Molecular Characterization of Extended-Spectrum β-Lactamase Enterobacteriaceae Isolated from Egyptian Patients with Community- and Hospital-Acquired Urinary Tract Infection

Shash, Rania; Elshimy, Amal; Soliman, Mohammed Y.; Mosharafa, Ashraf A.

doi:10.4269/ajtmh.18-0396

Cited by 20 publications

(14 citation statements)

References 34 publications

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“…1 a, Supplementary Figure S 3 ), which is in line with other studies [ 39 , 54 – 56 ]. In contrast, our prevalence rate was higher than that reported in earlier Egyptian studies, namely, 17% by [ 57 ] and 38.8% by [ 58 ]. Therefore, an increase in the ESBL production rate has emerged over time in Egypt due to the uncontrolled use of antimicrobials, mostly third-generation cephalosporins, as routine therapy against UTIs [ 59 , 60 ].…”

Section: Discussioncontrasting

confidence: 99%

Prevalence of extended-spectrum β-lactamases, AmpC, and carbapenemases in Proteus mirabilis clinical isolates

2022

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Background Proteus mirabilis is an opportunistic pathogen, causing a variety of community-acquired and nosocomial illnesses. It poses a potential threat to patients via the production of β-lactamases, which decrease the efficacy of antimicrobial treatment and impair the management of its pathogenicity. Hence, this study was established to determine the prevalence of extended-spectrum β-lactamases (ESBLs), AmpC, and carbapenemases of P. mirabilis isolated from various clinical specimens. Results Proteus mirabilis was identified in 20.7% (58/280) of specimens. ESBL producers were present at a rate of 51.7% (30/58). All AmpC-positive isolates (n = 20) produced ESBLs as well, so 66.7% of ESBL-producing isolates coproduced AmpC enzymes. The modified Hodge test confirmed carbapenemase production in six out of seven imipenem nonsusceptible isolates. Of these, only two (5.7%) isolates were also ESBL-and AmpC-positive. Antibiotic resistance reached the highest level for cotrimoxazole (62.1%, n = 36/58 isolates) and the lowest for imipenem (12.1%, n = 7/58 isolates). The levels of multidrug-resistant (MDR) was 41.4% among the tested isolates. The blaSHV (83.3%), blaAmpC (80%), and blaVIM-1 (50%) were the most detected genes in phenotypically confirmed ESBL-, AmpC-, and carbapenemase-producing isolates, respectively. Besides, more than a half of the tested P. mirabilis strains (53%) coproduced ESBLs and AmpC. Moreover, two isolates coproduced ESBLs and AmpC together with carbapenemases. Furthermore, dendrogram analysis showed great genetic divergence based on the 21 different enterobacterial repetitive intergenic consensus (ERIC) patterns (P1–P21) through the 34 β-lactamase producers. ERIC analysis distinguished clonal similarities between isolates 21 and 22 in P2 and 9 and 10 in P4, which were isolated from the same clinical source and possessed similar patterns of β-lactamase-encoding genes. Conclusion Hence, there is an urgent need to monitor hospitalized patients and improve healthcare in order to reduce the incidence of infection and outbreaks of infection with antibiotic-resistant Proteus.

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Section: Discussioncontrasting

confidence: 99%

Prevalence of extended-spectrum β-lactamases, AmpC, and carbapenemases in Proteus mirabilis clinical isolates

2022

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“…This high frequency is comparable to a recent data reported by Hassuna et al, 2020 in our region, where 57.9% of E. coli isolated from community-acquired UTIs were ESBL producers [ 30 ]. On the other hand, our prevalence of ESBL-producing isolates is quite higher than that reported in several previous Egyptian studies; 17% by Fam et al, 2011 [ 28 ] and 38.8%, by Shash et al, 2019 [ 31 ], suggesting an increasing rate of ESBLs-producing Enterobacteriaceae spread in Egypt, that may be caused by extensive use of 3rd generation cephalosporines as empiric treatment in Egypt. The prevalence of ESBL production varies according to species, geographical areas, variations in infection control programs, different patterns of empiric antibiotic regimens and even over time .…”

Section: Discussioncontrasting

confidence: 71%

“…Global spread of β-lactamases-producing strains gives a great importance to the study of these strains in community and hospitals for reassessment of the existing treatment protocols. In Egypt, multiple studies have investigated the prevalence of ESBLs among Enterobacteriaceae isolated from hospital and community acquired-UTIs [28][29][30] [31], suggesting an increasing rate of ESBLsproducing Enterobacteriaceae spread in Egypt, that may be caused by extensive use of 3rd generation cephalosporines as empiric treatment in Egypt. The prevalence of ESBL production varies according to species, geographical areas, variations in infection control programs, different patterns of empiric antibiotic regimens and even over time.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and molecular characteristics of ESBL and AmpC β -lactamase producing Enterobacteriaceae strains isolated from UTIs in Egypt

