{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T07:52:30Z","timestamp":1776325950188,"version":"3.50.1"},"reference-count":56,"publisher":"Microbiology Society","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,8]]},"abstract":"\n Introduction.<\/jats:bold>\n The soaring resistance of\n \n \n Klebsiella pneumoniae<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic>\n to fluoroquinolones in PR China has substantially limited the application of these antimicrobials, especially in those clinical settings that were threatened by persistent carbapenem-resistant\n \n \n K. pneumoniae<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic>\n (CRKP), necessitating strict implementation of antimicrobial stewardship and active enhanced surveillance of infection control.\n <\/jats:p>\n \n Hypothesis.<\/jats:bold>\n There is interplay between plasmid-mediated quinolone resistance (PMQR) determinants and quinolone resistance-determining region (QRDR) mutations during the acquisition of a clinically important fluoroquinolone resistance (CI-FR) profile in multidrug-resistant\n \n \n K. pneumoniae<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic>\n (MDR-KP) isolates.\n <\/jats:p>\n \n Aim.<\/jats:bold>\n To investigate the high-risk CRKP clones responsible for nosocomial spread and analyse the molecular patterns of CI-FR in MDR-KP isolates in a tertiary hospital in Shanghai, PR China.\n <\/jats:p>\n \n Methodology.<\/jats:bold>\n A total of 34 isolates, including 30 CRKPs, were molecularly characterized. Investigations included antimicrobial susceptibility tests, multilocus sequence typing (MLST) and\n wzi<\/jats:italic>\n genotyping, PCR sequencing and phylogenetic analysis for resistance-associated genes, and clinical information retrieval from medical records.\n <\/jats:p>\n \n Results.<\/jats:bold>\n Two high-risk CRKP clones, ST11-\n wzi<\/jats:italic>\n 64 and ST15-\n wzi<\/jats:italic>\n 19\/\n wzi<\/jats:italic>\n 24, were identified as being responsible for nosocomial outbreaks in the intensive care unit (ICU) and the neurosurgery department, potentially by the respiratory route. QRDR mutations of both\n gyrA<\/jats:italic>\n and\n parC<\/jats:italic>\n were detected in isolates of ST15 (S83F\/D87A\/S80I), ST11 (S83I\/D87G\/S80I) and ST218 (D87A\/S80I), respectively. The PMQR genes,\n qnr<\/jats:italic>\n S1,\n aac(6\u2032)-Ib-cr<\/jats:italic>\n and\n oqx<\/jats:italic>\n AB, were present in 32 (94.1\u200a%) of the isolates alone or in combination, co-occurring with genes (\n bla<\/jats:italic>\n ) encoding \u03b2-lactamases, 16S rRNA methylases and putrescine ABC permeases. AcrR, an AcrAB transcriptional repressor, was insertion-inactivated by the IS5-like element in ST11 isolates. The encoding sequences of OmpK35 and OmpK36 genes were associated with specific STs and\n wzi<\/jats:italic>\n alleles. ST11, ST15-\n wzi<\/jats:italic>\n 19 and ST218 isolates had frameshift disruptions in OmpK35 and specific GD insertions at position 134\u2013135 in OmpK36. The 27 isolates with clinically important ciprofloxacin resistance (MICs \u22652\u2009mg l\n \u22121<\/jats:sup>\n ) included 25 isolates (ST15, ST11, ST218) with multiple QRDR mutations, plus 1 with only 2 PMQR determinants (ST290-\n wzi<\/jats:italic>\n 21) and another with an unknown resistance mechanism (ST65-\n wzi<\/jats:italic>\n 72). Ciprofloxacin-susceptible isolates maintained intact\n ompK36<\/jats:italic>\n genes, including two CRKPs each with ST13-\n wzi<\/jats:italic>\n 74 (KPC-2 and NDM-1 coproducers) and ST65-\n wzi<\/jats:italic>\n 72, plus carbapenem-susceptible isolates (ST15-\n wzi<\/jats:italic>\n 24, ST65-\n wzi<\/jats:italic>\n 72, ST107-\n wzi<\/jats:italic>\n 173).\n <\/jats:p>\n \n Conclusions.<\/jats:bold>\n Under selective pressures, the accumulation of mutations of three types (QRDR,\n acrR<\/jats:italic>\n ,\n ompK<\/jats:italic>\n 36) and the acquisition of resistance-conferring genes have continuously contributed to CI-FR in MDR-KP isolates.\n <\/jats:p>","DOI":"10.1099\/jmm.0.001583","type":"journal-article","created":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T13:21:38Z","timestamp":1667913698000},"source":"Crossref","is-referenced-by-count":2,"title":["Molecular patterns of clinically important fluoroquinolone resistance in multidrug-resistant Klebsiella pneumoniae isolates during nosocomial outbreaks in Shanghai, PR China"],"prefix":"10.1099","volume":"71","author":[{"given":"Guoping","family":"Cai","sequence":"first","affiliation":[{"name":"Science and Education Division, Jinshan Hospital, Fudan University, No.1508 Longhang Road, Shanghai 201508, PR China"},{"name":"Molecular Diagnostic Laboratory for Microbiology, Research Center for Clinical Medicine, Jinshan Hospital, Fudan University, No. 1508 Longhang Road, Shanghai 201508, PR China"},{"name":"Department of Surgery, Jinshan Hospital, Fudan University, No.1508 Longhang Road, Shanghai 201508, PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8457-5287","authenticated-orcid":false,"given":"Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"Science and Education Division, Jinshan Hospital, Fudan University, No.1508 Longhang Road, Shanghai 201508, PR China"},{"name":"Molecular Diagnostic Laboratory for Microbiology, Research Center for Clinical Medicine, Jinshan Hospital, Fudan University, No. 1508 Longhang Road, Shanghai 201508, PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"345","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1086\/514923"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.12830"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.44.9.2233-2241.2000"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.000691"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.000452"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.000981"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2020.00314"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(18)30792-8"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2022.823684"},{"key":"R10","article-title":"The Center for Disease Dynamics, Economics & Policy","year":"2022"},{"key":"R11","article-title":"Surveillance results of antimicrobial resistance in 2020. 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