Resistance among Non-Typhoidal Salmonella with Reduced Susceptibility to Ciprofloxacin Isolated from Patients at a Tertiary Care Hospital in Kuala Lumpur, Malaysia

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  • Karunakaran Rina
    Department of Medical Microbiology, Faculty of Medicine, University of Malaya
  • Tay Sun Tee
    Department of Medical Microbiology, Faculty of Medicine, University of Malaya
  • Rahim Fairuz Fadzilah
    Department of Medical Microbiology, Faculty of Medicine, University of Malaya
  • Lim Bee Bee
    Department of Medical Microbiology, Faculty of Medicine, University of Malaya
  • Puthucheary Savithri D.
    Department of Medical Microbiology, Faculty of Medicine, University of Malaya Medical Education, Research and Evaluation Department, Duke-NUS Graduate Medical School Singapore

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  • Molecular Analysis of Ciprofloxacin Resistance among Non-Typhoidal <i>Salmonella</i> with Reduced Susceptibility to Ciprofloxacin Isolated from Patients at a Tertiary Care Hospital in Kuala Lumpur, Malaysia

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We investigated the prevalence of non-typhoidal Salmonella (NTS) with “reduced susceptibility to ciprofloxacin” (RS-Cip) (minimum inhibitory concentration [MIC], 0.12–1.0 μg/mL) as well as their resistance genes in 75 NTS isolates (53 from stool, 21 from blood, and 1 from urine) from patients at a tertiary care Malaysian hospital between January and December 2009. RS-Cip was detected in 24/75 (32.0%) isolates. Using the ciprofloxacin MIC interpretive criteria for Salmonella in the Clinical and Laboratory Standards Institute 2013 guidelines, 51/75 (68.0%) isolates were found to be sensitive, 22/75 (29.3%) were intermediate, and 2/75 (2.7%) were resistant to ciprofloxacin. The 24 isolates that were intermediate or resistant to ciprofloxacin were the same isolates categorized as having RS-Cip. Among the 23 tested isolates with RS-Cip, the qnrS gene was detected in 17/23 (73.9%) and single gyrA mutations were detected in 6/23 (26.1%) (Asp87Tyr [n = 3], Asp87Asn [n = 2], and Ser83Phe [n = 1]). A parC (Thr57Ser) mutation was detected in 13/23 (56.5%) isolates, coexisting with either a qnrS gene or a gyrA mutation. The high incidence of the qnrS gene among isolates with RS-Cip needs to be monitored because qnr genes can spread via plasmids and aid in the emergence of increased resistance levels.

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