Emerging extended-spectrum β-lactamase-producing  Klebsiella pneumoniae  causing community-onset urinary tract infections: a case–control–control study

Boix-Palop, Lucía; Xercavins, Mariona; Badía, Cristina; Obradors, Meritxell; Riera, Montserrat; Freixas, N.; Pérez, J. Enrique; Rodríguez-Carballeira, Mónica; Garau, Javier

doi:10.1016/j.ijantimicag.2017.03.009

Cited by 24 publications

(23 citation statements)

References 27 publications

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“…Several studies have reported the strong involvement of Escherichia coli in urinary (15)(16)(17) and cervicovaginal infections (18)(19)(20). Klebsiella pneumoniae was the second most isolated bacterium in our specimens, which has also been reported in urinary and vaginal infections (21)(22)(23). A high resistance to cephalosporins was recorded in the present study.…”

Section: Discussionsupporting

confidence: 78%

First Sequence Analysis of Genes Mediating Extended-Spectrum Beta-Lactamase (ESBL) bla-TEM, SHV- and CTX-M Production in Isolates of Enterobacteriaceae in Southern Benin

et al. 2018

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The production of extended-spectrum beta-lactamase (ESBL) by Enterobacteriaceae is a global public health problem. The present study was carried out on 156 strains of enteric bacteria isolated from urinary and cervicovaginal fluid samples. Identification of the strains was performed using MALDI-TOF MS and antibiotic susceptibility tests by disk diffusion method on Mueller Hinton agar in accordance with the recommendations of the Antibiogram Committee of the French Society for Microbiology. ESBL genes were sought by real time-polymerase chain reaction (RT-PCR) and by gel-based PCR. Gel-based PCR products were used for sequencing of the resistance genes, which were analyzed in the NCBI and Arg Annot databases. Results showed a predominance of Escherichia coli both in the urinary and cervicovaginal fluid samples. Klebsiella pneumoniae was the second most isolated bacterium in the specimens. Sensitivity to antibiotics revealed high levels of cephalosporin resistance but low resistance to carbapenem. No resistance was noted to colistine. The bla-TEM gene was present in Escherichia coli, while bla-SHV was found in Klebsiella pneumoniae and bla-CTX-M was recovered in both strains. Analysis of the sequences revealed that bla-Tem1 was predominant in bla-TEM and bla-CTX-M-15 was most represented by bla-CTX-M. This study confirms the presence of ESBL-producing Enterobacteria in Benin. This was an epidemiological study aimed at detecting cephalosporin resistance in gram-negative Bacillus isolated from urinary tract and genital infections developed by women. Since the advent of molecular biology techniques for the identification of resistance in bacteria including determination of ESBL resistance genes (i.e., TEM, SHV, CTX-M), no study has been conducted to identify the different variants that circulate in Benin by sequencing these resistance genes. This sequencing is essential in order to differentiate the non-ESBL parental enzymes, which is not possible with the commonly used PCR techniques that do not permit differentiation of the point generating different variants of the ESBL genes. The present study then helped to identify those variants, in particular Tem1, SHV1, and CTX-M15, which are most encountered in Benin and around the world.

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Section: Discussionsupporting

confidence: 78%

First Sequence Analysis of Genes Mediating Extended-Spectrum Beta-Lactamase (ESBL) bla-TEM, SHV- and CTX-M Production in Isolates of Enterobacteriaceae in Southern Benin

et al. 2018

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“…In the last 5 years, we have detected an increase in the incidence of hospital-acquired ESBL-Kp infections in our area (from 0.06 in 2011 to 0.35/1.000 stays in 2015) alongside a rise in the prevalence of communityacquired urinary tract infection due to ESBL-Kp (from 2.4% in 2010 to 10.3% in 2014). Most of these clinical isolates harbored CTX M-15 enzymes [9].…”

Section: Introductionmentioning

confidence: 99%

High clonal diversity of ESBL-producing Klebsiella pneumoniae isolates from clinical samples in a non-outbreak situation. A cohort study

