Journal of Kerman University of Medical Sciences

Prevalence of blaCTX-M1, blaCTX-M14 and blaCTX-M15 Genes among Escherichia ColiIsolated from Urinary Tract Infections in Outpatients, Kermanshah City, Iran

Authors

Alisha Akya 1
Mehrdad Khodadoost 2

1 Associate Professor, Department of Medical Microbiology, School of Medicine and Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran

2 Instructor, Department of Midwifery, Abadan Branch, Islamic Azad University, Abadan, Iran

Abstract
Background and Aims: The rate of urinary tract infection caused by the extended-spectrum-β-lactamase- (ESBL) producing Escherichia coli (E. coli) is increasing worldwide. This study aimed to assess the frequency of blaCTX-M genes in the E. coli isolated from urinary tract infection (UTI) in outpatients. Methods: 240 E. coli bacteria were isolated from the outpatients’ urine samples in the Kermanshah city, Iran. The susceptibility of isolates to 10 selected antibiotics was tested using the disc diffusion method. Then, the phenotype of the extended-spectrum-β-lactamase-producing isolates was determined using the combined disc method. Finally, blaCTX-M1, blaCTX-M14 and blaCTX-M15 genes were determined via polymerase chain reaction (PCR) method. Results: Of 240 isolates, 199 isolates (82.9%) showed resistance to ampicillin, but 100% were sensitive to imipenem. 96 isolates (40.0%) were resistant to three or more antibiotic groups. Moreover, 67 isolates (27.9%) were extended-spectrum-β-lactamase producer and 61 (91.0%), 58 (86.6%) and 21 (31.3%) isolates contained blaCTX-M1, blaCTX-M14 and blaCTX-M15 genes, respectively. Conclusion: Resistance to various β-lactam antibiotics, in particular the third generation of cephalosporins, among community-acquired E. coli isolates is a serious concern in Kermanshah city. Production of extended-spectrum β-lactamase, specially the dissemination of blaCTX-M genes among communityacquired E. coli isolates, is a big threat for using expected-spectrum cephalosporins. Given the presence of extended-spectrum-β-lactamase genes in the high proportion of the urinary tract infection isolates, suitable antibiotics should be chosen according to the antibiotic susceptibility tests.

