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Characterization of Quinolone Resistance Genes in Gram-Negative Bacilli Isolated from Pus and Vaginal Swabs at Saint Camille Hospital, Ouagadougou (HOSCO), Burkina Faso

Received: 20 August 2025     Accepted: 29 August 2025     Published: 27 October 2025
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Abstract

Introduction: Antibiotic resistance, particularly to quinolones, represents a major public health concern in Burkina Faso. In recent decades, plasmid-mediated quinolone resistance (PMQR) mechanisms have emerged, especially among Gram-negative bacteria. These mechanisms include, among others, qnr genes (qnrA, qnrB, qnrS). This study aimed to investigate the presence of quinolone resistance determinants in Gram-negative bacilli isolated from pus and vaginal samples at Saint Camille Hospital of Ouagadougou (HOSCO). Methodology: A total of 19 strains of Escherichia coli isolated from pus and vaginal swabs were collected for bacteriological and molecular analysis. Four antibiotics, namely ciprofloxacin (CIP), norfloxacin (NOR), ofloxacin (OF) and levofloxacin (LEV) were used for sensitivity testing and molecular analysis focused on the detection of qnrA, qnrB, and qnrS type genes. Results: Resistance rates to CIP, NOR, OF, and LEV were 57.89%, 52.63%, 52.63%, and 31.37%, respectively. Molecular analysis revealed the presence of qnrB, and qnrS genes in 28.47% of the isolates, for each gene. The qnrA gene was not detected in any isolate. The analysis of the genetic support of resistance genes revealed that 50% of the qnrS genes were plasmid-borne, while only 25% of the qnrB genes were associated with plasmids. La Correlation analysis between resistance genes and antibiotics showed a moderate positive correlation between qnrB and NOR/LEV, thereby suggesting the involvement of qnrB in resistance to these antibiotics. Conclusion: These findings highlight the need for continuous surveillance of antibiotic resistance in clinical isolates.

Published in American Journal of Biomedical and Life Sciences (Volume 13, Issue 5)
DOI 10.11648/j.ajbls.20251305.11
Page(s) 90-97
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Quinolones, Qnr Genes, Burkina Faso

1. Introduction
Quinolones are a class of broad-spectrum synthetic antimicrobial agents commonly used to treat infections caused by Gram-negative bacteria. Their primary mechanism of action involves the inhibition of DNA gyrase and topoisomerase IV, enzymes essential for bacterial DNA replication and transcription . For many years, quinolone resistance was believed to arise exclusively through chromosomal mechanisms—particularly mutations in genes encoding DNA gyrase and topoisomerase IV, overexpression of efflux pumps leading to active drug extrusion, and reduced outer membrane permeability due to porin loss .
However, over the past few decades, plasmid-mediated quinolone resistance (PMQR) mechanisms have emerged, particularly among Gram-negative organisms . These mechanisms include the qnr genes (qnrA, qnrB, qnrC, qnrD, qnrS, and qnrVC), which encode proteins that protect DNA gyrase from quinolone binding ; enzymes such as the aminoglycoside acetyltransferase encoded by aac(6′)-Ib-cr, which modifies certain fluoroquinolones ; and efflux pump genes such as qepA and oqxAB, which actively expel quinolones from the bacterial cell .
Although qnr genes alone typically confer low-level resistance, their presence facilitates the selection of additional chromosomal mutations that can lead to high-level resistance, thereby contributing to the alarming global rise in quinolone resistance .
In Burkina Faso, data on the distribution of quinolone resistance genes remain scarce. This study aims to contribute to the understanding of resistance profiles among Gram-negative bacilli isolated from clinical samples. Specifically, we seek to detect the presence of key plasmid-mediated quinolone resistance determinants (qnrA, qnrB and qnrS in isolates obtained from pus and vaginal specimens collected at Saint Camille Hospital of Ouagadougou (HOSCO).
2. Methodology
2.1. Sample Collection
A total of 19 clinical samples—including 14 pus samples and 5 vaginal swabs—were collected from patients at Saint Camille Hospital of Ouagadougou (HOSCO) over a one-month period, from March to April 2024.
2.2. Bacteriological Analysis
Samples were subjected to standard bacteriological procedures, including macroscopic examination, inoculation and incubation, microscopic observation, bacterial isolation, identification, and antibiotic susceptibility testing. Bacterial isolation was performed on Eosin Methylene Blue selective agar. Once isolated, bacterial strains were identified using biochemical assays, specifically the API 20E system, according to the manufacturer’s instructions.
Antimicrobial susceptibility testing was conducted using the disc diffusion method on Mueller-Hinton agar, in accordance with the guidelines of the French Society for Microbiology's Antibiogram Committee (CASFM). The antibiotics tested included ciprofloxacin (CIP), norfloxacin (NOR), levofloxacin (LEV), and ofloxacin (OF).
2.3. Bacterial DNA Extraction
Genomic DNA was extracted from the isolated bacterial strains using the boiling method. Bacterial cells were lysed by heating at 100°C to release their genetic material. The lysate was then centrifuged to remove cellular debris, and the supernatant containing DNA was collected. DNA concentration and purity were measured using a Nanodrop spectrophotometer prior to PCR amplification.
2.4. Polymerase Chain Reaction (PCR)
Table 1. Primer sequences used for the detection of quinolone resistance genes.

