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Quinolone-resistant Salmonella Typhi in South Africa, 2003–2007

  • A. M. SMITH (a1) (a2), N. GOVENDER (a1) and K. H. KEDDY (a1) (a2)
  • DOI:
  • Published online: 29 June 2009

In South Africa, for the years 2003–2007, the Enteric Diseases Reference Unit received 510 human isolates of Salmonella Typhi, of which 27 were nalidixic acid-resistant [minimum inhibitory concentrations (MICs) 128–512 μg/ml] with reduced susceptibility to ciprofloxacin (MICs 0·125–0·5 μg/ml). Pulsed-field gel electrophoresis analysis of 19 available isolates differentiated them into five DNA pattern types; multiple-locus variable-number tandem repeat analysis differentiated the isolates into 10 types. This level of genetic diversity suggested that resistant strains usually emerged independently of one another. A 16- to 32-fold decrease in nalidixic acid MIC and a 2- to 8-fold decrease in ciprofloxacin MIC, was observed in the presence of an efflux pump inhibitor. All isolates were negative by PCR screening for qnr genes. Seven resistant isolates were further analysed for mutations in the quinolone resistance-determining region of gyrA, gyrB, parC and parE. No amino-acid mutations were identified in GyrB and ParE; all isolates showed amino-acid mutations in both GyrA and ParC. We conclude that amino-acid mutations in GyrA and ParC in combination with active efflux of antibiotic out of the bacterial cell are the probable mechanisms conferring quinolone resistance.

Corresponding author
*Author for correspondence: Dr A. M. Smith, Enteric Diseases Reference Unit, National Institute for Communicable Diseases, Private Bag X4, Sandringham, 2131, South Africa. (Email:
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2.FM Aarestrup , Is it time to change fluoroquinolone breakpoints for Salmonella spp.? Antimicrobial Agents and Chemotherapy 2003; 47: 827829.

3.GA Jacoby . Mechanisms of resistance to quinolones. Clinical Infectious Diseases 2005; 41 (Suppl. 2): S120S126.

4.GA Jacoby , N Chow , KB Waites . Prevalence of plasmid-mediated quinolone resistance. Antimicrobial Agents and Chemotherapy 2003; 47: 559562.

5.S Kariuki , Characterization of multidrug-resistant typhoid outbreaks in Kenya. Journal of Clinical Microbiology 2004; 42: 14771482.

6.KO Akinyemi , AO Coker . Trends of antibiotic resistance in Salmonella enterica serovar typhi isolated from hospitalized patients from 1997 to 2004 in Lagos, Nigeria. Indian Journal of Medical Microbiology 2007; 25: 436437.

7.NJ Nkemngu , ED Asonganyi , AL Njunda . Treatment failure in a typhoid patient infected with nalidixic acid resistant S. enterica serovar Typhi with reduced susceptibility to ciprofloxacin: a case report from Cameroon. BMC Infectious Diseases 2005; 5: 49.

8.Y Liu , Molecular typing of Salmonella enterica serovar typhi isolates from various countries in Asia by a multiplex PCR assay on variable-number tandem repeats. Journal of Clinical Microbiology 2003; 41: 43884394.

9.DJ Eaves , Prevalence of mutations within the quinolone resistance-determining region of gyrA, gyrB, parC, and parE and association with antibiotic resistance in quinolone-resistant Salmonella enterica. Antimicrobial Agents and Chemotherapy 2004; 48: 40124015.

10.GA Jacoby , qnrB, another plasmid-mediated gene for quinolone resistance. Antimicrobial Agents and Chemotherapy 2006; 50: 11781182.

11.KL Hopkins , Plasmid-mediated quinolone resistance determinant qnrS1 found in Salmonella enterica strains isolated in the UK. Journal of Antimicrobial Chemotherapy 2007; 59: 10711075.

12.S Baucheron , The AcrB multidrug transporter plays a major role in high-level fluoroquinolone resistance in Salmonella enterica serovar typhimurium phage type DT204. Microbial Drug Resistance 2002; 8: 281289.

13.S Baucheron , AcrAB-TolC directs efflux-mediated multidrug resistance in Salmonella enterica serovar typhimurium DT104. Antimicrobial Agents and Chemotherapy 2004; 48: 37293735.

14.JM Ling , Mutations in topoisomerase genes of fluoroquinolone-resistant Salmonellae in Hong Kong. Antimicrobial Agents and Chemotherapy 2003; 47: 35673573.

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