Prevalence of CTX-M and TEM β-lactamases in Klebsiella pneumoniae Isolates from Patients with Urinary Tract Infection, Al-Zahra Hospital, Isfahan, Iran

Maleki, Nafiseh; Tahanasab, Zahra; Mobasherizadeh, Sina; Rezaei, Aliakbar; Faghri, Jamshid

Prevalence of CTX-M and TEM β-lactamases in Klebsiella pneumoniae Isolates from Patients with Urinary Tract Infection, Al-Zahra Hospital, Isfahan, Iran

Document Type : Original Article

Authors

Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Extended-spectrum β-lactamase (ESBL)-producing is a significant resistant mechanism to β-lactams in Enterobacteriaceae, especially in Klebsiella pneumoniae. The main objectives of this study were to genetically characterize urinary clinical isolates of K. pneumoniae through the investigating of blaTEM, blaCTX-M and using molecular typing by Enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) method. We also determined the frequency of antibiotic resistance of K. pneumoniae strains to characterize the β-lactamases included. Materials and Methods: A cross-sectional study was carried out to evaluate 98 strains of K. pneumoniae isolated from urine culture of outpatients referred to Al-Zahra Hospital, Isfahan, Iran. Antibiotic susceptibility testing was performed using Kirby–Bauer's method. Screening of ESBLs was carried out using double-disk screening test. PCR technique was performed to detect TEM and CTX-M genes. The total DNA of each strain was tested by ERIC-PCR. Results: In 98 K. pneumoniae studied clinical isolates, 25.5% were ESBL producing and 44.9% multidrug-resistant (MDR). From 25 ESBL isolates, 23 (92%) cases showed MDR phenotype. In ESBL producing isolates, 23 (92%) were blaCTX-M and 19 (76%) blaTEM positive. The antimicrobial drug susceptibilities of ESBL isolates indicated high resistant rates for cefotaxime and ceftazidime. All 25 ESBL producing isolates were resistant to cefotaxime. Complex patterns of fingerprints isolates showed that 36% of the isolates were belonged to the cluster no 5. Conclusion: This study revealed high antimicrobial resistance rates among ESBL isolates which can lead to various health difficulties. Epidemiological data collection from patients is recommended to develop the strategies to manage antibiotic resistance.

