Accumulation of plasmid-mediated fluoroquinolone resistance genes, qepA and qnrSl, in Enterobacter aerogenes co-producing RmtB and class A β-lactamase LAP-1

A new plasmid-mediated fluoroquinolone efflux pump gene, qepA, is known to be associated with the rmtB gene, which confers high-level resistance to aminoglycosides. We investigated the qepA gene in 573 AmpC-producing Enterobacteriaceae including one Citrobacter freundii known to harbor rmtB. Of them, two clonally unrelated E. aerogenes harbored qepA. Both isolates co-harbored rmtB, qnrS1, qepA, and bla_LAP-1 on an IncFI type plasmid. The qepA was flanked by two copies of IS26 containing ISCR3C, tnpA, tnpR, bla_TEM, and rmtB. The qnrS1 and bla_LAP-1 were located upstream of qepA. All the resistance determinants (qepA, qnrS1, rmtB, and bla_LAP-1) were co-transferred to E. coli J53 by filter mating from both isolates. Although the prevalence of qepA is currently low, considering the presence of ISCR3C and the possibility of co-selection and co-transferability of plasmids, more active surveillance for these multi-drug resistant bacteria and prudent use of antimicrobials are needed.