Examining the Frequency of bla CTX-M and bla TEM Genes in Escherichia Coli Isolates with Multiple Drug Resistance Isolated from Patients Hospitalized in Ahvaz University Hospitals

Document Type : Original Article


1 Department of Microbiology and Microbial Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran

2 Associate Professor, Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

3 Associate Professor, Department of Microbiology and Microbial Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran



Background and Objectives In the last few decades, Escherichia coli strains producing extended-spectrum beta-lactamases (ESBLs) have increased and are now considered a major problem in hospitalized patients. The aim of this study was to investigate the prevalence of blaCTX-M and blaTEM genes in Escherichia coli with multiple drug resistance. Subjects and Methods This study was conducted from October 2021 to May 2022. The research site included the microbiology laboratories of Golestan, Imam Khomeini, and Shahid Beqai hospitals where isolates suspected of Escherichia coli were isolated from urine culture samples of patients with urinary tract infection. All Escherichia coli samples were identified by conventional biochemical and molecular methods. The antibiotic sensitivity of the isolates was determined by disk diffusion method. Then, in order to finally confirm the presence of blaCTX-M and blaTE genes, PCR method was used. Results Out of the 160 bacterial isolates examined, 138 (86.3%) showed multidrug resistance (MDR). The highest and lowest percentage of resistance was related to Amoxicillin-Clavonic acid (84.1%) and Meropenem (5.8%), respectively. Based on the combined disk method, 96 isolates (69.6%) were positive for Beta-lactamase enzymes (ESBLs). Among the 96 ESBL-positive isolates, 85 (88.5%) and 38 (39.6%) carried blaCTX-M and blaTEM genes, respectively. Conclusion Given the significant prevalence of Escherichia coli strains that are resistant to multiple drugs and carrying ESBLs beta-lactamase genes in hospital, there is a need for effective surveillance measures to prevent the further spread of drug resistance in these isolates.


