{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:25:10Z","timestamp":1793316310447,"version":"4.5.0"},"reference-count":55,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007939","name":"Rangsit University","doi-asserted-by":"publisher","award":["36\/2564"],"award-info":[{"award-number":["36\/2564"]}],"id":[{"id":"10.13039\/501100007939","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p><jats:italic>Escherichia coli<\/jats:italic> is the major causative agent for urinary tract infections (UTIs), and fluoroquinolones (FQ) are commonly used in the treatment of patients with UTIs. The surge in FQ-resistant <jats:italic>E. coli<\/jats:italic> is an important public health threat worldwide. We investigated the prevalence and mechanisms of FQ resistance among FQ-resistant <jats:italic>E. coli<\/jats:italic> isolated from UTI patients. A total of 131 FQ-resistant <jats:italic>E. coli<\/jats:italic> strains were characterized and broth microdilution assay showed that 108 strains (82.4%) were highly resistant to ciprofloxacin (MIC\u2009\u2265\u200932 \u03bcg\/mL). All strains were analyzed for plasmid-mediated quinolone resistance (PMQR) genes, with 37 (28.2%) testing positive. Among the PMQR genes detected, <jats:italic>aac(6\u2019)-Ib-cr<\/jats:italic> was the most frequent, found in 30 strains (22.9%), followed by <jats:italic>qnrS<\/jats:italic> in 10 strains (7.6%) and <jats:italic>qnrB<\/jats:italic> in 1 strain (0.8%). PCR assay showed that all carried <jats:italic>acrA<\/jats:italic>, <jats:italic>acrB,<\/jats:italic> and <jats:italic>tolC<\/jats:italic> genes, but 33 strains (25.2%) revealed at least 4-fold reduction in ciprofloxacin MIC when using PA\u03b2N and CCCP as efflux pump inhibitors, indicating the role of the AcrAB efflux pump in ciprofloxacin resistance in these strains. The 19 strains of high-level ciprofloxacin-resistant <jats:italic>E. coli<\/jats:italic> were selected to determine the target enzyme alteration by PCR assay and DNA sequencing. Genetic analysis revealed that 16 strains (84.2%) had double mutations in <jats:italic>gyrA<\/jats:italic> (S83L and D87 to N or Y) with single mutation in <jats:italic>parC<\/jats:italic> (S80I), while 3 strains (15.8%) had double mutations in <jats:italic>gyrA<\/jats:italic> (S83L and D87 to N or Y) and <jats:italic>parC<\/jats:italic> (S80I and E84 to G or V). The positive efflux activity was linked to increased MIC values of ciprofloxacin (P\u2009&lt;\u20090.001). Overall, the carriage of PMQR genes, efflux activity, and target mutations across <jats:italic>E. coli<\/jats:italic> strains contribute to ciprofloxacin resistance, a result that may necessitate a reassessment of the antibiotics in use for empirical UTIs therapy.<\/jats:p>","DOI":"10.1371\/journal.pone.0325175","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T17:48:16Z","timestamp":1748627296000},"page":"e0325175","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Mechanisms of fluoroquinolone resistance among Escherichia coli isolates from urinary tract infections in Thailand"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1098-3701","authenticated-orcid":true,"given":"Nipaporn","family":"Tewawong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siriporn","family":"Kowaboot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warangkana","family":"Lektrakul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1304-9335","authenticated-orcid":true,"given":"Utsanee","family":"Supcharoengoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naiyana","family":"Watanagul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pannamthip","family":"Pitaksajjakul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"issue":"12","key":"pone.0325175.ref001","article-title":"Genotypic 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