Occurrence of Extended Spectrum Beta Lactamase Encoding Genes among Urinary Pathogenic Escherichia coli and Klebsiella pneumoniae Isolates Obtained from a Tertiary Hospital in Gombe Nigeria (original) (raw)
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Research Square (Research Square), 2023
Background The emergence of antimicrobial resistance (AMR) and multidrug resistance (MDR) among Escherichia coli and Klebsiella pneumoniae, especially through the production of extended spectrum β-lactamases (ESBLs), limits therapeutic options and poses a signi cant public health threat. Objective The aim of this study was to phenotypically and genotypically characterise the ESBL-associated AMR and MDR of Escherichia coli and Klebsiella pneumoniae isolates from patient samples in two Kenyan Hospitals. Methods We collected 138 E. coli and 127 K. pneumoniae isolates from various clinical specimens at the two health facilities from January 2020 to Feb 2021. ESBL production and antibiotic susceptibility of the isolates were phenotypically con rmed using a standard procedure. Molecular analysis was done through conventional Polymerase Chain Reaction (PCR) with appropriate primers for gadA, rpoB, bla TEM , bla SHV , bla OXA , bla CTX-M-group-1 , bla CTX-M-group-2 , bla CTX-M-group-9 , and bla CTX-M-group-8/25 genes, sequencing and BLASTn analysis. Results Most E. coli (82.6%) and K. pneumoniae (92.9%) isolates were ESBL producers, with the highest resistance was against Ceftriaxone (69.6% among E. coli and 91.3% among K. pneumoniae) and Amoxicillin/clavulanic acid (70.9% among K. pneumoniae). The frequency of MDR was 39.9% among E. coli and 13.4% among K. pneumoniae isolates. The commonest MDR phenotypes among the E. coli isolates were CRO-FEB-AZM-LVX and CRO-AZM-LVX, while the FOX-CRO-AMC-MI-TGC-FM, FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI, and CRO-AMC-TZP-AZM-MI were the most frequent among K. pneumoniae isolates. Notably, the FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI phenotype was observed in both ESBL-positive and ESBL-negative K. pneumoniae isolates. The most frequent ESBL genes were bla TEM (42%), bla SHV (40.6%), and bla OXA (34.1%) among E. coli, and bla TEM (89%), bla SHV (82.7%), bla OXA (76.4%), and bla CTX−M−group−1 (72.5%) among K. pneumoniae isolates. The bla SHV and bla OXA, and bla TEM genotypes were predominantly associated with FOX-CRO-FEP-MEM and CRO-FEP MDR, and CRO AMR phenotypes, among E. coli isolates from Embu Level V (16.7%) and Kenyatta National Hospital (7.0%) respectively. Conclusions The high proportion of ESBL-producing E. coli and K. pneumoniae isolates increases the utilization of last-resort antibiotics, jeopardizing antimicrobial chemotherapy. Furthermore, the antimicrobial resistance patterns exhibited towards extended-spectrum cephalosporins, betalactam/beta-lactamase inhibitor combinations, uoroquinolones, and macrolides show the risk of co-resistance associated with ESBLproducing isolates responsible for MDR.
2013
Extended-spectrum beta-lactamases (ESBLs) are plasmid-mediated beta lactamases commonly found in the Enterobacteriaceae that are capable of hydrolysing ?-lactams except carbapenems and cephamycins. ESBLs confer resistance to several non-s-lactam antibiotics. ESBL-producing organisms appear susceptible to cephalosporins in vitro using conventional breakpoints but ineffective in vivo . This work sought to determine the occurrence of ESBL in E. coli and K. pneumoniae and their antibiotic resistance profile. Four hundred K . pneumoniae and E . coli non-duplicate isolates were collected at the Central Laboratory of Korle Bu Teaching Hospital and Advent Clinical Laboratories. They were definitively identified and their minimum inhibition concentration and antibiotic sensitivity testing for 17 antibiotics were determined using Vitek 2 Compact System (bioMerieux, Marcy I’Etoile, France). The isolates were confirmed as ESBL-producing strains using the Combination Disk Synergy Method. The re...