Main Subjects

[1] Ny S, Edquist P, Dumpis U, Gröndahl-Yli-Hannuksela K, Hermes J, Kling AM, Klingeberg A, Kozlov R, Källman O, Lis DO, Pomorska-WesoĊ‚owska M. Antimicrobial resistance of Escherichia coli isolates from outpatient urinary tract infections in women in six European countries including Russia. Journal of global antimicrobial resistance. 2019 Jun 1;17:25-34. [ 10.1016/j.jgar.2018.11.004 ] [PMID]
[2] Murray PR, Rosenthal KS, Pfaller MA. Medical microbiology. Elsevier Health Sciences; 2015 Oct 28. [Link]
[3] Sanchez UM, Bello TH, Dominguez YM, Mella MS, Zemelman ZR, Gonzalez RG. Transference of extended-spectrum beta-lactamases from nosocomial strains of Klebsiella pneumoniae to other species of Enterobacteriaceae. Revista medica de Chile. 2006 Apr 1;134(4):415-20. [10.4067/s0034-9887200 6000400002 ] [PMID]
[4] Minami J, Katayama SI, Matsushita O, Sakamoto H, Okabe A. Enterotoxic activity of Klebsiella oxytoca cytotoxin in rabbit intestinal loops. Infection and immunity. 1994 Jan;62(1):172-7. [10.1128/iai.62.1.172-177.1994 ] [PMID]
[5] Brooks GF, Carroll KC, Butel JS, Mprse SA, Mietzner TA. Medical microbiology. United States. [Link]
[6] Arlet G, Jacoby GA. Plasmid-determined AmpC-type -lactamases. Antimicrob. Agents Chemother. 2002. [10.1128/AAC.46.1.1-11.2002 ] [PMID]
[7] Chevalier J, Mulfinger C, Garnotel E, Nicolas P, Davin-Régli A, Pagès J-MJPO. Identification and evolution of drug efflux pump in clinical Enterobacter aerogenes strains isolated in 1995 and 2003. 2008;3(9):e3203. [10.1371/journal.pone.0003203 ] [PMID]
[8] Thirapanmethee KJMUJPS. Extended spectrum β-lactamases: critical tools of bacterial resistance. 2012;39(1):1-8. [Link]
[9] Humphries R, Bobenchik AM, Hindler JA, Schuetz ANJJocm. Overview of changes to the clinical and laboratory standards institute performance standards for antimicrobial susceptibility testing, M100. 2021;59(12):e00213-21. [10. 1128/JCM.00213-21 ] [PMID]
[10] Yazdanpour Z, Vaez H. Molecular Detection of Aminoglycoside Acetyltransferases Genes in Escherichia coli Isolated from Community-Acquired Urinary Tract Infections of Patients Referred to Amiralmomenin Hospital, Zabol, 2019-2021. yafte 2022; 24 (1) :1-10. [link]
[11] Ponnusamy P, Nagappan RJIJMR. Molecular characterization of bla CTX-M, bla TEM, bla SHV-beta lactamase produced by uropathogenic Escherichia coli isolates. 2015;6:67-73. [Link]
[12] Mouanga Ndzime Y, Onanga R, Kassa Kassa RF, Bignoumba M, Mbehang Nguema PP, Gafou A, et al. Epidemiology of community origin Escherichia coli and Klebsiella pneumoniae uropathogenic strains resistant to antibiotics in Franceville, Gabon. 2021:585-94. [10.2147/IDR.S296054 ] [PMID]
[13] Bala R, Singh VA, Gupta N, Rakshit PJTJoIiDC. Prevalence, multidrug-resistance and risk factors for AmpC β-lactamases producing Escherichia coli from hospitalized patients. 2020;14(12):1466-9. [10.3855/jidc.13483 ] [PMID]
[14] Jomehzadeh N, Ahmadi K, Rahmani ZJOPH, Perspectives R. Prevalence of plasmid-mediated AmpC β-lactamases among uropathogenic Escherichia coli isolates in southwestern Iran.
2021;12(6):390. [10.24171/j.phrp.2021.0272 ] [PMID]
[15] Barati Leila, Qazlsafli Farzad, Azarhosh Ramin, Heydari Farida, Nora Mohammad. Determining the sensitivity of Escherichia coli bacteria isolated from the urine of pregnant women to antibiotics in Kalaleh (1387) (short report).[Link]
[16] Mohammadi M, Ghasemi E, Mokhayeri H, Pournia Y, Boroun HJAJoBS. Antimicrobial resistance patterns of E. coli detected from hospitalized urine culture samples. 2010;3(4):195-201. [Link]
[17] Ait-Mimoune N, Hassaine H, Boulanoir MJIJoM. Bacteriological profile of urinary tract infections and antibiotic susceptibility of Escherichia coli in Algeria. 2022;14(2):156. [10.18502/ ijm.v14i2.9180 ] [PMID]
[18] Post A, Guiraud I, Peeters M, Lompo P, Ombelet S, Karama I, et al. Escherichia Coli From Urine Samples of Pregnant Women as an Indicator for Antimicrobial Resistance in the Community: a Field Study From Rural Burkina Faso. 2021. [10.1186/s13756-022-01142-7 ] [PMID]
[19] Amiri M, Farzin H, Jamshidian-Mojaver M. Phenotypic and Genotypic Study of Antibiotic Resistance among Escherichia coli Isolates from Human Urinary Infection Cases in Bojnord Province. Avicenna Journal of Clinical Medicine. 2019 Dec 15;26(3):173-80. [Link]
[20] Barari Sawadkouhi R, Sorkhi H, Pournasrollah M, Bijani A, Babazadeh N, Baleghi Damavandi S. Antibiotic resistance of bacteria causing urinary tract infections in children hospitalized in Amirkola Children Hospital during 2010-2011. Journal of Babol University of Medical Sciences. 2013 Sep 10;15(5):89-94 [Link]
[21] Hosseini F. Antibacterial evaluation of Vancomycin/Trimethoprim combination on beta-lactamase resistant genes of Escherichia coli isolated from patients with urinary tract infection referring to the Shahid Rajaii hospital of Gachsaran. Islamic Azad University Gachsaran Branch. 2018. [Link]
[22] Mansouri S, Neyestanaki DK, Shokoohi M, Halimi S, Beigverdi R, Rezagholezadeh F, Hashemi A. Characterization of AmpC, CTX-M and MBLs types of β-lactamases in clinical isolates of Klebsiella pneumoniae and Escherichia coli producing extended spectrum β-lactamases in Kerman, Iran. Jundishapur journal of microbiology. 2014 Feb;7(2). [10.5812/jjm.8756 ] [PMID]
[23] Kandakai-Olukemi YT, Mawak JD, Onojo MM. Isolation of enteropathogenic Escherichia coli from children with diarrhoea attending the national hospital in Abuja, Nigeria. Shiraz E-Medical Journal. 2009 Aug 31;10(3). [Link]
[24] Heidari-soureshjani E, Heidari M, Doosti A. Epidemiology of urinary tract infection and antibiotic resistance pattern of E. coli in patients referred to Imam Ali hospital in Farokhshahr, Chaharmahal va Bakhtiari, Iran. Journal of Shahrekord University of Medical Sciences. 2013 May 15;15(2):9-15. [Link]
[25] Kumar D, Singh AK, Ali MR, Chander Y. Antimicrobial susceptibility profile of extended spectrum β-lactamase (ESBL) producing Escherichia coli from various clinical samples. Infectious Diseases: Research and Treatment. 2014 Jan;7:IDRT-S13820. [10.4137/IDRT.S13820 ] [PMID]
[26] Habeeb MA, Haque A, Nematzadeh S, Iversen A, Giske CG. High prevalence of 16S rRNA methylase RmtB among CTX-M extended-spectrum β-lactamase-producing Klebsiella
Nejat S H, et al. Frequency of bla CTX-M and bla TEM genes in Escherichia coli isolates. JSMJ. 2024; 22(4):469-482
Journal of Medical Sciences
September & October 2024. Vol 22. No 4
pneumoniae from Islamabad, Pakistan. International journal of antimicrobial agents. 2013 Jun 1;41(6):524-6. [10.1016/j. ijantimicag.2013.02.017 ] [PMID]
[27] Mohammed H, Elsadek Fakhr A, Al Johery SA, Abdel Ghani Hassanein W. Spread of TEM, VIM, SHV, and CTX-M β-lactamases in imipenem-resistant Gram-negative bacilli isolated from Egyptian hospitals. International Journal of Microbiology. 2016 Mar 31;2016. [10.1155/2016/8382605 ] [PMID]
[28] Liao K, Chen Y, Wang M, Guo P, Yang Q, Ni Y, Yu Y, Hu B, Sun Z, Huang W, Wang Y. Molecular characteristics of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae causing intra-abdominal infections from 9 tertiary hospitals in China. Diagnostic Microbiology and Infectious Disease. 2017 Jan 1;87(1):45-8. [10.1016/j. diagmicrobio.2016.10.007 ] [PMID]
[29] Malande OO, Nuttall J, Pillay V, Bamford C, Eley B. A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa. PloS one. 2019 Sep 24;14(9):e0222675. [10.1371/journal.pone.0222675 ] [PMID]
[30] Jena J, Sahoo RK, Debata NK, Subudhi E. Prevalence of TEM, SHV, and CTX-M genes of extended-spectrum β-lactamase-producing Escherichia coli strains isolated from urinary tract infections in adults. 3 Biotech. 2017 Aug;7:1-7. [10.1007/ s13205-017-0879-2 ] [PMID]