Molecular mechanisms of quinolone resistance in uropathogenic Escherichia coli in South America: A systematic review
DOI:
https://doi.org/10.5281/zenodo.21544040Keywords:
Escherichia coli, quinolone resistance, urinary tract infections, South America, molecular mechanismsAbstract
Introduction: Quinolone resistance in uropathogenic Escherichia coli (UPEC) constitutes a critical public health threat in South America, compromising the efficacy of fluoroquinolones, traditionally first-line drugs for urinary tract infections (UTI).
Objective: To identify and analyze molecular mechanisms of resistance, including mutations in the Quinolone Resistance-Determining Region (QRDR) and Plasmid-Mediated Quinolone Resistance (PMQR) genes, reported in clinical E. coli strains in South America.
Methods: A systematic review was conducted under the PRISMA 2020 guidelines. PubMed, SciELO and LILACS were searched for studies published between 2008 and 2025 on human isolates in the region. Quality was assessed using Joanna Briggs Institute tools.
Results: Five representative studies from Brazil, Argentina and a multinational cohort were included. The predominant mechanism was accumulation of high-level chromosomal mutations, specifically the D87N substitution in gyrA and alterations in parC (S80I), closely linked to the pandemic clone ST131. Among plasmid determinants, qnrB19 and the aac(6')-Ib-cr variant stood out.
Conclusions: Resistance in the region is a multifactorial process driven by synergy between QRDR mutations and horizontal dissemination of PMQR genes, facilitated by high-risk lineages. These findings underscore the need to restrict empirical use of fluoroquinolones in South America.
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Copyright (c) 2026 Dominick Farias De Oliveira Xerez, Beatriz De Oliveira Rodrigues, Felipe Pereira Barbosa, Jessica Lemos Rezende, Nicole Priscila Da Silva Olbrisch, Lucas Silva Bernardo, Luana Feitosa dos Santos, Andrea Paola Britos Gómez (Autor/a)
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