FUDMA Journal of Sciences, 2019
Klebsiella pneumoniae and Escherichia coli are the major bacterial pathogens being isolated and reported from urine samples worldwide as Extended Spectrum Beta Lactamases (ESBLs) producers. This study was conducted to determine the prevalence of ESBLs producing K. pneumoniae and E. coli from urinary clinical isolates in Federal Teaching Hospital Gombe. A total of two hundred and nine (209) bacterial isolates comprising 100 E. coli and 109 K. pneumonia were collected and recovered on MacConkey agar at 35 o C. The isolates were further identified as members of Enterobacteriaceae family using conventional biochemical test. Preliminary screening for ESBL production was carried out using antibiotics disk of ceftadizime (30µg), ceftriazone (30µg) and cefpodozime (10µg) placed on to a surface of Muller-Hinton agar plates, separated from each other by a distance not less than 20mm apart, zones of growth inhibition were measured to the nearest mm. The screened isolates were further confirmed...
The Malaysian journal of medical sciences : MJMS, 2016
To assess antimicrobial susceptibility of extended-spectrum β-lactamase- (ESBL-) producing Klebsiella pneumoniae and Escherichia coli isolates from Hospital Tengku Ampuan Afzan (HTAA), as well as to identify ESBL genes. Non-duplicate K. pneumoniae and E. coli isolates were recovered from various clinical samples. Isolates were screened for antimicrobial resistance by disc diffusion method. Isolates resistant to oxyimino-cephalosporins were subjected to phenotypic ESBL production. Detection of resistance genes was then performed using primers specific for ESBL genes (bla CTX-M, bla SHV and bla TEM). Piperacillin/tazobactam and carbapenems remained the active β-lactam antibiotic against K. pneumoniae and E. coli. ESBLs were detected among 35.5% (39/110) of K. pneumoniae and 18.8% (28/149) of E. coli isolates. CTX-M β-lactamase was detected in 90% of all ESBL-positive isolates, whereas bla SHV and bla TEM genes were found among 56% and 52% of them, respectively. Twenty-eight percent (2...
International Journal of Biological Chemistry
Multidrug resistant strains of Klebsiella pneumoniae and Escherichia coli constitute a problem in many hospitals. The antibiotic susceptibility profile and the Production of Extended Spetrum Beta-Lactamase (ESBL) of the strains of Klebsiella pneumoniae and Escherichia coli were assessed by the Kirby-Bauer technique and the modified disc diffusion technique respectively. Out of a total of 65 urinary specimens submitted to the Medical Microbiology laboratory at the Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria, 50 isolates consisting of 33 (66%) Escherichia coli and 17 (34%) strains of Klebsiella pneumoniae were recovered from patients suspected to have Urinary Tract Infections (UTIs). Of these 50 isolates, 15(30%) were ESBL producers, made up of 6/17 (35.3%) ESBL-positive Klebsiella pneumoniae isolates and 9/33 (27.3%) ESBL-positive E. coli isolates. The susceptibility of the ESBL-positive Klebsiella pneumoniae isolates to ciprofloxacin, ofloxacin and amikacin were ...