Xercavins

Jiménez²,

Padilla³

et al. 2020

Antimicrob Resist Infect Control

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Background: Klebsiella pneumoniae has been responsible for a large number of clonal hospital outbreaks. However, some epidemiological changes have been observed since the emergence of CTX-M enzymes in K. pneumoniae. Aim: To analyse the transmission dynamics of Extended Spectrum β-Lactamase-producing Klebsiella pneumoniae (ESBL-Kp) in an acute care hospital. Methods: In 2015 a prospective cohort study was conducted. All new consecutive adult patients with ESBL-Kp isolates in all clinical samples were included. Patients with a previous known infection/colonization by ESBL-Kp and patients in high risk areas (e.g., intensive care units) were excluded. Cross-transmission was defined as the carriage of a clonally-related ESBL-Kp between newly diagnosed patients who shared the same ward for ≥48 h with another case, within a maximum time window of 4 weeks. ESBL-production was confirmed using the double-disk diffusion method and PCR. Clonal relationships were investigated by rep-PCR and multilocus sequence typing (MLST). Results: Sixty ESBL-Kp isolates from 60 patients were included and analysed. Infections and colonizations were classified as hospital-acquired (52%), healthcare-related (40%) or community-acquired (8%). High genetic diversity was detected. When epidemiological clinical data were combined with the rep-PCR, the patterns identified did not show any cases of cross-transmission. ESBL-Kp were detected in 12.5% of environmental samples. No clonal relationship could be established between environmental reservoirs and patients. The genetic mechanism detected in all strains was associated with bla CTX-M genes, and 97% were CTX-M-15. Conclusions: The dynamics of ESBL-K. pneumoniae isolated in our setting could not be explained by clonal transmission from an index patient. A polyclonal spread of ESBL-Kp was identified.

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“…The evidence shows that the prevalence of ESBL‐P Enterobacteriaceae is increasing at both hospital and community settings globally. A thorough knowledge in terms of the prevalence of ESBL‐P Enterobacteriaceae in maternal UTIs in various geographic regions is clinically important from two aspects.…”

Section: Introductionmentioning

confidence: 99%

“…5,7 Furthermore, co-resistance of ESBL-P organisms to non-beta-lactam antibiotics (eg aminoglycosides such as streptomycin (50%) and kanamycin (26%), tetracyclines, and quinolones such as nalidixic acid (56%)) has been observed. 8,9 The evidence shows that the prevalence of ESBL-P Enterobacteriaceae is increasing at both hospital 10 and community 11 settings globally. A thorough knowledge in terms of the prevalence of ESBL-P Enterobacteriaceae in maternal UTIs in various geographic regions is clinically important from two aspects.…”

Section: Introductionmentioning

confidence: 99%

Extended‐spectrum beta‐lactamase (ESBL)‐producingEnterobacteriaceaeand urinary tract infections in pregnant/postpartum women: A systematic review and meta‐analysis

et al. 2019

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Background Urinary tract infections (UTI) and asymptomatic bacteriuria (AB) during pregnancy can result in considerable maternal and foetal adverse outcomes. Production of extended‐spectrum beta‐lactamase (ESBL) is a major antibiotic resistance mechanism by Enterobacteriaceae. Objectives To determine the global prevalence of ESBL‐producing (ESBL‐P) Enterobacteriaceae in symptomatic UTI/AB among pregnant/postpartum females. Data sources A systematic review of the PubMed, Embase, Scopus, WOS (Web of Science), ProQuest and the grey literature was conducted. Study selection and data extraction Studies that reported the frequency of ESBL‐P Enterobacteriaceae in pregnant/postpartum women with UTI and/or AB were eligible. First, the titles and abstracts of the retrieved articles were reviewed. Then, the full texts of the remained articles were reviewed. Synthesis In order to estimate the pooled prevalence and the 95% confidence interval (95% CI), meta‐analysis was performed using the random‐effects model. Results Twenty‐three studies (six from Africa, two from North America, one from South America, 12 from Asia and two European studies) that reported data on 20 033 Enterobacteriaceae strains were included. The pooled prevalence of ESBL‐P Enterobacteriaceae was 25% (95% CI 18%, 32%); I2 = 98.8%. The estimated prevalence (95% CI) rates were 45% (22, 67%) in Africa, 33% (22, 44%) in India, 15% (6, 24%) in other Asian countries, 5% (2, 8%) in Europe, 4% (1, 11%) in South America and 3% (1, 5%) in North America (P < .001). This estimate was 21% (95% CI 11, 31%) in patients with symptomatic UTI and it was 28% (95% CI 15, 41%) in patients with AB (P = .40). Conclusions The prevalence of ESBL‐P Enterobacteriaceae among pregnant women with UTI/AB was significant and geographic region was a major source for heterogeneity. The findings could be taken into account by healthcare providers and programmers in the management and antibiotic selection of UTI/AB during pregnancy, especially in high prevalence areas.

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Emerging extended-spectrum β-lactamase-producing Klebsiella pneumoniae causing community-onset urinary tract infections: a case–control–control study

Cited by 24 publications

References 27 publications

First Sequence Analysis of Genes Mediating Extended-Spectrum Beta-Lactamase (ESBL) bla-TEM, SHV- and CTX-M Production in Isolates of Enterobacteriaceae in Southern Benin

First Sequence Analysis of Genes Mediating Extended-Spectrum Beta-Lactamase (ESBL) bla-TEM, SHV- and CTX-M Production in Isolates of Enterobacteriaceae in Southern Benin

High clonal diversity of ESBL-producing Klebsiella pneumoniae isolates from clinical samples in a non-outbreak situation. A cohort study

Extended‐spectrum beta‐lactamase (ESBL)‐producingEnterobacteriaceaeand urinary tract infections in pregnant/postpartum women: A systematic review and meta‐analysis

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