Extended-Spectrum β-Lactamase- and Carbapenemase-Producing Enterobacteriaceae Isolated from Egyptian Patients with Suspected Blood Stream Infection.

H M Abdallah,B B Wintermans,A M Ammar,C M J E Vandenbroucke-Grauls,A A Mohamed,A Koek,N Al Naiemi,E A Reuland,Massimiliano Galdiero

doi:10.1371/journal.pone.0128120

H M Abdallah, B B Wintermans + Show 7 more

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https://doi.org/10.1371/journal.pone.0128120

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Abstract

ObjectivesThe aim of the study was to investigate the prevalence of extended-spectrum β-lactamase and carbapenemase production among Enterobacteriaceae isolated from Egyptian patients with suspected blood stream infection.MethodsNinety-four Enterobacteriaceae blood culture isolates from Egyptian patients with suspected blood stream infection were collected, one isolate per patient. Identification of bacterial isolates was performed with MALDI-TOF (MS-based Vitek MS system, bioMerieux). Screening for ESBLs and carbapenemases production was done with the Vitek 2 system (bioMérieux). ESBL production was confirmed using the combined disk diffusion method for cefotaxime, ceftazidime, and cefepime, all with and without clavulanic acid (Rosco). Real-time PCR and sequencing were used to characterize the resistance genes. The phylogenetic groups of E. coli were identified by a PCR-based method.ResultsOf the 94 Enterobacteriaceae isolates 46 (48.93%) showed an ESBL phenotype. One Enterobacter spp isolate was ESBL-producer and meropenem-resistant. The genetic analysis showed that CTX-M was present in 89.13% (41/46) of the ESBL-producing Enterobacteriaceae, whereas TEM and SHV were detected in 56.52% (26/46) and 21.74% (10/46) respectively (47.83%) of the ESBL-producing isolates were multidrug resistant (MDR). Eleven out of 30 ESBL-producing E-coli isolates were assigned to phylogroup B2, followed by groups B1 (8 isolates), A (6 isolates) and D (5 isolates).ConclusionsThe high ESBL-E rates (48.93%) found in this study together with the identification of one carbapenem-resistant Enterobacter spp isolate is worrisome. Our results indicate that systems for monitoring and detection of ESBL-producing bacteria in Egyptian hospitals have to be established. Also strict hospital infection control policies with the restriction of the consumption of extended-spectrum cephalosporins are necessary.

Highlights

The β-lactam antibiotics are the most commonly used therapeutic class of antimicrobials for treatment of bacterial infection because of their broad antibacterial spectrum and excellent safety profile [1]
The aim of the study was to investigate the prevalence of extended-spectrum β-lactamase and carbapenemase production among Enterobacteriaceae isolated from Egyptian patients with suspected blood stream infection
The genetic analysis showed that CTX-M was present in 89.13% (41/46) of the ESBL-producing Enterobacteriaceae, whereas TEM and SHV were detected in 56.52% (26/46) and 21.74% (10/46)

Summary

Introduction

The β-lactam antibiotics are the most commonly used therapeutic class of antimicrobials for treatment of bacterial infection because of their broad antibacterial spectrum and excellent safety profile [1]. Bacterial resistance to antibiotics is increasing worldwide in healthcare settings and in the community [2]. Extended-spectrum β-lactamases (ESBLs) are a rapidly evolving group of β-lactamases which hydrolyze the extended-spectrum cephalosporins, the penicillins, as well as aztreonam, but not carbapenems [5,6].The spread of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) is increasing worldwide [7]. They cause community- and hospital-associated infections in both humans and animals [8]. According to the Pan European Antimicrobial Resistance Local Surveillance (PEARLS) study (2001–2002), performed in 13 European, three Middle Eastern countries and

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