Prevalence of blaCTX-M gene in multi-resistant Escherichia coli isolated from Urinary Tract Infections, Tehran, Iran
The emergence and increase in the incidence of Extended-spectrum beta lactamase (ESBL) producing Escherichia coli has become an emerging challenge especially in hospitalized patients with UTI. The aim of the present study was to survey the frequency of bla CTX-M genotype in ESBL producing E. coli isolated from hospitalized patients with UTI and determination of their antibiotic resistance pattern.
Material and methods
A total of 135 E. coli isolates were collected from isolated from patients with UTI. The isolates were subjected to confirmatory phenotype tests for the presence of ESBL. 75 E. coli isolates were confirmed as ESBL-positive by means of the Double disc synergy test. In vitro susceptibility of ESBL isolates to 15 antimicrobial agents amoxicillin, penicillin, ceftazidime, cefotaxime, cefoxitin, ceftriaxone, cefixime, cephalexin, co-trimoxazole, gentamicin, nalidixic acid, ciprofloxacin, nitrofourantoin, amikacin and imipenem was performed by Kirby-Bauer’s Disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI, 2012) guideline. PCR method was used to identify bla CTX-M gene in 75 ESBL positive strains.
PCR and sequence analysis showed that 75 (55.5%) isolates produced bla CTX-M genes. In vitro susceptibility of ESBL producing E. coli showed that all of them were resistant to amoxicillin and penicillin and The rates of resistance to the majority of tested antibiotics varied between 61% to 100 %, with the exception of amikacin (14.7%) and imipenem (2.7%). Our results showed that the frequency of bla CTX-M was strikingly high (93.3%).
These data confirmed that the frequency of bla CTX-M genes were high among E. coli isolated from patients with UTI. The trend of multidrug-resistant profile has been associated with bla CTX-M gene is alarming. Therefore, it is very important to establish a routine screening of ESBL in clinical isolates to prevent dissemination of resistant isolates in health care settings.
Livermore D, Hawkey P. CTX-M: changing the face of ESBLs in the UK. Journal of Antimicrobial Chemotherapy. 2005;56(3):451-4.
Eckert C, Gautier V, Arlet G. DNA sequence analysis of the genetic environment of various blaCTX-M genes. Journal of Antimicrobial Chemotherapy. 2006;57(1):14-23.
Gupta V. An update on newer beta-lactamases. Indian Journal of Medical Research. 2007;126(5):417.
Bonnet R. Growing group of extended-spectrum β-lactamases: the CTX-M enzymes. Antimicrobial agents and chemotherapy. 2004;48(1):1-14.
Ambler R, Coulson A, Frère J-M, Ghuysen J-M, Joris B, Forsman M, et al. A standard numbering scheme for the class A beta-lactamases. Biochemical Journal. 1991;276(Pt 1):269.
Feizabadi MM, Delfani S, Raji N, Majnooni A, Aligholi M, Shahcheraghi F, et al. Distribution of bla TEM, bla SHV, bla CTX-M genes among clinical isolates of Klebsiella pneumoniae at Labbafinejad Hospital, Tehran, Iran. Microbial drug resistance. 2010;16(1):49-53.
Goudarzi M, Seyedjavadi SS, Goudarzi H, Boromandi S, Ghazi M, Azad M, et al. Characterization of coagulase-negative staphylococci isolated from hospitalized patients in Tehran, Iran. Journal of Paramedical Sciences. 2014;5(2).
Ruppé E, Hem S, Lath S, Gautier V, Ariey F, Sarthou J-L, et al. CTX-M β-lactamases in Escherichia coli from community-acquired urinary tract infections, Cambodia. Emerging infectious diseases. 2009;15(5):741.
Komatsu M, Ikeda N, Aihara M, Nakamachi Y, Kinoshita S, Yamasaki K, et al. Hospital outbreak of MEN-1-derived extended spectrum β-lactamase-producing Klebsiella pneumoniae. Journal of infection and chemotherapy. 2001;7(2):94-101.
Sana T, Rami K, Racha B, Fouad D, Marcel A, Hassan M, et al. Detection of genes TEM, OXA, SHV and CTX-M in 73 clinical isolates of Escherichia coli producers of extended spectrum Betalactamases and determination of their susceptibility to antibiotics. The International Arabic Journal of Antimicrobial Agents. 2011;1(1).
Forbes BA, Sahm DF, Weissfeld AS. Bailey & Scott's diagnostic microbiology. 12th edition, Mosby Elsevier, 2007; 842-55.
Bali EB, Accedil L, Sultan N. Phenotypic and molecular characterization of SHV, TEM, CTX-M and extended-spectrum-lactamase produced by Escherichia coli, Acinobacter baumannii and Klebsiella isolates in a Turkish hospital. African Journal of Microbiology Research. 2010;4(8):650-4.
Lee S, Park Y-J, Kim M, Lee HK, Han K, Kang CS, et al. Prevalence of Ambler class A and D β-lactamases among clinical isolates of Pseudomonas aeruginosa in Korea. Journal of Antimicrobial Chemotherapy. 2005;56(1):122-7.