Indian Journal of Medical Microbiology, 2007
To study the prevalence of TEM-, SHV- and GES-type beta -lactamases among Escherichia coli and Klebsiella pneumoniae strains having ceftazidime MICs higher than 2 mg/L. A total of 63 E. coli and 41 K. pneumoniae isolated from five different university hospitals were studied for the existence of TEM-, SHV- and GES-type beta -lactamases. Susceptibility tests were carried out according to the criteria of National Committee for Clinical Laboratory Standards. MICs were obtained by agar dilution method. Existence of extended-spectrum beta -lactamases (ESBLs) were assessed by double-disc synergy test (DDST). Existence of the above-mentioned beta -lactamase genes were studied both by PCR with specific oligonucleotide primers and isoelectric focusing methods. None of the isolates were carbapenem-resistant. DDSTs were positive in 50 (79.3%) and 33 (80.5%) of E. coli and K. pneumoniae , respectively. TEM gene was detected in 41 (65.1%) and 19 (46.3%), whereas SHV gene in 18 (28.6%) and 20 (48.8%) of E. coli and K. pneumoniae strains, respectively. GES genes were not detected. TEM and SHV genes are highly prevalent among ESBL-producing E. coli and K. pneumoniae , whereas GES-type ESBLs are absent and found not to be responsible of ceftazidime resistance in Turkish hospitals. Indian J Med Microbiol. 2007 Oct;25(4):346-50. Extended-spectrum beta-lactamases in ceftazidime-resistant Escherichia coli and Klebsiella pneumoniae isolates in Turkish hospitals. Hoşoğlu S1, Gündes S, Kolayli F, Karadenizli A, Demirdağ K, Günaydin M, Altindis M, Caylan R, Ucmak H. Author information 1 Department of Infectious Diseases and Clinical Microbiology, Dicle University Hospital, Diyarbakir, Turkey. hosoglu@hotmail.com Abstract
BMC Research Notes, 2013
Background: Escherichia coli and Klebsiella pneumoniae are the major bacterial pathogens being isolated and reported from mid stream urine (MSU) specimens, globally. These uropathogens are mostly implicated as the major extended spectrum beta-lactamase (ESBL) producers, severely limiting the therapeutic management in cases of urinary tract infections. Limited studies had been reported from Nepal investigating the ESBL producers among uropathogens. This study was designed to assess the prevalence of ESBL producing E.coli and K. pneumoniae in urinary isolates at a centrally located major tertiary care hospital in Kathmandu valley, Nepal. Methods: Between September 2011 and May 2012, during the nine months period, 6308 MSU specimens were collected aseptically from the same number of clinically suspected patients of urinary tract infections. The samples were cultured on MacConkey agar and blood agar. The isolates with significant bacteriuria (10 5 CFU / ml) were identified based on standard laboratory procedures. Antimicrobial susceptibility tests were carried out using various antimicrobial discs alongwith ceftriaxone on E.coli and K. pneumoniae isolates by Kirby Bauer disc diffusion method as per the recommendations of CLSI. On initial screening with ceftriaxone (30 μg) disc showing resistance was then confirmed for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT) using ceftazidime (30 ug) and ceftazidime + clavulanic acid (30 μg + 10ug) disc as per guidelines of CLSI (2011). Results: Out of a total of 6308 MSU specimens investigated for significant bacteriuria, E.coli isolates were 444 (7.04%) and K.pneuminiae were 145 (2.3%) making a total of 589 (9.34%). Initial screening with ceftriaxone disc revealed 155 isolates of E.coli and 70 isolates of K.pneumoniae to be resistant. Further testing by PCDDT method showed 60/444 (=13.51%) of E. coli and 24/145 (=16.55%) of K. pneumoniae isolates to be confirmed ESBL producers. These ESBLproducer uropathogens showed high degree of resistance to ceftriaxone (100.0%), amoxycillin, fluoroquinolones and co-trimoxazole. Conclusion: An emerging and moderately high prevalence of ESBL-producing E. coli and K. pneumoniae was observed and confirmed in the urinary isolates investigated. It is essential to have a regular and routine monitoring of ESBL producing clinical isolates in laboratory practice.
