ArticlePLoS neglected tropical diseases2012
Quinolone resistance in absence of selective pressure: the experience of a very remote community in the Amazon forest.
Article in PLoS neglected tropical diseases, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- High prevalence of antibiotic resistance in commensal Escherichia coli from healthy human sources in community settings.Scientific reports · 2021Pooled it
- Fluoroquinolone resistance without fluoroquinolone use; the genie is truly out of the bottle.Frontiers in microbiology · 2026Review
- Chance Favors the Prepared Genomes: Horizontal Transfer Shapes the Emergence of Antibiotic Resistance Mutations in Core Genes.Molecular biology and evolution · 2023Article
- Fluoroquinolone Use and Seasonal Patterns of Ciprofloxacin Resistance in Community-Acquired Urinary Escherichia coli Infection in a Large Urban Center.American journal of epidemiology · 2020Article
- Soft sweep development of resistance in Escherichia coli under fluoroquinolone stress.Journal of microbiology (Seoul, Korea) · 2019Article
- Transferable Mechanisms of Quinolone Resistance from 1998 Onward.Clinical microbiology reviews · 2019Review
- Longitudinal Shedding Patterns and Characterization of Antibiotic ResistantAntibiotics (Basel, Switzerland) · 2019Article
- Antibiotic-ResistantThe American journal of tropical medicine and hygiene · 2019Article
- Resistance to Antimicrobians - A Global Problem with Sectoral Resolution.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2018Article
- Article
- The fitness costs of antibiotic resistance mutations.Evolutionary applications · 2015Review
- Comparative analysis of quinolone resistance in clinical isolates of Klebsiella pneumoniae and Escherichia coli from Chinese children and adults.BioMed research international · 2015Article
- Recovery of plasmid pEMB1, whose toxin-antitoxin system stabilizes an ampicillin resistance-conferring β-lactamase gene in Escherichia coli, from natural environments.Applied and environmental microbiology · 2015Article
- Characterization of fecal extended-spectrum-β-lactamase-producing Escherichia coli in a remote community during a long time period.Antimicrobial agents and chemotherapy · 2013Article
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12 authors.
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Abstract
backgroundQuinolones are potent broad-spectrum bactericidal agents increasingly employed also in resource-limited countries. Resistance to quinolones is an increasing problem, known to be strongly associated with quinolone exposure. We report on the emergence of quinolone resistance in a very remote community in the Amazon forest, where quinolones have never been used and quinolone resistance was absent in 2002.
methodsThe community exhibited a considerable level of geographical isolation, limited contact with the exterior and minimal antibiotic use (not including quinolones). In December 2009, fecal carriage of antibiotic resistant Escherichia coli was investigated in 120 of the 140 inhabitants, and in 48 animals reared in the community. All fluoroquinolone-resistant isolates were genotyped and characterized for the mechanisms of plasmid- and chromosomal-mediated quinolone resistance. PRINCIPAL
findingsDespite the characteristics of the community remained substantially unchanged during the period 2002-2009, carriage of quinolone-resistant E. coli was found to be common in 2009 both in humans (45% nalidixic acid, 14% ciprofloxacin) and animals (54% nalidixic acid, 23% ciprofloxacin). Ciprofloxacin-resistant isolates of human and animal origin showed multidrug resistance phenotypes, a high level of genetic heterogeneity, and a combination of GyrA (Ser83Leu and Asp87Asn) and ParC (Ser80Ile) substitutions commonly observed in fluoroquinolone-resistant clinical isolates of E. coli.
conclusionsRemoteness and absence of antibiotic selective pressure did not protect the community from the remarkable emergence of quinolone resistance in E. coli. Introduction of the resistant strains from antibiotic-exposed settings is the most likely source, while persistence and dissemination in the absence of quinolone exposure is likely mostly related with poor sanitation. Interventions aimed at reducing the spreading of resistant isolates (by improving sanitation and water/food safety) are urgently needed to preserve the efficacy of quinolones in resource-limited countries, as control strategies based only on antibiotic restriction policies are unlikely to succeed in those settings.
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