UJMR, Volume 5 Number 1, June, 2020, pp 31 - 35 ISSN: 2616 – 0668

https://doi.org/10.47430/ujmr.2051.005

Received: 29th May, 2020 Accepted: 01st July, 2020

Evaluation of Susceptibility Profiles of Some Bacteria to Flouroquinolones in Kano
Metropolis, Nigeria
1*
Mohammed, B. and 2Ahmad, R. H.
Department of Microbiology, Bayero University, Kano. P. M. B. 3011
Correspondence Author: [email protected]; 08126620363
Abstract
Resistance to broad spectrum antibiotics such as flouroquinolones by bacteria is becoming a
major threats towards the chemotherapy of some common pathogenic bacterial infections in
the world especially the developing nations. In view of that, susceptibility profiles of some
pathogenic bacteria to some flouroquinolones were evaluated using modified Kirby-Bauer Disc
Diffusion Technique. Four flouroquinolones antibiotics; ofloxacin and ciprofloxacin (second
generation), levofloxacin (third generation), moxifloxacin (fourth generation) were tested on
five bacterial species (Staphyllococcusaureus, Escherichia coli, Pseudomonas aeruginosa,
Enterococcus faecalis and Klebsiella pneumoniae) sourced from Aminu Kano Teaching Hospital,
Kano, Nigeria, and re-confirmed at Microbiology Laboratory in Bayero University, Kano. The
results of the study revealed that 8(26.7%) of E. faecalis isolates were sensitive levofloxacin,
6(20.0%) were saensitive to ciprofloxacin and 1(3.33%) were sensitive to ofloxacin, while
0(0.00%) was sensitive to moxifloxacin. Seven isolates (23.3%) of S. aureus were sensitive to
levofloxacin, 15(50.0%) were sensitive to ciprofloxacin and 4(13.3%) were sensitive to
ofloxacin, while none (100%) were sensitive to moxifloxacin. E. coli isolates were 96.6%
resistant to levofloxacin, Klebsiella pneumoniae and P. aeruginosa isolates exhibited 76.6 and
50.0% resistance to the antibiotic respectively. There was significant difference in the
performance of the four antibiotics used, ciprofloxacin better than others (p-value 0.00604).
There was no significant difference in the percentages of sensitive bacterial species to the
antibiotics used in the research (p-value 0.614), however, P. aeruginosa showed relatively
higher number of sensitive isolates 30(40%). It can be concluded that 58% of the isolates were
moderately sensitive to all the antibiotics in this study.
Key words: flouroquinolones, clinical bacterial isolates, sensitivity and resistance profiles.

INTRODUCTION had been used intensively worldwide and

Flouroquinolones are broad spectrum resistant lineages of many bacterial species had
antibiotics capable of exerting their evolved (Jo, 2018).
antibacterial activity on wide range of bacteria Researchers divided quinolones into generations
(both Gram-positive and Gram-negative); they based on their antibacterial spectrum; the
are highly effective for the treatment of a earlier generation agents are in general more
variety of clinical and veterinary infections narrow-spectrum than the later ones (Jo,
(Valery et al., 2014). They are derivatives of 2018). Flouroquinolone antibiotics most
quinolones group of antibiotics having fluorine frequently prescribed today consist of
atom attached to the central ring system, ciprofloxacin, levofloxacin, moxifloxacin and to
typically at the 6-position or C-7 position. They some extent their generic equivalents (Oliphant
are synthetic bactericidal agents which prevent and Eray, 2002). Flouroquinolones have proved
bacterial DNA from unwinding and duplicating; effective in many infections, including
the antibiotics bind with enzymesDNA uncomplicated or complicated urinary tract
gyraseand topoisomerse IV which brings about infections (Jo, 2018), respiratory tract
the unwinding of DNA (Willey et al., 2008), a infections, gonorrhea, bacterial gastroenteritis
necessary step for its replication. United State and soft tissue infections due to Gram-negative
doctors in 2015 doled out 32million prescription organisms. In Kano State, flouroquinolones are
for the drugs, making them the country’s fourth among the most widely prescribed antibiotics
most popular class of antibiotic (Jo, 2018). In for the treatment of bacterial infections.
African countries, widespread use of the Treatment of bacterial infections is increasingly
antibiotics came into being in the early 2000s, complicated by the ability of bacteria to
after patents for the first generation expired. develop resistance to antimicrobial agents
By that time, quinolone antibacterial agents including fluoroquinolones (Fred, 2006).
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 UJMR, Volume 5 Number 1, June, 2020, pp 31 - 35 ISSN: 2616 – 0668