Goudarzi H, Douraghi M, Ghalavand Z, Goudarzi M. Assessment of antibiotic resistance pattern in Acinetobacter bumannii carrying bla oxA type genes isolated from hospitalized patients. Novelty in Biomedicine. 2013;1(2):54-61.
Ahmed OI, El-Hady SA, Ahmed TM, Ahmed IZ. Detection of bla SHV and bla CTX-M genes in ESBL producing Klebsiella pneumoniae isolated from Egyptian patients with suspected nosocomial infections. Egyptian Journal of Medical Human Genetics. 2013;14(3):277–83.
Ahmed SM, Jakribettu R, Koyakutty S, Arya B, Shakir V. Urinary tract infections–an overview on the prevalence and the anti-biogram of gram negative uropathogens in a tertiary care center in North Kerala, India. J Clin Diagn Res. 2012;6:1192-5.
Fernandes R, Amador P, Oliveira C, Prudêncio C. Molecular Characterization of ESBL-Producing Enterobacteriaceae in Northern Portugal. The Scientific World Journal. 2014;2014.
Hamedelnil F, Eltayeb H. Molecular detection of Extended Spectrum β-lactamases (ESBLs) genes in E. coli isolated from urine specimens. 2012.
Martinez P, Garzón D, Mattar S. CTX-M-producing Escherichia coli and Klebsiella pneumoniae isolated from community-acquired urinary tract infections in Valledupar, Colombia. The Brazilian Journal of Infectious Diseases. 2012;16(5):420-5.
Cicek AC, Saral A, Duzgun AO, Yasar E, Cizmeci Z, Balci PO, et al. Nationwide study of Escherichia coli producing extended-spectrum β-lactamases TEM, SHV and CTX-M in Turkey. The Journal of antibiotics. 2013;66(11):647-50.
Ibrahim M, Bilal N, Hamid M. Increased multi-drug resistant Escherichia coli from hospitals in Khartoum state, Sudan. African health sciences. 2013;12(3):368-75.
Salem MM, Muharram M, Alhosiny IM. Distribution of classes 1 and 2 integrons among multi drug resistant E. coli isolated from hospitalized patients with urinary tract infection in Cairo, Egypt. Australian Journal of Basic and Applied Sciences. 2010;4(3):398-407.
Harada Y, Morinaga Y, Yamada K, Migiyama Y, Nagaoka K. Clinical and Molecular Epidemiology of Extended-Spectrum β-lactamase-Producing Klebsiella pneumoniae and Escherichia Coli in a Japanese Tertiary Hospital. J Med Microb Diagn. 2013;2(127):2161-0703.1000127.
Yu Y, Ji S, Chen Y, Zhou W, Wei Z, Li L, et al. Resistance of strains producing extended-spectrum β-lactamases and genotype distribution in China. Journal of Infection. 2007;54(1):53-7.
Kiratisin P, Apisarnthanarak A, Laesripa C, Saifon P. Molecular characterization and epidemiology of extended-spectrum-β-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates causing health care-associated infection in Thailand, where the CTX-M family is endemic. Antimicrobial agents and chemotherapy. 2008;52(8):2818-24.
Hassan H, Abdalhamid B. Molecular characterization of extended-spectrum beta-lactamase producing Enterobacteriaceae in a Saudi Arabian tertiary hospital. The Journal of Infection in Developing Countries. 2014;8(03):282-8.
Bartoloni A, Pallecchi L, Benedetti M, Fernandez C, Vallejos Y, Guzman E, et al. Multidrug-resistant commensal Escherichia coli in children, Peru and Bolivia. Emerg Infect Dis. 2006;12(6):907-13.
Giske CG, Monnet DL, Cars O, Carmeli Y. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrobial agents and chemotherapy. 2008;52(3):813-21.
Kibret M, Abera B. Antimicrobial susceptibility patterns of E. coli from clinical sources in northeast Ethiopia. African health sciences. 2011;11(3):40-5.
Ngwai YB, Akpotu MO, Obidake RE, Sounyo AA, Onanuga A, Origbo SO. Antimicrobial susceptibility of Escherichia coli and other coliforms isolated from urine of asymptomatic students in Bayelsa State, Nigeria. African Journal of Microbiology Research. 2011;5(3):184-91.
Šeputienė V, Linkevičius M, Bogdaitė A, Povilonis J, Plančiūnienė R, Giedraitienė A, et al. Molecular characterization of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates from hospitals in Lithuania. Journal of Medical Microbiology. 2010;59(10):1263-5.
Mendonça N, Leitão J, Manageiro V, Ferreira E, Caniça M. Spread of extended-spectrum β-lactamase CTX-M-producing Escherichia coli clinical isolates in community and nosocomial environments in Portugal. Antimicrobial agents and chemotherapy. 2007;51(6):1946-55.
Barlow M, Reik RA, Jacobs SD, Medina M, Meyer MP, McGowan Jr JE, et al. High rate of mobilization for blaCTX-Ms. Emerging infectious diseases. 2008;14(3):423.