Genes

Primer Sequences (5' → 3')

Amplicon Size (bp)

References

qnrA

For: ATTTCTCACGCCAGGATTTG

516 bp

Rev: GATCGGCAAAGGTTAGGTCA

qnrB

For: GATCGTGAAAGCCAGAAAGG

469 bp

Rev.: ACGATGCCTGGTAGTTGTCC

qnrS

For: ACGACATTCGTCAACTGCAA

417 bp

Rev: TAAATTGGCACCCTGTAGGC

Conventional PCR was employed to detect the presence of quinolone resistance genes (qnrA, qnrB and qnrS, using gene-specific primers (see Table 1). Amplified products were subsequently visualized via agarose gel electrophoresis.
2.5. Plasmid DNA Extraction
In order to determine the genetic support of the identified resistance genes, plasmid DNA extraction was performed on the strains harboring at least one of the targeted genes. The alkaline lysis method was employed for this purpose. Following plasmid quantification, conventional PCR was carried out using the primers previously described (Table 1).
2.6. Data Analysis
Data were compiled using Microsoft Excel and statistically analyzed with R software, version 4.3.3.
3. Results
Antibiotic susceptibility testing was conducted for four fluoroquinolones: ciprofloxacin (CIP), levofloxacin (LEV), ofloxacin (OF), and norfloxacin (NOR). The presence of quinolone resistance genes—qnrA, qnrB and qnrS, was also assessed. Molecular analysis was performed on bacterial isolates exhibiting resistance to at least one of the tested antibiotics.
3.1. Distribution of Bacterial Species
The analysis of bacterial species distribution (Table 2) revealed that Escherichia coli was the most prevalent species, identified in 10 isolates (7 from pus samples and 3 from vaginal swabs). Klebsiella pneumoniae was detected in 5 isolates (3 pus, 2 vaginal), followed by Pseudomonas aeruginosa in 3 isolates (all from pus), and Proteus mirabilis in a single isolate (pus).
Table 2. Distribution of Bacterial Species.

Species

Pus samples

Vaginal swabs

E. coli

7

3

K. pneumoniae

3

2

P. aeruginosa

3

0

P. mirabilis

1

0

3.2. Antibiotic Resistance Profile
The results of the antibiotic susceptibility testing (Table 3) revealed considerable variability in resistance rates depending on the antibiotic tested.
Table 3. Antibiotic Susceptibility Profile.

Identification Number

Sex

Bacterial Species

CIP

LEV

OF

NOR

Pus 2

M

K. pneumoniae

S

S

R

S

Pus 11

F

P. aeruginosa

R

S

S

R

Pus 10

M

E. coli

R

R

R

R

Pus 1

M

E. coli

R

R

R

S

PV32

F

K. pneumoniae

R

S

R

R

PUS 5931

F

E. coli

R

R

R

R

PUS42

F

E. coli

R

R

R

R

PV2

M

E. coli

R

S

S

R

Pus 9

M

P. mirabilis

S

R

R

S

Pus 8

F

K. pneumoniae

R

R

R

R

Pus 5

F

E. coli

S

S

S

S

Pus 4

M

P. aeruginosa

R

S

S

R

Pus 3

M

E. coli

R

S

R

R

Pus 12

F

E. coli

R

S

R

R

PV32

F

E. coli

S

S

S

S

PV12

F

K. pneumoniae

S

S

S

S

PV 1

M

E. coli

S

S

S

S

Pus 7

M

K. pneumoniae

S

S

S

S

Pus 6

F

P. aeruginosa

S

S

S

S

This table demonstrates a high level of resistance to ciprofloxacin (CIP), with 11 resistant isolates (57.9%), followed by ofloxacin (OF) and norfloxacin (NOR), each exhibiting resistance in 10 isolates (52.63%). Levofloxacin (LEV) showed a moderate resistance level, with 6 resistant isolates (31.6%).
Table 4. Distribution of Resistance Genes.