According to Alkali et al. (2019) morethan 80% Antibiotic susceptibility test

of nosocomial infection in Kano are cause by The antibiotics susceptibility profiles of the
the negative bacteria predominantly isolates was determined using the Kirby-Bauer
Pseudomonas aeruginosa, Klebsiella modified disc diffusion technique as described
pneumoniae and E. coli. by CLSI (2014). Disc potency of 5µg was used
Resistance to fluoroquinolones by bacteria had for each antibiotic against the test organisms as
been reported in many parts of the world by reported by Cheesbrough (2006).
Hooper (2001) therefore, it is important to Fifteen milliliter of warm and sterile Muller
periodically evaluate the susceptibility profile Hinton agar (MHA) was dispensed in to separate
of clinical bacterial isolates to these antibiotics Petri dishes and allowed to solidify. Using
so as to ascertain their relevance or otherwise sterile swab sticks, each standardized inoculum
in clinical applications. The study aimed at was smeared evenly on the surface of the MHA
evaluating the susceptibility profiles of some plates and allowed to dry. Then, using sterile
bacteria to flouroquinolones in Kano Metropolis. forcep, disks of the flouroquinolone
antibioticswith potencies of 5µg were placed
MATERIALS AND METHODS atthe distance of 5cm from each other and 3cm
Sourcing of Bacterial Clinical Isolates from the edge of the plates. Then plates, were
One hundred and fifty (150) bacterial isolates inverted and incubated at 37ºC for 24hrs. Zone
(thirty isolates each of Enterococcus faecalis, diameters of inhibition were measured and
Staphyllococcus aureus, Escherichia coli, recorded in millimeter (Cheesbrough, 2006).
Klebsiella pneumoniae and Pseudomonas Statistical Analysis
aeruginosa were randomly collected from The results were analyzed by two – way
Microbiology Laboratory atAminu Kano Teaching analyses of variance (ANOVA), using Microsoft
Hospital, Kano, Nigeria from September to excel.
December, 2015.
Confirmation of the Test Isolates RESULTS
Gram Staining Test The results of the susceptibility profiles of the
The isolates were subjected to Gram staining bacterial isolates revealed that 22(73.3%),
reaction to ascertain their identity as Gram 23(76.6%) and 15(50%) of E. faecalis, S. aureus
positive or Gram negative as reported by and Pseudomonas aeruginosa were moderately
Cheesbrough(2006). sensitive to levofloxacin (16 to 20mm zone
Biochemical Test for Identification of the diameter of inhibition), while 23(76.6%),
Isolates 29(96.6%) and none of the E. faecalis and S.
The tests carried out include; coagulase test, aureus were resistant to the antibiotic (< 15mm
catalase test, indole, Methyl red, zone diameter of inhibition) (Table 1). Most of
Vogesproskauer, Triple sugar Iron and citrate as the isolates were moderately resistant to
described by (Cheesbrough 2006; Shamsuddeen ofloxacin (Table 2), similarly, the isolates were
et al, 2013). mostly moderately sensitive to ciprofloxacin
Preparation of Standardized Inoculum (Table 3). Between 18 (60.0%), 20(66.6%),
Standardization of the inocula wasperformed 22(73.3%), 25(83.3%) and 27(90.0%) of the
using the protocols of CLSI (2014). The turbidity isolates were moderately sensitive to
of each inoculum suspension was matched with moxifloxacin (Table 4).
that of 0.5 McFarland turbidity standards 1.5 x
108 CFU/ML.

Table 1. Susceptibility Profiles of some Bacteria to Levofloxacin Antibiotics

Organisms No of isolates tested Sensitive Mod. Sensitive Resistant
(%) (%) (%)
E. faecalis 30 8(26.7) 22(73.3) 0(0.0)
S. aureus 30 7(23.3) 23(76.6) 0(0.0)
E. coli 30 0(0.0) 1(3.33) 29(96.6)
Klebsiella pneumoniae 30 0(0.0) 7(23.3) 23(76.6)
Pseudomonas aeruginosa 30 0(0.0) 15(50.0) 15(50.0)
p-value0.184
Key: Sensitive = >21mm, Moderately sensitive = 16 to 20mm, Resistant < 15mm Source: CLSI (2014)

