Emergence of extended spectrum beta-lactamases-producing strains belonging to cefotaxime-M-1 class from intensive care units patients and environmental surfaces in Pakistan

Abstract

Aim:The emergence of multidrug-resistant (MDR) bacteria is the most dangerous threat for the treatment of infectious diseases. The aim of this study was to detect and characterize extended spectrum beta-lactamases (ESBLs) and carbapenemaseproducing Klebsiella pneumoniae and Escherichia coli among patients and environment of intensive care units (ICUs) of three tertiary care hospitals in Pakistan. Materials and Methods:A total of 82 samples from ICU's patients and inanimate environment (injection trays, wash basins, door handles, hand swabs of professionals, and ICU fridges) were screened for ESBL by culturing on CHROMagar-ESBL. ESBL and carbapenemases production were confirmed by double disc synergy test and modified Hodge's test, respectively. Polymerase chain reaction was used to detect ESBL encoding genes bla cefotaxime (CTX-M), blaCTX-M-1, blaCTX-M-2, blaCTX-M-9, blaTEM, blaSHV and carbapenemase genes blaKPC, bla New Delhi metallo-beta-lactamase-1, blaOXA-48 and blaVIM.Results: Overall, ESBL production was found high 30/82 (36.5%) among isolates of which 15.8% K. pneumoniae and 20.7% E. coli were identified. All the K. pneumoniae and majority of E. coli isolates were MDR, i.e., resistance to three or more antimicrobial categories. Molecular characterization showed the blaCTX-M-1 as the predominant genotype found in 17/21 (80%) of the isolates. None of the strains was found positive for carbapenemase-encoding genes. Conclusion:In conclusion, this study demonstrates the emergence of MDR ESBL producing strains among ICU patients and hospital environment, posing a serious threat for the control of nosocomial infections.

Distribution and genetic diversity of multi-drug-resistant Klebsiella pneumoniae at the human–animal–environment interface in Pakistan

“…Additionally, a study conducted in the recent past found ESBL producing K. pneumoniae with a rate of 15.8% ( Bukhari et al, 2016 ), the low percentage prevalence may be due to the small sampling fraction and a huge diversity of sample sources as compared to our studied samples. Worryingly, a significant percentage prevalence (32%) of carbapenem-resistant K. pneumoniae has also been detected in the present study.…”

Magnitude and antimicrobial susceptibility patterns of extended-spectrum β-lactamase producing Enterobacteriaceae recovered from environmental samples at Tikur Anbessa Specialized Hospital, Ethiopia

“…In our study, ESBL producing Enterobacteriaceae were isolated in 16 of the 65 (24.6%) environmental samples. In published reports, the percentage of inanimate hospital environments contaminated with ESBL are signi cantly varied ranging from 3% to 33% of surfaces in patients' rooms on regular hospitals wards, as reported from Gonder in Ethiopia (14.8%) [6], Tunisia (4%) [11], Israel (9%) [20], Tunisia (4%) [5], UK (3.1%) [12] and Pakistan (33%) [2]. These discrepancies could possibly be due to differences in patient colonization load, hospital's cleaning/disinfection protocols, study design including timing of sample collection and laboratory method used [5,11,20,21].…”

“…In Gram-negative bacteria, β-lactamase production remains the most important mechanism of resistance to β-lactam group of antibiotics and has become a global challenge in infection control. One group of these enzymes is called extended-spectrum β-lactamases (ESBLs) [1][2][3]. ESBLs hydrolyze a wide range of cephalosporins including the oxyimino group of cephalosporins such as ceftriaxone, ceftazidime, cefotaxime and the monobactam drugs such as aztreonam, but do not hydrolyze cephamycins and carbapenems, and their activity is inhibited by clavulanic acid [3,4].…”