Combination of known and unknown mechanisms confers high-level resistance to fluoroquinolones in Enterococcus faecium.

In order to elucidate the mechanisms of fluoroquinolone resistance in Enterococcus faecium, spontaneous mutants isolated from Ent. faecium ATCC 19434 by stepwise selection with sparfloxacin (SPX) or norfloxacin (NOR) and 13 clinical isolates of Ent. faecium were characterized by analysing quinolone-resistance-determining regions (QRDRs) of the gyrA, gyrB, parC and parE genes and examining changes in MICs of SPX and NOR in the presence of efflux pump inhibitors.

Cooperation between alteration of DNA gyrase genes and over-expression of MexB and MexX confers high-level fluoroquinolone resistance in Pseudomonas aeruginosa strains isolated from a patient who received a liver transplant followed by treatment with fluoroquinolones.

Clinical isolates of highly fluoroquinolone-resistant Pseudomonas aeruginosa had a mutation in either A or B subunit of DNA gyrase and over-expressed MexB and MexX, the efflux system proteins. Introduction of wild-type gyrase genes of Escherichia coli into the isolates made them as fluoroquinolonesusceptible as the moderately fluoroquinolone-resistant strains that only over-expressed efflux system proteins. These findings demonstrate that high fluoroquinolone-resistance in P.