Abstract
Objective: To investigate the extent, distribution and sequence analysis of bla<sub>CTX-M</sub> genes carried by Escherichia coli isolated from patients admitted to all government hospitals in Kuwait. Methods: Extended-spectrum β-lactamase (ESBL)-producing E. coli isolates were collected from the 8 major hospitals in Kuwait. CTX-M ESBLs were analyzed by PCR and sequenced. Clonality of the positive isolates was determined for genetic relatedness using pulsed-field gel electrophoresis (PFGE) with XbaI digestion of the genomic DNA. Results: Of the 136 ESBL-positive isolates, 106 (77.9%) harbored bla<sub>CTX-M</sub> genes. Among these, bla<sub>CTX-M-15</sub> was the most frequent with a prevalence rate of 84.1%, followed by bla<sub>CTX-M-14</sub> (6.8%), bla<sub>CTX-M-14b</sub> (5.7%) and bla<sub>TOHO-1</sub> (3.4%). Ninety-three (87.7%) were isolated from Kuwaiti (35.9%), Egyptian (31.1%) and Indian (20.8%) nationals; the majority of isolates positive for bla<sub>CTX-M-15</sub> were mainly from these 3 nationalities. PFGE analysis did not demonstrate any clustering of positive isolates in any particular hospital. Conclusion: This study confirms an explosive emergence of CTX-M-15 β-lactamase among E. coli isolates in Kuwait and shows that the strains were clonally heterogeneous with no evidence of inter- or intra-hospital spread. Thus Kuwait may represent an important source of CTX-M-15-positive E. coli.
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