Genes

Presence/Absence

Frequency

Total

Percentage

qnrA

Négative

14

14

100

qnrB

Négative

10

14

71.4

qnrB

Positive

4

14

28.6

qnrS

Négative

10

14

71,4

qnrS

Négative

4

14

28,6

The table above reports, for each resistance gene (qnrA, qnrB, qnrS), the number of bacterial isolates identified as either "Positive" or "Negative." The qnrB and qnrS genes exhibited the same distribution pattern, each being present in 4 isolates (28.6%) and absent in 10. In contrast, the qnrA gene was not detected in any of the tested isolates. The PCR results, as illustrated by the images obtained, are shown in Figure 1.
Figure 1. Visualization of PCR Amplification Products by Agarose Gel Electrophoresis.
3.3. Genetic Support of Resistance Genes
The test for determining the genetic support of resistance genes yielded the following results:
Table 5. Genetic Support Assessment of Antimicrobial Resistance Genes.

Genes

Positive

Negative

P-qnrS

2 (50%)

2 (50%)

p-qnrB

1 (25%)

3 (75%)

As shown in Table 5 above, among the four qnrS-type genes identified, 50% were carried by plasmids. In contrast, only 25% of the qnrB-type genes were found to be plasmid-borne.
3.4. Correlation Between Resistance Genes and Antibiotic Susceptibility
The correlation analysis between resistance genes and antibiotic susceptibility profiles (Figure 2) revealed a significant positive correlation between qnrB and NOR (r = 0.40), as well as with LEV (r = 0.33). Conversely, a strong negative correlation was observed between qnrS and OF (r = –0.548).
Figure 2. Heatmap of Correlations Between Resistance Genes and Antibiotics.
The heatmap illustrates strong positive correlations (in blue), strong negative correlations (in red), and weak or negligible correlations (in white).
4. Discussion
The emergence of antibiotic-resistant bacteria, particularly those resistant to quinolones, poses a serious threat to the effectiveness of antimicrobial agents that have revolutionized medicine and saved millions of lives . This challenge is particularly alarming in low-resource countries such as Burkina Faso, where infectious diseases, poverty, and malnutrition remain endemic . Prompt administration of appropriate antimicrobial therapy is essential for effective infection management. Empirical treatment strategies must therefore be informed by a thorough understanding of the pathogens involved and their resistance profiles .
The aim of this study was to assess the prevalence of fluoroquinolone resistance among Gram-negative bacilli and to identify the associated resistance genes. Among the isolates analyzed, E. coli was the most frequently detected species (52.63%), a finding consistent with several previous studies . However, other reports have identified K. pneumoniae as the dominant species .
In the present study, high resistance rates were observed for ciprofloxacin (CIP, 57.89%), norfloxacin (NOR, 52.63%), and ofloxacin (OF, 52.63%), with levofloxacin (LEV) exhibiting a comparatively lower resistance rate (31.37%). Similar trends have been reported elsewhere—for example, Swedan et al. found ciprofloxacin resistance to be predominant in Jordan , while Rafya et al. reported a high resistance rate to levofloxacin (93.4%) in Iraq . Differences across studies may be attributed to various factors, including population socio-economic characteristics, methodological differences, antibiotic accessibility, patterns of antibiotic misuse, and the clinical origin of the isolates.
Among the known mechanisms of fluoroquinolone resistance, plasmid-mediated resistance is one of the most recently identified . This study specifically investigated three qnr genes (qnrA, qnrB, qnrS). The qnrB and qnrS genes were each detected in 28.57% of the isolates, while qnrA was not detected in any sample. These frequencies are lower than those reported in a study from Togo, where the prevalence of qnrB, qnrS, and qnrA was 47.74%, 47.10%, and 2.58%, respectively . In studies conducted in Morocco , Mexico , and Côte d’Ivoire , qnrB was the most commonly identified gene.
In our dataset, qnr gene prevalence was highest in E. coli isolates (28.57%). This contrasts with studies from Tunisia and South Korea, where K. pneumoniae exhibited a significantly higher prevalence of qnr genes (up to 80%) . Such discrepancies may reflect regional variation in circulating resistance genes and phenotypes, as well as differences in sample size and bacterial strain distribution. The analysis of the genetic support of resistance genes revealed that 50% of the qnrS genes were plasmid-borne, while only 25% of the qnrB genes were associated with plasmids. However, several studies have reported and confirmed that qnr genes are typically carried by plasmids . This discrepancy could be explained by the possibility that the bacterial strain under investigation may have lost the plasmid carrying the qnr gene during culture or isolation. Additionally, the qnr gene may be located on other mobile genetic elements, such as transposons or integrons, which are not necessarily plasmid-associated but can still facilitate chromosomal integration. It is also possible that qnr genes are directly integrated into the bacterial chromosome rather than being carried by mobile genetic elements such as plasmids.
We also conducted a correlation analysis to explore potential relationships between resistance genes and the antibiotics to which they confer resistance. A significant positive correlation was found between qnrB and both NOR (r = 0.40) and LEV (r = 0.33). Conversely, qnrS showed a strong negative correlation with OF. The observed positive correlation supports the role of qnrB in resistance to NOR and LEV. Meanwhile, the negative correlation suggests the presence of alternative resistance mechanisms, such as chromosomal mutations in genes encoding DNA gyrase or overexpression of efflux pumps .
5. Conclusion
This study investigated quinolone resistance in various Gram-negative bacilli isolated from pus and vaginal swab samples. A high prevalence of resistance to ciprofloxacin, norfloxacin, and ofloxacin was observed. Additionally, a significant presence of specific resistance genes (qnrB, qnrS) was noted. These findings underscore the importance of continuous monitoring of antibiotic resistance in clinical isolates to inform effective antimicrobial stewardship.
Abbreviations