Introduction. Antimicrobial resistance is a growing international problem resulting from the enzyme β-lactamase production by bacteria, to degrade antibiotics, especially β-lactam antibiotics. In Brong Ahafo Regional Hospital, Sunyani, these antibiotics are heavily depended upon for the treatment of serious infections, but unfortunately high proportions of bacterial isolates in the hospital, have been found to be resistant to the commonly prescribed antibiotics. This study aims to determine the prevalence of ESBL-producing E. coli so as to determine if ESBL are responsible for the high antimicrobial resistance seen at the Brong-Ahafo Regional Hospital, Sunyani. Methods. The study was a cross sectional study, involving 51 E. coli isolates from urine samples of both in-and outpatients between January and December, 2014. Antimicrobial susceptibility profiles of the isolates were determined by the Kirby Bauer disc diffusion method against 12 antibiotics. The isolates were screened for ESBL production, and then confirmed by the combined disc method. The isolates were tested for the presence of ESBL blaCTX-M and blaTEM by conventional PCR. Results. Non-repeat 1,302 midstream urine samples were cultured from which 200 different pathogens were isolated. Of the 200 isolates 51 were E. coli. Isolates obtained from Community isolates were 16(37.2) and isolates from in-patients were 27(62.8). Resistant strains were detected to all the 12 antimicrobials tested. Low proportions were sensitive to cephalosporins (cefotaxime and ceftazidime), both recording 8/51(15.7%), and quinolones (nalidixic acid and ciprofloxacin), 7/51(13.7%) and 8/51(15.7%) respectively. The isolates had varied susceptibility to aminoglycosides, with
African Health Sciences
Background: Escherichia coli and Klebsiella pneumoniae are commonly implicated in urinary tract infections accounting for majority of the antimicrobial resistance encountered in hospitals. Objectives: To determine the prevalence and antimicrobial susceptibility of extended-spectrum beta-lactamases (ESBLs) producing E. coli and K. pneumoniae among patients in Anyigba, Nigeria. Methods: This hospital-based cross-sectional study was conducted using urine samples from 200 patients of Grimmard Catholic hospital and Maria Goretti hospital. Urine samples were processed to identify ESBL-producing E. coli and K. pneu- moniae using standard microbiological techniques. Isolates were then tested against antimicrobial agents. Results: A total of 156 bacterial isolates were recovered consisting 128 of E. coli and 28 of K. pneumoniae. Extended spec- trum beta-lactamases production was observed in 69% of E. coli and 31% of K. pneumoniae. These pathogens were resistant to 3 or more antibiotics. Of t...
Background: Extended-Spectrum β-Lactamase (ESBL) producing Enterobacteriaceae have become widespread in hospitals and are increasing in community settings where they cause a variety of infections. In addition to hydrolyzing most beta-lactam agents, bacteria harboring these enzymes display resistance to other unrelated antimicrobial agents and thus often pose a therapeutic dilemma. Though these resistance patterns have been studied elsewhere within Africa, such data from hospitals in Kenya are scanty. We therefore undertook to determine these patterns at the Aga Khan University hospital by studying multidrug resistant Escherichia coli and Klebsiella pneumoniae isolates from patients' samples. Findings: A total of 159 isolates (109 E. coli and 50 K. pneumoniae) were confirmed as ESBL producers and tested against eighteen antimicrobials. The proportion of resistant isolates was high (>80%) for the antimicrobials tested with the exception of the carbapenems (<1%), nitrofurantoin (23%) and gentamicin (63%). Klebsiella pneumoniae had a higher proportion of isolates resistant to ceftazidime, gentamicin and nitrofurantoin (P < 0.05) than E. coli which had a higher proportion of isolates resistant to ciprofloxacin, levofloxacin and tetracycline (P < 0.05). Conclusions: In our study, antimicrobial coresistance is common in ESBL producers; however resistance to carbapenems is low and these drugs would be the appropriate empiric therapy for serious or life threatening systemic infections. Nitrofurantoin retains good activity among the multidrug resistant isolates and can be the drug of choice for non-complicated urinary tract infections due to ESBL producing E. coli. Keywords: Extended-spectrum beta lactamases, Escherichia coli, Klebsiella pneumoniae, antimicrobial susceptibility, empiric therapy