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 UJMR, Volume 5 Number 1, June, 2020, pp 31 - 35 ISSN: 2616 – 0668
Table 2. Susceptibility Profiles of some Bacteria to Ofloxacin Antibiotics
Organisms No of isolates tested Sensitive (%) Mod. Sensitive (%) Resistant
(%)
E. faecalis 30 1(3.3) 14(46.6) 15(50.0)
S. aureus 30 4(13.3) 24(80.0) 2(6.66)
E. coli 30 10(33.3) 18(60.0) 2(6.66)
K. pneumoniae 30 4(13.3) 23(76.6) 3(10.0)
P. aeruginosa 30 9(30) 21(70.0) 0(0.0)
p-value 0.00476
Key: Mod. Sensitive= Moderately sensitive, Sensitive = >16mm, Moderately sensitive = 13 to 15mm,
Resistant < 12mm Source: CLSI (2014)
Table 3. Susceptibility Profiles of some Bacteria to Ciprofloxacin Antibiotics
Organisms No of isolates tested Sensitive (%) Mod. Sensitive (%) Resistant (%)
E. faecalis 30 6(20.0) 17(56.6) 7(23.3)
S. aureus 30 15(50.0) 15(50.0) 0(0.0)
E. coli 30 14(46.6) 16(53.3) 0(0.0)
K. pneumoniae 30 13(43.3) 17(56.6) 0(0.0)
P.aeruginosa 30 13(43.3) 17(56.6) 0(0.0)
p-value 0.00033
Key: Sensitive = >21mm, Moderately sensitive = 16 to 20mm, Resistant < 15mm Source: CLSI (2014)
Table 4. Susceptibility Profiles of some Bacteria toMoxifloxacin Antibiotics
Organisms No of isolates tested Sensitive (%) Mod. Sensitive (%) Resistant (%)
E. faecalis 30 0(0.0) 22(73.3) 8(26.6)
S. aureus 30 0(0.0) 27(90.0) 3(10.0)
E. coli 30 1(3.33) 20(66.6) 9(30.0)
K.pneumoniae 30 1(3.33) 25(83.3) 4(13.3)
P. aeruginosa 30 8(26.6) 18(60.0) 4(13.3)
P-value 0.00009
Key: Sensitive = >21mm (zone diameter of inhibion), Moderately sensitive = 16 to 20mm, Resistant <
15mm, Source: CLSI (2014)

DISCUSSION resistant to the antibiotic, but significant

The results of the study had revealed that there percentage (70%) were moderately resistant;
was wide spread of resistance to levofloxacin this is contrary to the findings of the above
by the E. coli, K. pnuemoniae and P. aeruginosa mentioned researchers who obtained up to 40%
isolates; 75% of the isolates were not 100% resistance to ofloxacin by Pseudomonas
sensitive to the antibiotic. This finding was aeruginosa isolates.
contrary to that of Siegrist et al. (1999), who Most of the isolates were moderately resistant
obtained 100%, 94%, 97%, 98% and 87% to ciprofloxacin; however, there was no
sensitivity to levofloxacin by Enterococcus significant difference (p-value 0.08625)
faecalis, Staphyllococcus aureus, E. coli, between the resistant and the moderately
Klebsiella pneumoniae and Pseudomonas resistant isolates. No resistance against
aeruginosa respectively in a susceptibility study ciprofloxacin was observed among the isolates
on clinical isolates of bacteria conducted in except some isolates of Enterococcus faecalis.
Switzerland. This finding is not in conformity with that of
Generally, over 80% of the isolates used in this Reis et al. (2016) who reported some level of
study were moderately sensitive to ofloxacin, resistance against ciprofloxacin by most the
this was not in conformity with the findings of species used in their study.
Griedrys-Kalemba and Bilska (1993), who Most of the isolates used in this study were
reported that Enterococcus faecalis, found to be moderately sensitive to
Staphyllococcus aureus, E. coli and Klebsiella moxifloxacin, this finding is not in conformity
pneumonia were frequently susceptible to with that of Gita et al. (2007) who recorded
ofloxacin with less than 10-20% resistance to 97.5% susceptibility to moxifloxacinby some
the antibiotic in a susceptibility study of clinical isolates of bacteria (Staphyllococcus
bacteria to ofloxacin in Poland. Similary, the albus, Pseudomonas aeruginosa, Streptococcus
results of the study have shown viridans, Streptococcus pneumoniae,
thatPseudomonas aeruginosa isolates were not Staphyllococcus aureus and Escherichia coli in
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 UJMR, Volume 5 Number 1, June, 2020, pp 31 - 35 ISSN: 2616 – 0668
India. Similarly, there was increase in Hooper (2001), Threlfall and Hopkins, 2005),
resistance to moxifloxacin by the isolates used Tenover (2006) and Alekshun and Levy (2007).
in this study (18.4%) when compared with 2.75%
recorded by Gita et al. (2007). CONCLUSION
Resistance to fluoroquinolones by bacteria such In conclusion, there was high resistance to
as S. aureus, E. coli, P. aeruginosa, N. fluoroquinolones among the isolates used in this
gonorrhoeae, S. pneumoniaewere reported to study, however, ciprofloxacin was found to be
be the same for all the generations of the the best among the fluoroquinolones tested.
antibiotics. This could be due to chromosomal Similarly, E. faecalis is the most resistant
mutation, acquisition of extra-chromosomal specie observed in this study.
materials (plasmids, integrons, transposons)
through conjugation, all these results in the RECOMMENDATION
alteration of binding sites (DNA gyrase and It is recommended that susceptibility profile of
topoisomrase IV enzymes); other causes of bacteria be determined before patients are
resistance include activation of efflux pump placed on fluoroquinolone antibiotics. Then
and over expression of porins which brings patients should adhere strickly to the dosage of
about reduction in the uptake or accumulation antibiotic recommended by physicians.
of the antibiotics in the bacteria as reported by
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