HOSCO

Saint Camille Hospital of Ouagadougou

PMQR

Plasmid-Mediated Quinolone Resistance

CIP

Ciprofloxacin

NOR

Norfloxacin

LEV

Levofloxacin

OF

Ofloxacin

DNA

Deoxyribonucleic Acid

EMB

Eosin Methylene Blue

CASFM

French Society for Microbiology's Antibiogram Committee

Acknowledgments
The author wishes to thank all study participants and extends sincere gratitude to the staff of Saint Camille Hospital of Ouagadougou for their support.
Conflicts of Interest
The authors declare no conflicts of interest.
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Cite This Article
  • APA Style

    Nikiema, R., Dabire, A. M., Kouta, O. F., Bambara, E. B. L., Ouedraodo, N., et al. (2025). Characterization of Quinolone Resistance Genes in Gram-Negative Bacilli Isolated from Pus and Vaginal Swabs at Saint Camille Hospital, Ouagadougou (HOSCO), Burkina Faso. American Journal of Biomedical and Life Sciences, 13(5), 90-97. https://doi.org/10.11648/j.ajbls.20251305.11

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    Nikiema, R.; Dabire, A. M.; Kouta, O. F.; Bambara, E. B. L.; Ouedraodo, N., et al. Characterization of Quinolone Resistance Genes in Gram-Negative Bacilli Isolated from Pus and Vaginal Swabs at Saint Camille Hospital, Ouagadougou (HOSCO), Burkina Faso. Am. J. Biomed. Life Sci. 2025, 13(5), 90-97. doi: 10.11648/j.ajbls.20251305.11

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    Nikiema R, Dabire AM, Kouta OF, Bambara EBL, Ouedraodo N, et al. Characterization of Quinolone Resistance Genes in Gram-Negative Bacilli Isolated from Pus and Vaginal Swabs at Saint Camille Hospital, Ouagadougou (HOSCO), Burkina Faso. Am J Biomed Life Sci. 2025;13(5):90-97. doi: 10.11648/j.ajbls.20251305.11