Keywords

References

1.	Wang Q, Li B, Tsang AK, Yi Y, Woo PC, Liu CH. Genotypic analysis of Klebsiella pneumoniae isolates in a Beijing Hospital reveals high genetic diversity and clonal population structure of drug-resistant isolates. PLoS One 2013;8:e57091. [PUBMED]
2.	Moini AS, Soltani B, Taghavi Ardakani A, Moravveji A, Erami M, Haji Rezaei M, et al. Multidrug-resistant Escherichia coli and Klebsiella pneumoniae isolated from patients in Kashan, Iran. Jundishapur J Microbiol 2015;8:e27517. [PUBMED]
3.	El Bouamri MC, Arsalane L, El Kamouni Y, Zouhair S. Antimicrobial susceptibility of urinary Klebsiella pneumoniae and the emergence of carbapenem-resistant strains: A retrospective study from a university hospital in Morocco, North Africa. Afr J Urol 2015;21:36-40.
4.	Giamarellou H. Multidrug-resistant Gram-negative bacteria: How to treat and for how long. Int J Antimicrob Agents 2010;36 Suppl 2:S50-4. [PUBMED]
5.	Giske CG, Monnet DL, Cars O, Carmeli Y; ReAct-Action on Antibiotic Resistance. Clinical and economic impact of common multidrug-resistant Gram-negative bacilli. Antimicrob Agents Chemother 2008;52:813-21. [PUBMED]
6.	Lagha N, Abdelouahid DE, Hassaine H, Robin F, Bonnet R. First characterization of CTX-M-15 and DHA- 1 β-lactamases among clinical isolates of Klebsiella pneumoniae in Laghouat Hospital, Algeria. Afr J Microbiol Res 2014;8:1221-7.
7.	Wachino J, Doi Y, Yamane K, Shibata N, Yagi T, Kubota T, et al. Nosocomial spread of ceftazidime-resistant Klebsiella pneumoniae strains producing a novel class a beta-lactamase, GES-3, in a neonatal intensive care unit in Japan. Antimicrob Agents Chemother 2004;48:1960-7. [PUBMED]
8.	Ahmed ZB, Ayad A, Mesli E, Messai Y, Bakour R, Drissi M. CTX-M-15 extended-spectrum beta-lactamases in Enterobacteriaceae in the Intensive Care Unit of Tlemcen Hospital, Algeria. East Mediterr Health J 2012;18:382-6. [PUBMED]
9.	Rakotonirina HC, Garin B, Randrianirina F, Richard V, Talarmin A, Arlet G. Molecular characterization of multidrug-resistant extended-spectrum β-lactamase-producing Enterobacteriaceae isolated in Antananarivo, Madagascar. BMC Microbiol 2013;17:13-85.
10.	Edelstein M, Pimkin M, Palagin I, Edelstein I, Stratchounski L. Prevalence and molecular epidemiology of CTX-M extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Russian hospitals. Antimicrob Agents Chemother 2003;47:3724-32. [PUBMED]
11.	Ramazanzadeh R, Zamani S, Zamani S. Genetic diversity in clinical isolates of Escherichia coli by enterobacterial repetitive intergenic consensus (ERIC)-PCR technique in Sanandaj hospitals. Iran J Microbiol 2013;5:126-31. [PUBMED]
12.	Cockerill FR, Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. Twenty Second International Supplement M100- S22. USA Clinical and Laboratory Standards Institute; 2012.
13.	Sedighi M, Vaez H, Moghoofeie M, Hadifar S, Oryan G, Faghri J. Molecular detection of metallo-ß-lactamase gene blaVIM-1 in imipenem-resistant Pseudomonas aeruginosa strains isolated from hospitalized patients in the hospitals of Isfahan. Adv Biomed Res 2015;4:57. [PUBMED] [Full text]
14.	Norouzi A, Azizi O, Nave HH, Shakibaie MR. Analysis of amino acid substitution mutations of gyrA and parC genes in clonal lineage of Klebsilla pneumoniae conferring high-level quinolone resistance. J Med Microbiol Infect Dis 2014;2:109-17.
15.	Livermore DM. Beta-lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995;8:557-84. [PUBMED]
16.	Feizabadi MM, Delfani S, Raji N, Majnooni A, Aligholi M, Shahcheraghi F, et al. Distribution of bla(TEM), bla(SHV), bla(CTX-M) genes among clinical isolates of Klebsiella pneumoniae at Labbafinejad Hospital, Tehran, Iran. Microb Drug Resist 2010;16:49-53. [PUBMED]
17.	Saeidi S, Alavi-Naini R, Shayan S. Antimicrobial susceptibility and distribution of TEM and CTX-M genes among ESBL-producing Klebsiella pneumoniae and Pseudomonas aeruginosa causing urinary tract infections. Zahedan J Res Med Sci 2014;16:1-5.
18.	Kontopoulou K, Protonotariou E, Vasilakos K, Kriti M, Koteli A, Antoniadou E, et al. Hospital outbreak caused by Klebsiella pneumoniae producing KPC-2 beta-lactamase resistant to colistin. J Hosp Infect 2010;76:70-3. [PUBMED]
19.	Rezaee MA, Sheikhalizadeh V, Hasani A. Detection of integrons among multi-drug resistant (MDR) Escherichia coli strains isolated from clinical specimens in Northern West of Iran. Braz J Microbiol 2011;42:1308-13. [PUBMED]
20.	Ibrahim ME, Bilal NE, Hamid ME. Increased multi-drug resistant Escherichia coli from hospitals in Khartoum state, Sudan. Afr Health Sci 2012;12:368-75. [PUBMED]
21.	Knothe H, Shah P, Krcmery V, Antal M, Mitsuhashi S. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 1983;11:315-7. [PUBMED]
22.	Jones RN. Global epidemiology of antimicrobial resistance among community-acquired and nosocomial pathogens: A five-year summary from the SENTRY Antimicrobial Surveillance Program (1997-2001). Semin Respir Crit Care Med 2003;24:121-34. [PUBMED]
23.	Khosravi AD, Hoveizavi H, Mehdinejad M. Prevalence of Klebsiella pneumoniae encoding genes for Ctx-M-1, Tem-1 and Shv-1 extended-spectrum beta lactamases (ESBL) enzymes in clinical specimens. Jundishapur J Microbiol 2013;6:e8256.
24.	Moayednia R, Shokri D, Mobasherizadeh S, Baradaran A, Fatemi SM, Merrikhi A. Frequency assessment of ß-lactamase enzymes in Escherichia coli and Klebsiella isolates in patients with urinary tract infection. J Res Med Sci 2014;19 Suppl 1:S41-5.
25.	Barguigua A, El Otmani F, Talmi M, Bourjilat F, Haouzane F, Zerouali K, et al. Characterization of extended-spectrum ß-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates from the community in Morocco. J Med Microbiol 2011;60(Pt 9):1344-52.
26.	Wang G, Huang T, Surendraiah PK, Wang K, Komal R, Zhuge J, et al. CTX-M ß-lactamase-producing Klebsiella pneumoniae in suburban New York City, New York, USA. Emerg Infect Dis 2013;19:1803-10. [PUBMED]
27.	Lautenbach E, Patel JB, Bilker WB, Edelstein PH, Fishman NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: Risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32:1162-71. [PUBMED]

Advanced Biomedical Research