Detection of &lt;i&gt; Enterobacteriaceae&lt;/i&gt; producing CTX-M extended spectrum β-lactamases from a tertiary care hospital in south India

Padmini, S Baby; Raju, B Appala; Mani, KR

doi:10.4103/0255-0857.40534

Cited by 21 publications

(19 citation statements)

References 14 publications

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“…Dual FQ and blactam resistance is quite problematic, especially among immunocompromised patients. In agreement with other Indian studies, the majority of our ESBL/AmpC-producing E. coli exhibited a high level of resistance towards quinolone (93.1 %) and FQ (75 %), which would have therapeutic implications (Baby Padmini et al, 2008). Several reports have documented a strong correlation between qnrA prevalence and ESBL positivity in E. coli isolates, especially the CTX-M type (Jacoby et al, 2003;Mammeri et al, 2005;Lavigne et al, 2006), which could frequently be due to the presence of these resistance determinants on mobile genetic elements (Jacoby & Sutton, 1991;Partridge et al, 2001;Preston et al, 2003;Villa et al, 2000;Wang et al, 2003 The virulence potential and multiple drug resistance observed among the E. coli of non-B2 phylogroups further strengthens the claim that horizontal gene transfer might play a major role in the emergence of drug resistance among these originally avirulent/less virulent strains which can no longer be called 'innocent bystanders'.…”

Section: Discussionsupporting

confidence: 92%

“…Among the E. coli isolates that harboured bla TEM , 65.9 % exhibited an ESBL phenotype, while all the bla CTX-M + isolates exhibited an ESBL phenotype. SHVderived ESBL enzymes were not detected in the present study, which is in agreement with other Indian studies (Baby Padmini et al, 2008;Alfaresi & Elkoush, 2010). Conversely, Sharma et al (2010) reported that 12 (48 %) of the 25 ESBL-producing E. coli isolates they studied possessed a bla SHV gene.…”

Section: Discussionsupporting

confidence: 92%

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Extended-spectrum β-lactamase/AmpC-producing uropathogenic Escherichia coli from HIV patients: do they have a low virulence score?

Padmavathy

Krishnan

Rajasekaran

2013

Journal of Medical Microbiology

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Extended-spectrum b-lactamase (ESBL) production and quinolone resistance are often associated in enterobacteria. Prior exposure to 3G cephalosporins/quinolones accelerates the risk of resistance to both these groups of antibiotics. Hence, information on the antimicrobial resistance pattern of uropathogenic Escherichia coli (UPEC) isolates is important to better formulate the guidelines for the empirical therapy of urinary tract infection in the context of HIV/ AIDS. The aim of this study was to determine the incidence of ESBL/AmpC and fluoroquinolone (FQ) resistance among urinary E. coli isolates and to establish the association of extraintestinal virulence and phylogenetic distribution with antibiotic resistance and host immunocompromisation. Accordingly, 118 urinary Escherichia coli isolates from HIV (n576) and non-HIV antenatal patients (n542) from Chennai, South India, were analysed for the presence of five virulence-associated genes (VAGs): pap, sfa/foc, afa/dra, iutA and kpsMII. Compared with the susceptible HIV isolates, the majority of the ESBL + AmpC + FQ R isolates harboured iutA (66.7 %) and pap (40 %). The FQ-resistant HIV isolates were significantly enriched for iutA (67.8 %) and kpsMII (47.5 %) and qualified as UPEC (54.2 %), while a majority of the FQ-susceptible isolates from the non-HIV patients were found to harbour pap (48.4 %), sfa/foc (41.9 %) and kpsMII (48.4 %) and were classified as UPEC (40.5 %). We conclude that antibiotic-resistant (ESBL + AmpC + and/or FQ R ) phylogroup D isolates with limited virulence are competent enough to establish infections in HIV patients, while among non-HIV patients, an array of virulence factors is essential for E. coli to overcome host defences irrespective of antibiotic resistance. INTRODUCTIONThe liberal use of quinolones and b-lactams has triggered bacterial resistance worldwide. Urinary Escherichia coli are increasingly reported to exhibit resistance to the conventional front-line antibiotic ciprofloxacin (Lüthje & Brauner, 2010). The recent EAU (European Association of Urology) guidelines (2011; see http://www.uroweb.org/guidelines/ online-guidelines/) recommend the use of Group 3a/b cephalosporins (cefotaxime, ceftazidime, cefoperazone) for the treatment of complicated urinary tract infections and urosepsis (Grabe et al., 2011). However, emergence of b-lactam resistance mediated by extended-spectrum blactamases (ESBLs) and group 1 AmpC cephalosporinases (especially plasmid-mediated AmpC b-lactamasesPMACBLs) is a major global problem (Winokur et al., 2001;Lampri et al., 2012). ESBL/AmpC-producing organisms are of paramount concern as they limit therapeutic options, cause treatment failures and increase the cost/ duration of hospitalization (Odeh et al., 2002). Emerging resistance in E. coli is frequently due to the irrational use of antibiotics and is associated with high mortality rates. Hence, rapid detection of such strains is a prerequisite to limit their dissemination and for the selection of appropriate antimicrobial therapy, which is frequentl...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Extended-spectrum β-lactamase/AmpC-producing uropathogenic Escherichia coli from HIV patients: do they have a low virulence score?