Keywords

blaCTX-M
Escherichia coli
Urinary tract infection
  1. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002; 113(Suppl 1A): 5S-13S.
  2. Wiener J, Quinn JP, Bradford PA, Goering RV, Nathan C, Bush K, et al. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999; 281(6): 517-23.
  3. Kerrn MB, Klemmensen T, Frimodt-Moller N, Espersen F. Susceptibility of Danish Escherichia coli strains isolated from urinary tract infections and bacteraemia, and distribution of SUL genes conferring sulphonamide resistance. J Antimicrob Chemother 2002; 50(4): 513-6.
  4. Li Q, Lee JY, Castillo R, Hixon MS, Pujol C, Doppalapudi VR, et al. NB2001, a novel antibacterial agent with broad-spectrum activity and enhanced potency against beta-lactamase-producing strains. Antimicrob Agents Chemother 2002; 46(5): 1262-8.
  5. Tenover FC, Raney PM, Williams PP, Rasheed JK, Biddle JW, Oliver A, et al. Evaluation of the NCCLS extended-spectrum beta-lactamase confirmation methods for Escherichia coli with isolates collected during Project ICARE. J Clin Microbiol 2003; 41(7): 3142-6.
  6. Bush K. Extended-spectrum beta-lactamases in North America, 1987-2006. Clin Microbiol Infect 2008; 14(Suppl 1): 134-43.
  7. Tashkori M, Farokhnia M, Zia Sheikhaleslami N, Mirzaei T, Yosefi H, Mokhtari F. Evaluation of producing extended spectrum ß -lactamase among isolated Escherchia coli from patients suffering from urinary tract infections: (Short Report). J Rafsanjan Univ Med Sci 2011; 10(1): 62-8. [In Persian].
  8. Bush K, Jacoby GA, Medeiros AA. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother 1995; 39(6): 1211-33.
  9. Lin CF, Hsu SK, Chen CH, Huang JR, Lo HH. Genotypic detection and molecular epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a regional hospital in central Taiwan. J Med Microbiol 2010; 59(Pt 6): 665-71.
  10. Sidjabat HE, Paterson DL, Adams-Haduch JM, Ewan L, Pasculle AW, Muto CA, et al. Molecular epidemiology of CTX-M-producing Escherichia coli isolates at a tertiary medical center in western Pennsylvania. Antimicrob Agents Chemother 2009; 53(11): 4733-9.
  11. Mirzaee M, Pourmand MR, Chitsaz M, Mansouri S. Antibiotic resistance to third generation cephalosporins due to ctx-m-type extended-spectrum ß-lactamases in clinical isolates of Escherichia coli. Iran J Public Health 2009; 38(1): 10-7.
  12. Yazd M, Nazemi A, Mirinargesi M, Khataminejad M, Sharifi S, Babai Kochkaksaraei M. Prevalence of SHV/CTX-M/TEM (ESBL) Beta-lactamase resistance genes in Escherichia coli isolated from urinary tract infections in Tehran, Iran. Med Lab J 2010; 4(1): 48-54. [In Persian].
  13. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty-second informational supplement [Online]. [cited 2012 Jan]; Available from: URL: http://antimicrobianos.com.ar/ATB/wp-content/uploads/2012/11/M100S22E.pdf
  14. 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(12): 3724-32.
  15. Chia JH, Chu C, Su LH, Chiu CH, Kuo AJ, Sun CF, et al. Development of a multiplex PCR and SHV melting-curve mutation detection system for detection of some SHV and CTX-M beta-lactamases of Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae in Taiwan. J Clin Microbiol 2005; 43(9): 4486-91.
  16. Jacoby GA, Sutton L. Properties of plasmids responsible for production of extended-spectrum beta-lactamases. Antimicrob Agents Chemother 1991; 35(1): 164-9.
  17. Mirsalehian A, Jabalameli F, Mirafshar SM, Bazarjani F, Gorjipor A, Goli HR. Determination of antimicrobial resistance patterns and extended spectrum ß lactamases in clinical isolates of E. coli. Tehran Univ Med J 2008; 66(6): 373-8. [In Persian].
  18. Goyal A, Prasad KN, Prasad A, Gupta S, Ghoshal U, Ayyagari A. Extended spectrum beta-lactamases in Escherichia coli & Klebsiella pneumoniae & associated risk factors. Indian J Med Res 2009; 129(6): 695-700.
  19. Bali EB, Açýk L, Sultan N. Phenotypic and molecular characterization of SHV, TEM, CTX-M and extended-spectrum -lactamase produced by Escherichia coli, Acinobacter baumannii and Klebsiella isolates in a Turkish hospital. African Journal of Microbiology Research 2010; 4(8): 650-4.
  20. Abujnah AA, Zorgani A, Sabri MA, El-Mohammady H, Khalek RA, Ghenghesh KS. Multidrug resistance and extended-spectrum beta-lactamases genes among Escherichia coli from patients with urinary tract infections in Northwestern Libya. Libyan J Med 2015; 10: 26412.
  21. Peirano G, Pitout JD. Molecular epidemiology of Escherichia coli producing CTX-M beta-lactamases: the worldwide emergence of clone ST131 O25:H4. Int J Antimicrob Agents 2010; 35(4): 316-21.
  22. Severin JA, Mertaniasih NM, Kuntaman K, Lestari ES, Purwanta M, Lemmens-Den TN, et al. Molecular characterization of extended-spectrum beta-lactamases in clinical Escherichia coli and Klebsiella pneumoniae isolates from Surabaya, Indonesia. J Antimicrob Chemother 2010; 65(3): 465-9.
  23. Ibrahimagic A, Bedenic B, Kamberovic F, Uzunovic S. High prevalence of CTX-M-15 and first report of CTX-M-3, CTX-M-22, CTX-M-28 and plasmid-mediated AmpC beta-lactamase producing Enterobacteriaceae causing urinary tract infections in Bosnia and Herzegovina in hospital and community settings. J Infect Chemother 2015; 21(5): 363-9.
  24. Onnberg A, Molling P, Zimmermann J, Soderquist B. Molecular and phenotypic characterization of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum beta-lactamases with focus on CTX-M in a low-endemic area in Sweden. APMIS 2011; 119(4-5): 287-95.
  25. Pitout JD, Church DL, Gregson DB, Chow BL, McCracken M, Mulvey MR, et al. Molecular epidemiology of CTX-M-producing Escherichia coli in the Calgary Health Region: emergence of CTX-M-15-producing isolates. Antimicrob Agents Chemother 2007; 51(4): 1281-6.
  26. O'Keefe A, Hutton TA, Schifferli DM, Rankin SC. First detection of CTX-M and SHV extended-spectrum beta-lactamases in Escherichia coli urinary tract isolates from dogs and cats in the United States. Antimicrob Agents Chemother 2010; 54(8): 3489-92.
  27. Bertrand S, Weill FX, Cloeckaert A, Vrints M, Mairiaux E, Praud K, et al. Clonal emergence of extended-spectrum beta-lactamase (CTX-M-2)-producing Salmonella enterica serovar Virchow isolates with reduced susceptibilities to ciprofloxacin among poultry and humans in Belgium and France (2000 to 2003). J Clin Microbiol 2006; 44(8): 2897-903.
Journal of Kerman University of Medical Sciences
Volume 23, Issue 2
2016
Pages 145-155

Home

Editorial Board

Guide for Authors

Submit Manuscript

Guide for Reviewers

Contact Us