Abstract
Objectives:Infectious diseases caused by ESBL-producingEnterobacteraleare an emerging problem worldwide, which increase hospital costs, empirical treatment failure, together with rates of morbidity and mortality. The aims of this study were to determine the antibiotic-resistant patterns and the frequency ofblaTEM,blaCTX-M andblaSHV genes amongEnterobacterale.Methods:A total of 239 non-repeated clinical isolates of theEnterobacteralefamily, including 202 (84.5%)Escherichia coliandKlebsiella pneumoniae25 (12.3%) were collected. Identification and susceptibility tests were carried out on 60 (25.9%) ESBL phenotypes using biomérieux VITEK®2 compact system. Isolates showing ESBL positivity by the phenotypic method were all screened forblaTEM,blaCTX-M andblaSHV genes by PCR.Results:The prevalence of ESBL-producingEnterobacteraleisolates was found to be 25.9%. These ESBL-producing isolates displayed an increasing rate of resistance for aminopenicillins (ampicillin) (96.3%), followed by piperacillin-tazobactam (54.2%), amoxicillin/clavulanic acid (45.8), the cephalosporin groups, ceftriaxone (52.4%), ceftazidime (46.7%), and fluoroquinolone (ciprofloxacin) (42.7%). Both the organisms showed a higher susceptibility to the carbapenems (Imipenem) and aminoglycosides (Amikacin). Out of the 62 ESBL positive isolates, 11 (17.7%) carried the TEM gene, 22 (35.5%) carried the CTX-M gene alone, 8 (12.9%) carried both TEM and CTX-M genes, 1(1.6%) carried both SHV and CTX-M genes, and 20 (32.3%) carried the TEM, SHV, and CTX-M genes. SHV gene alone was not reported in any of the isolates.Conclusion:The study indicated a moderate occurrence of ESBL-producingEnterobacteralewith CTX-M being the most dominant gene. The co-existence of all three genes on many occasions suggested the carriage of multiple plasmids with three resistance genes that might pose a serious epidemiological, clinical and public health threat.
Highlights
Extended-Spectrum Beta-Lactamases (ESBLs) are rapidly evolving plasmid-mediated enzymes produced by certain bacteria that can hydrolyze extended-spectrum cephalosporin, making them effective against beta-lactam antibiotics [1, 2]
Enterobacterale species [1], the main bacterial family associated with ESBL production, of which Escherichia coli and klebsiella pneumoniae are the most important
E. coli was the most resistance to ampicillin (96.5%), cefepime (56.4%), ceftriaxone (50.0%), ceftazidime (48.5%), piperacillin/tazobactam (46.0%), amoxicillin/Clavulanate (43.6%), and ciprofloxacin (41.6%)
Summary
Extended-Spectrum Beta-Lactamases (ESBLs) are rapidly evolving plasmid-mediated enzymes produced by certain bacteria that can hydrolyze extended-spectrum cephalosporin, making them effective against beta-lactam antibiotics [1, 2]. ESBLs are found in gram-negative bacteria, especially in Enterobacterale species [1], the main bacterial family associated with ESBL production, of which Escherichia coli and klebsiella pneumoniae are the most important. These organisms are of medical importance, causing infections in the various body systems. The plasmid-mediated lactamase-producing isolates of the family Enterobacterale mainly possess the blaTEM gene which can hydrolyze penicillin and first-generation cephalosporins. The majority of the ESBLs are derivatives of TEM or SHV enzymes, which are most often found in the enterobacteria E. coli and K. pneumonia [5]
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