Prevalence of TEM and SHV Genes in Diarrheaogenic Escherichia Coli Resistant to Beta Lactam Antibiotics in Egyptian Infants

Abstract

Abstract Introduction/Objective Diarrhea is considered as the fifth leading cause of mortality in children worldwide. It kills 1 of 9 children according to CDC and causes morbidity in 1.7 billion pediatric cases every year. The most pathogenic strain of diarrheaogenic Escherichia coli (DEC) in Egypt is entero-hemorrhagic Escherichia coli (9.38%), while the most prevalent is entero-toxigenic Escherichia coli (15.63%). The aim of this study is to measure the percentage of TEM and SHV genes in diarrheagenic Escherichia coli (DEC) that are resistant to beta lactam antibiotics among infants. Indicating the essence of different antibiotics prescription for treatment in such cases. Methods Inclusion criteria included age between 2 months and 12 months. Stool samples from 196 cases of acute diarrhea were collected from inpatient and outpatient pediatric clinic in pediatric department at Zagazig University hospitals in Egypt. In 56 samples, diarrheaogenic Escherichia coli strains were confirmed by multiplex PCR after being biochemically identified. Culture and susceptibility tests were conducted. Resistant DEC strains were tested for the presence of TEM and SHV genes using universal primers for conventional PCR. Results By using culture and susceptibility test, 91.1% (51 cases) of isolated DEC strains were found to be resistant to amoxicillin-clavulanic acid. 78.6% (44 cases) resistant to ampicillin-sulbactam. 28.6% (16 cases) resistant to cefotaxime. 28.6% (16 cases) resistant to ceftazidime. 28.6% (16 cases) resistant to cefuroxime. 26.8% (15 cases) resistant to cefoxitin. 26.8% (15 cases) resistant to ceftriaxone. 14.3% (8 cases) resistant to cefepime. 10.7% (6 cases) resistant to aztreonam. 3.5% (2 cases) resistant to imipenem. By using conventional PCR, TEM gene was positive in 28.6% (16 cases) and SHV gene in 7.1% of (4 cases). Conclusion TEM gene was detected in 28.6% (16 out of 56 true positive DEC cases) and SHV gene in 7.1% (4 out of 56 true positive DEC cases). Around 28.6% of diarrheaogenic Escherichia coli or about 8% of infantile diarrhea (16 out of 196 total cases) were found to be resistant to different beta lactam antibiotics due to presence of TEM and SHV genes. This reflects the usefulness of other type antibiotics for treatment in such percentage.