Hamed S.M.Elkhatib W.F.El-Mahallawy H.A.Helmy M.M.Ashour M.S.Aboshanab K.M.A.Department of Microbiology and ImmunologyFaculty of PharmacyOctober University for Modern Sciences and Arts6th of OctoberGizaEgypt; Department of Microbiology and ImmunologyFaculty of PharmacyAin Shams UniversityAfrican Union Organization St. AbbassiaCairo11566Egypt; Department of Clinical PathologyNational Cancer InstituteCairo UniversityCairoEgypt; Department of Microbiology and ImmunologyFaculty of MedicineZagazig UniversityZagazigEgypt; Department of Microbiology and ImmunologyFaculty of PharmacyAl-Azhar UniversityCairoEgypt2020-01-092020-01-09201820452322https://doi.org/10.1038/s41598-018-30756-4PubMed ID 30115947https://t.ly/b2jPEScopusFluoroquinolones have been used for prophylaxis against infections in cancer patients but their impact on the resistance mechanisms still require further investigation. To elucidate mechanisms underlying ciprofloxacin (CIP) resistance in Gram-negative pathogens causing infections to cancer patients, 169 isolates were investigated. Broth microdilution assays showed high-level CIP resistance in 89.3% of the isolates. Target site mutations were analyzed using PCR and DNA sequencing in 15 selected isolates. Of them, all had gyrA mutations (codons 83 and 87) with parC mutations (codons 80 and 84) in 93.3%. All isolates were screened for plasmid-mediated quinolone resistance (PMQR) genes and 56.8% of them were positive in this respect. Among PMQR genes, aac(6?)-Ib-cr predominated (42.6%) while qnr genes were harbored by 32.5%. This comprised qnrS in 26.6% and qnrB in 6.5%. Clonality of the qnr-positive isolates using ERIC-PCR revealed that most of them were not clonal. CIP MIC reduction by CCCP, an efflux pump inhibitor, was studied and the results revealed that contribution of efflux activity was observed in 18.3% of the isolates. Furthermore, most fluoroquinolone resistance mechanisms were detected among Gram-negative isolates recovered from cancer patients. Target site mutations had the highest impact on CIP resistance as compared to PMQRs and efflux activity. � 2018, The Author(s).Englishciprofloxacinantibiotic resistancebacterial genedrug effectgeneticsGram negative bacteriumhumanmicrobiologymultidrug resistanceneoplasmphylogenyphysiologyCiprofloxacinDrug Resistance, BacterialDrug Resistance, Multiple, BacterialGenes, BacterialGram-Negative BacteriaHumansNeoplasmsPhylogenyArticlehttps://doi.org/10.1038/s41598-018-30756-4PubMed ID 30115947