Prevalence of CTX-M Genes in Escherichia Coli Strains in Outpatient and Inpatient Cases with Urinary Tract Infections in Isfahan, Iran

Document Type : Original Article (s)

Authors

1 Department of Genetics and Biotechnology, School of Sciences, Payame Noor University, Tehran, Iran

2 Assistant Professor, Department of Genetics and Biotechnology, School of Sciences, Payame Noor University, Tehran, Iran

3 Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan Iran

Abstract

Background: Extended-spectrum beta-lactamase of CTX-M-type is considered as an important mechanism resistant to beta-lactam drugs in the gram-negative pathogens. In this study, the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) as well as the frequency of CTX-M genes from urinary tract infections in inpatients and outpatients caused by Escherichia coli in selected health centers in Isfahan, Iran, was studied in 2013.Methods: The study was carried out on 120 E. coli isolates from inpatients and outpatients with urinary tract infection. The susceptibility of isolates was tested using disc diffusion method. The ESBL-producer strains were confirmed using combined discs method. Finally, the blaCTX-M gene was determined in ESBL-producer isolates using polymerase chain reaction (PCR) method. To identify the strains of E. coli producing CTX-M genes, PCR method was used. The collected data were entered and analyzed in WHONET 5.6 and Excel softwares.Findings: From 120 strains of E. coli, 12 outpatient (20.0%) and 33 inpatient (55.0%) isolates were ESBL-producer. 84.4% and 60.1% of outpatient isolates and 94.9% and 84.8% of inpatient isolates showed resistance to ampicillin and co-trimoxazole, respectively. PCR analysis revealed that 30 isolates had CTX-M gene.Conclusion: The production of ESBL, in particular in isolates of inpatients, is a big threat for use of the broad-spectrum cephalosporins. Given the presence of CTX-M gene in the high proportion of the isolates, more molecular and epidemiological studies on pathogenic bacteria in health centers is required to be able to have a common plan to control bacterial resistance.

Keywords

References

  1. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16(3): 128-40.
  2. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13(10): 606-8.
  3. McGeer A, Campbell B, Emori TG, Hierholzer WJ, Jackson MM, Nicolle LE, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 1991; 19(1): 1-7.
  4. Best J, Kitlowski AD, Ou D, Bedolla J. Diagnosis and management of urinary tract infections in the emergency department. Emerg Med Pract 2014; 16(7): 1-23.
  5. Mehdipour Moghaddam MJ, Mirbagheri AA, Salehi Z, Habibzade SM. Prevalence of Class 1 Integrons and Extended Spectrum Beta Lactamases among Multi-Drug Resistant Escherichia coli Isolates from North of Iran. Iran Biomed J 2015; 19(4): 233-9.
  6. Bradford PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2001; 14(4): 933-51, table.
  7. Arakawa Y, Shibata N, Shibayama K, Kurokawa H, Yagi T, Fujiwara H, et al. Convenient test for screening metallo-beta-lactamase-producing gram-negative bacteria by using thiol compounds. J Clin Microbiol 2000; 38(1): 40-3.
  8. Bonnet R. Growing group of extended-spectrum beta-lactamases: the CTX-M enzymes. Antimicrob Agents Chemother 2004; 48(1): 1-14.
  9. Barthelemy M, Peduzzi J, Bernard H, Tancrede C, Labia R. Close amino acid sequence relationship between the new plasmid-mediated extended-spectrum beta-lactamase MEN-1 and chromosomally encoded enzymes of Klebsiella oxytoca. Biochim Biophys Acta 1992; 1122(1): 15-22.
  10. Bhaskar E. Clinical correlates of New Delhi metallo-beta lactamase isolates--a survey of published literature. Indian J Med Res 2012; 136(6): 1054-9.
  11. Forbes BA, Sahm DF, Weissfeld AS, Trevino E. Bailey and Scott's diagnostic microbiology. 10th ed. Philadeiphia, PA: Mosby; 1998.
  12. Kim YK, Pai H, Lee HJ, Park SE, Choi EH, Kim J, et al. Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob Agents Chemother 2002; 46(5): 1481-91.
  13. Lytsy B, Sandegren L, Tano E, Torell E, Andersson DI, Melhus A. The first major extended-spectrum B-lactamase outbreak in Scandinavia was caused by clonal spread of a multiresistant Klebsiella pneumoniae producing CTX-M-15. APMIS 2008; 116(4): 302-8.
  14. Kaspar T, Schweiger A, Droz S, Marschall J. Colonization with resistant microorganisms in patients transferred from abroad: who needs to be screened? Antimicrob Resist Infect Control 2015; 4: 31.
  15. Bui TM, Hirai I, Ueda S, Bui TK, Hamamoto K, Toyosato T, et al. Carriage of Escherichia coli Producing CTX-M-Type Extended-Spectrum beta-Lactamase in Healthy Vietnamese Individuals. Antimicrob Agents Chemother 2015; 59(10): 6611-4.
  16. Celikbilek N, Gozalan A, Ozdem B, Kirca F, Acikgoz ZC. Extended-spectrum beta-lactamase production by Enterobacteriaceae isolates from urine cultures of outpatients: results of a 7-year follow-up. Mikrobiyol Bul 2015; 49(2): 259-65. [In Turkish].
  17. Machado E, Coque TM, Canton R, Novais A, Sousa JC, Baquero F, et al. High diversity of extended-spectrum beta-lactamases among clinical isolates of Enterobacteriaceae from Portugal. J Antimicrob Chemother 2007; 60(6): 1370-4.
  18. Coque TM, Baquero F, Canton R. Increasing prevalence of ESBL-producing Enterobacteriaceae in Europe. Euro Surveill 2008; 13(47).
  19. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32(8): 470-85.
  20. Qi C, Pilla V, Yu JH, Reed K. Changing prevalence of Escherichia coli with CTX-M-type extended-spectrum beta-lactamases in outpatient urinary E. coli between 2003 and 2008. Diagn Microbiol Infect Dis 2010; 67(1): 87-91.
  21. Shahid M., Monil S, Abida M, Indu S, Khan HM. ESBL phenotypes and prevalent genotype of CTX-M type beta lactamases in clinical isolates of E. coli in a North Indian tertiary care hospital. Proceedings of the Microcon 2006 Conference; 2006 Oct 26-29; Nagpur, India.
  22. Rahman NMW, Lutfor AB, Jhora ST, Yasmin M, Haq JA. Detection of CTX-M gene in extended spectrum beta lactamase (ESBL) producing Escherichia coli and Klebsiella species of different hospitals. Bangladesh J Med Microbiol 2012; 4(2): 28-31.
  23. Torshizi R, Zamanzad B, Mokhtareyan K, Karimi A. Determination of CTX-M genes in enterobacteriaceae producing extended-spectrum beta-lactamase using PCR method. J Shahrekord Univ Med Sci 2011; 13(3): 9-17. [In Persian].
Journal of Isfahan Medical School
Volume 33, Issue 360 - Serial Number 360
September and October 2016
Pages 2019-2025

Files

History

  • Receive Date: 13 August 2015
  • Revise Date: 26 April 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics