evaluation of expression of nora efflux pump in ciprofloxacin resistant staphylococcus aureus against hexahydroquinoline derivative by real-time pcr.

staphylococcus aureus causes a wide variety of infections worldwide. methicillin-resistant s. aureus is one of most common causes of nosocomial and community acquired infections. the fluoroquinolones are an important class of antibiotics that used to treat infections caused by s. aureus. today, a significant increase in the rate of ciprofloxacin resistance in methicillin-resistant s. aureus strains is concerning. the nora efflux pump is considered as contributors to antibiotic resistance. here, we aimed to evaluate the expression of nora efflux pump in the presence of hexahydroquinoline derivative in methicillin and ciprofloxacin resistant s. aureus. we were determined minimum inhibitory concentration of ciprofloxacin and hexahydroquinoline derivative and their combination by broth microdilution method against ciprofloxacin resistant s. aureus. the expression of the nora efflux pump gene was evaluated by quantitative real-time pcr. this study showed that minimum inhibitory concentrations of ciprofloxacin in the presence of hexahydroquinoline derivative in comparison to ciprofloxacin were decreased. quantitative real-time pcr identified the increased expression of nora efflux pump gene in methicillin and ciprofloxacin resistant s. aureus strain. the increased expression of nora efflux pump gene may have resulted in the effort of s. aureus to survive. the results showed that the hexahydroquinoline derivative enhanced the antibacterial effect of ciprofloxacin against methicillin and ciprofloxacin resistant s. aureus. therefore, the derivatives may be used as inhibitors of antibiotic resistance for combination therapy.