Journal
JOURNAL OF CLINICAL MICROBIOLOGY
Volume 42, Issue 6, Pages 2701-2706Publisher
AMER SOC MICROBIOLOGY
DOI: 10.1128/JCM.42.6.2701-2706.2004
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The prevalence of active drug efflux pump and porin alterations was investigated in Turkish nosocomial strains of Klebsiella pneumoniae exhibiting a multidrug-resistant phenotype. MICs of various antibiotics, including quinolones, chloramphenicol, tetracycline, and beta-lactams, for those strains were determined either with or without the efflux pump inhibitor phenylalanine arginine beta-naphthylamide (PAbetaN). Thirty-nine percent of the strains exhibited a PAbetaN-modulated resistance for quinolones, chloramphenicol, and tetracycline. In these strains, a significant increase of chloramphenicol accumulation was gained in the presence of the efflux pump inhibitor PAbetaN or with the energy uncoupler carbonyl cyanide m-chlorophenylhydrazone. Moreover, high-level expression of the membrane fusion protein AcrA, which was immunodetected in most of those isolates, suggests that the AcrAB/ToIC efflux machinery contributed to their antibiotic resistance. Studies of K. pneumoniae porins indicated that the majority of the strains, including extended-spectrum beta-lactamase producers and efflux-positive ones, presented an alteration in their sorbitol-sensitive porin (OmpK35) expression. This is the first report showing the prominent role of active drug efflux in the antibiotic resistance of nosocomial K. pneumoniae strains from Turkey.
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