Mohamed

Khairy

Abdelrahim

2020

Antimicrob Resist Infect Control

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Background Infections caused by Enterobacteriaceae are mainly treated with the β-lactam antibiotics, nevertheless, the emergence of species with plasmid-borne β-lactamases has decreased the efficacy of these antibiotics. Therefore, continuing studies on the resistance pattern of different regions is important for assessment of proper antimicrobial therapy protocols. The study aimed to characterize extended-spectrum β-lactamase (ESBL) and AmpC β –lactamase (AmpC) producing Enterobacteriaceae isolated from community-acquired UTIs in Egypt. Methods Out of 705 urine samples, 440 Enterobacteriaceae isolates were investigated to detect ESBL and AmpC β -lactamases producers by phenotypic and molecular methods. Results Out of 440 Enterobacteriaceae isolates, 311 were identified as ESBL producers by phenotypic testing. ESBL genes were detected in 308 isolates. BlaCTX-M-type was the most prevalent 254 (81.6%), out of them blaCTXM-15 was the commonest (152, 48.8%) followed by blaCTX-M-1 (140, 45%), blaCTX-M-8 (72, 23.1%) and lastly blaCTX-M-2 (4, 1.3%). blaTEM gene also was detected in a high rate (189, 60.7%). Two hundred and thirty-five (75.5%) of ESBL producers harbored blaCTX-M in combination with blaTEM and/or blaSHV genes. Multiple drug resistance in the ESBL-producers was significantly (P < 0.05) higher than in non–ESBL producers. Imipenem was the most effective drug against ESBL producers. Among 35 cefoxitin resistant isolates, 18 (51.4%) identified as carrying AmpC genes by multiplex PCR. Within AmpC β -lactamase genes, DHA gene was the predominant gene (15, 42.3%). CIT and MOX genes were also present, but in a low rate (5, 14.2% and 4, 11.4%) respectively. Co-existence of multiple AmpC genes was detected exclusively in K. pneumoniae isolates. E. coli isolates harbored DHA gene only. However, FOX gene was not detected in the study isolates. Seventeen of isolates carrying AmpC genes were also positive for ESBL genes. Conclusion The study shows that the prevalence of ESBL producing Enterobacteriaceae spread in south Egypt is alarming, however AmpC β -lactamase production is not so high.

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“…coli isolates from catheterized patients in the present study are not only characterized by high rates of resistance and biofilm formation but there is also a high rate of expression of bla-CTX-M (100%). This is in agreement with some studies as that of the Egyptian study who detected the bla-CTX-M gene in 98% of isolates 41 . Also, an Indonesian study reported CTX-M-15 gene in more than 89% of isolates 42 .…”

Section: Groupsupporting

confidence: 93%

Expression of bla-CTX-M and fimH genes in uropathogenic Escherichia coli isolated from Egyptian catheterized patients

Mousa

Omar

Riad

et al. 2022

Azhar International Journal of Pharmaceutical and Medical Scien

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The most common uropathogen is Escherichia coli, which causes more than 80% of catheterassociated urinary tract infections (CAUTI). Catheter-associated uropathogenic E. coli is difficult to be eradicated due to biofilm formation alongside increasing antibiotic resistance. The goal of this study is to determine the prevalence of biofilm and non-biofilm producing uropathogenic E. coli isolates and the antibiogram of E. coli isolates among catheterized patients who were admitted to Mansoura's University Hospitals. Also, the expression of bla-CTX-M and Fim H genes was determined using quantitative real-time PCR. The correlation between expression of bla-CTX-M and Fim H genes was detected. Isolated E. coli were highly resistant to nitrofurantoin (75%), ceftazidime (72%), ceftriaxone (71%), amikacin (71%), piperacillintazobactam (61%), and cefepime (53%). Biofilm formation was detected in all E. coli isolates. Also, bla-CTX-M and FimH genes were highly expressed in all E. coli isolates, as their expression is higher than the reference gene by 359.3 and 914.6 folds respectively. Insignificant positive correlation was detected between bla-CTX-M expression and FimH expression (r= 0.05, P-value= 0). These findings confirmed the serious infections caused in the catheterized patients, hence the importance of performing appropriate aseptic procedures when inserting and maintaining catheters to avoid CAUTI.

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Molecular Characterization of Extended-Spectrum β-Lactamase Enterobacteriaceae Isolated from Egyptian Patients with Community- and Hospital-Acquired Urinary Tract Infection

Cited by 20 publications

References 34 publications

Prevalence of extended-spectrum β-lactamases, AmpC, and carbapenemases in Proteus mirabilis clinical isolates

Prevalence of extended-spectrum β-lactamases, AmpC, and carbapenemases in Proteus mirabilis clinical isolates

Prevalence and molecular characteristics of ESBL and AmpC β -lactamase producing Enterobacteriaceae strains isolated from UTIs in Egypt

Expression of bla-CTX-M and fimH genes in uropathogenic Escherichia coli isolated from Egyptian catheterized patients

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