Padmavathy

Krishnan

Rajasekaran

2013

Journal of Medical Microbiology

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“…The data which has been presented here, demonstrates the presence of the CTX-M genes in this part of our country. A similar study from south India also reported the CTX-M genes as the predominant ESBL genes [10]. CTX-M was reported to be the most prevalent gene among the E.coli strains and the Klebsiella species in another similiar study, but their co-production was not reported [11].…”

Section: Discussionmentioning

confidence: 86%

“…Clinical isolates from urine (344), pus (109), blood (15), IV catheter tip/ central line tip (10), sputum (12) and body fluid (10) specimens were processed.…”

Section: Samplesmentioning

confidence: 99%

Occurrence of the CTX-M, SHV and the TEM Genes Among the Extended Spectrum b-Lactamase Producing Isolates of Enterobacteriaceae in a Tertiary Care Hospital of North India

Kaur

Aggarwal²

2013

JCDR

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Purpose: The present study was carried out to assess the prevalence of the Extended Spectrum Beta Lactamases (ESBLs) and to characterize the ESBL types which were prevalent in our hospital.Material Methods: Five hundred gram negative isolates which belonged to the family, Enterobacteriaceae, which were isolated during the study period of 2009 to 2011, were investigated for ESBL production. Clinical isolates from urine (344), pus (109), blood (15), IV/ central line tip (10), sputum (12) and body fluid (10) specimens were processed. The organisms which were identified, included E.coli (351), Klebsiella pneumoniae (74), Klebsiella oxytoca (21), Proteus mirabilis (15), Proteus vulgaris (9) , Enterobacter spp (15) and Citrobacterspp (15). Antimicrobial susceptibility testing was done. The ESBL detection was carried out for all the isolates by the CLSI confirmatory method. The MIC of ceftazidime and ceftazidime plus clavulanic acid was determined by the E-test. Molecular typing of the ESBLs was performed by multiplex PCR among 93 ESBL isolates.Results: 45.8% isolates were found to be ESBL producers by the CLSI confirmatory method and they were confirmed by the E-test ESBL strips. A majority of E.coli in the study possessed the CTX-M genes (59.32%). Among the Klebsiella isolates, a majority were co producers of the ESBL genes; either 2 or all the 3 genes co-existed together.

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“…Sequencing of 4 isolates revealed the presence of CTX M-15. This was the first report identifying CTX-M type ESBL from clinical isolates of E. coli and K. pneumoniae from South India [24]. Grover et al [25] of New Delhi in 2006 reported the prevalence of TEM and SHV in ESBL producing Gramnegative bacteria to be up to 88.8 %.…”

Section: Iso-electric Focusingmentioning

confidence: 87%

First Report of OXA-4, an ESBL Isolated from Pseudomonas aeruginosa a South Indian Strain

Kingsley¹,

Verghese²

2012

Indian J Microbiol

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The OXA-type b-lactamases are so named because of their oxacillin-hydrolyzing abilities. In this study we characterize an extended spectrum b-lactamase, designated OXA-4, produced by a clinical isolate of Pseudomonas aeruginosa. ESBL production was detected by double disk synergy test. The P. aeruginosa isolate was obtained from endotracheal suction tip of 84 years old male patient diagnosed with CVA and hypertension. ESBL producing OXA b-lactamases was detected by PCR with primers specific to the conserved regions of the coding genes. Iso electric focusing was done to confirm the significance, sequencing the amplified product was also done. In the phenotypic identification, the strain was highly resistant to third generation cephalosporins and also to imipenem. The PCR amplified product for OXA b-lactamase was viewed at 919 bp. The pI point for the same was identified at 7.2. With the help of sequencing the amplified OXA b-lactamase was identified as OXA-4 gene. Here we report P. aeruginosa producing OXA-4 ESBL for the first time in the Indian subcontinent.

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Detection of <i> Enterobacteriaceae</i> producing CTX-M extended spectrum β-lactamases from a tertiary care hospital in south India

Cited by 21 publications

References 14 publications

Extended-spectrum β-lactamase/AmpC-producing uropathogenic Escherichia coli from HIV patients: do they have a low virulence score?

Extended-spectrum β-lactamase/AmpC-producing uropathogenic Escherichia coli from HIV patients: do they have a low virulence score?

Occurrence of the CTX-M, SHV and the TEM Genes Among the Extended Spectrum b-Lactamase Producing Isolates of Enterobacteriaceae in a Tertiary Care Hospital of North India

First Report of OXA-4, an ESBL Isolated from Pseudomonas aeruginosa a South Indian Strain

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