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  • @article{10.11648/j.ajbls.20251305.11,
      author = {Rabietou Nikiema and Amana Metuor Dabire and Olawoumi Fabrice Kouta and Eliada Benoit Lionel Bambara and Nicolas Ouedraodo and Rhaina Olivia Badini and Pegd-Wende Rose Bonkoungou},
      title = {Characterization of Quinolone Resistance Genes in Gram-Negative Bacilli Isolated from Pus and Vaginal Swabs at Saint Camille Hospital, Ouagadougou (HOSCO), Burkina Faso
    },
      journal = {American Journal of Biomedical and Life Sciences},
      volume = {13},
      number = {5},
      pages = {90-97},
      doi = {10.11648/j.ajbls.20251305.11},
      url = {https://doi.org/10.11648/j.ajbls.20251305.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajbls.20251305.11},
      abstract = {Introduction: Antibiotic resistance, particularly to quinolones, represents a major public health concern in Burkina Faso. In recent decades, plasmid-mediated quinolone resistance (PMQR) mechanisms have emerged, especially among Gram-negative bacteria. These mechanisms include, among others, qnr genes (qnrA, qnrB, qnrS). This study aimed to investigate the presence of quinolone resistance determinants in Gram-negative bacilli isolated from pus and vaginal samples at Saint Camille Hospital of Ouagadougou (HOSCO). Methodology: A total of 19 strains of Escherichia coli isolated from pus and vaginal swabs were collected for bacteriological and molecular analysis. Four antibiotics, namely ciprofloxacin (CIP), norfloxacin (NOR), ofloxacin (OF) and levofloxacin (LEV) were used for sensitivity testing and molecular analysis focused on the detection of qnrA, qnrB, and qnrS type genes. Results: Resistance rates to CIP, NOR, OF, and LEV were 57.89%, 52.63%, 52.63%, and 31.37%, respectively. Molecular analysis revealed the presence of qnrB, and qnrS genes in 28.47% of the isolates, for each gene. The qnrA gene was not detected in any isolate. The analysis of the genetic support of resistance genes revealed that 50% of the qnrS genes were plasmid-borne, while only 25% of the qnrB genes were associated with plasmids. La Correlation analysis between resistance genes and antibiotics showed a moderate positive correlation between qnrB and NOR/LEV, thereby suggesting the involvement of qnrB in resistance to these antibiotics. Conclusion: These findings highlight the need for continuous surveillance of antibiotic resistance in clinical isolates.
    },
     year = {2025}
    }
    

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  • TY  - JOUR
    T1  - Characterization of Quinolone Resistance Genes in Gram-Negative Bacilli Isolated from Pus and Vaginal Swabs at Saint Camille Hospital, Ouagadougou (HOSCO), Burkina Faso
    
    AU  - Rabietou Nikiema
    AU  - Amana Metuor Dabire
    AU  - Olawoumi Fabrice Kouta
    AU  - Eliada Benoit Lionel Bambara
    AU  - Nicolas Ouedraodo
    AU  - Rhaina Olivia Badini
    AU  - Pegd-Wende Rose Bonkoungou
    Y1  - 2025/10/27
    PY  - 2025
    N1  - https://doi.org/10.11648/j.ajbls.20251305.11
    DO  - 10.11648/j.ajbls.20251305.11
    T2  - American Journal of Biomedical and Life Sciences
    JF  - American Journal of Biomedical and Life Sciences
    JO  - American Journal of Biomedical and Life Sciences
    SP  - 90
    EP  - 97
    PB  - Science Publishing Group
    SN  - 2330-880X
    UR  - https://doi.org/10.11648/j.ajbls.20251305.11
    AB  - Introduction: Antibiotic resistance, particularly to quinolones, represents a major public health concern in Burkina Faso. In recent decades, plasmid-mediated quinolone resistance (PMQR) mechanisms have emerged, especially among Gram-negative bacteria. These mechanisms include, among others, qnr genes (qnrA, qnrB, qnrS). This study aimed to investigate the presence of quinolone resistance determinants in Gram-negative bacilli isolated from pus and vaginal samples at Saint Camille Hospital of Ouagadougou (HOSCO). Methodology: A total of 19 strains of Escherichia coli isolated from pus and vaginal swabs were collected for bacteriological and molecular analysis. Four antibiotics, namely ciprofloxacin (CIP), norfloxacin (NOR), ofloxacin (OF) and levofloxacin (LEV) were used for sensitivity testing and molecular analysis focused on the detection of qnrA, qnrB, and qnrS type genes. Results: Resistance rates to CIP, NOR, OF, and LEV were 57.89%, 52.63%, 52.63%, and 31.37%, respectively. Molecular analysis revealed the presence of qnrB, and qnrS genes in 28.47% of the isolates, for each gene. The qnrA gene was not detected in any isolate. The analysis of the genetic support of resistance genes revealed that 50% of the qnrS genes were plasmid-borne, while only 25% of the qnrB genes were associated with plasmids. La Correlation analysis between resistance genes and antibiotics showed a moderate positive correlation between qnrB and NOR/LEV, thereby suggesting the involvement of qnrB in resistance to these antibiotics. Conclusion: These findings highlight the need for continuous surveillance of antibiotic resistance in clinical isolates.
    
    VL  - 13
    IS  - 5
    ER  - 

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    1. 1. Introduction
    2. 2. Methodology
    3. 3. Results
    4. 4. Discussion
    5. 5. Conclusion
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