Survey of Frequency in Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae and Determination of the Antibiotic Resistant Pattern in Clinical Specimens in Teaching Hospitals of Ahvaz Jundishapur University of Medical Sciences

Document Type : Original Article

Authors

1 Department of Medical Microbiology, Faculty of Medicine, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

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

3 Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Abstract

Background and Objectives:Enterobacteriaceae produce the extended-spectrum beta-lactamases which is considered as an important resistant mechanism of beta-lactam antibiotics. The resistance to beta-lactam antibiotics is the main problem in the bacterial infections therapy. The present study aims to explore the frequency of the extended-spectrum beta-lactamase in isolated bacteria and to determine the isolates’ resistant pattern to antibiotics.
Subjects and Methods: A total of 240 isolated  Enterobacteriaceae  were collected from the clinical samples of Golestan and Imam Khomeini hospitals which were identified by standard biochemical tests. Next, the sensitivity of the isolates to the nine antibiotics was determined with Disk diffusion method. Then, isolated generator Enterobacteriaceae were detected with the combination disk method on the basis of CLSI criteria.
Results: Among 240 isolated bacteria E. coli, Entrobacter and Klebsiella comprised 71.3,27.1 and 1.2% most of the isolates. According to the results of the phenotypic tests, 108 (45%) isolates out of 240 Enterobacteriaceae were beta-lactamase producers.  Moreover, the results of diffusion disk showed that resistance of E coli, Entrobacter and Klebsilla isolates to ceftazidim and cefotaxim were 43.3 and 55.8 respectively.
Conclusion:The current study demonstrates that generator Enterobacteriaceae strains are increasing.Therefore, study of the extended-spectrum beta-lactamase enzymes would help in   prescribing the suitable medicine and consequently could prevent the spread of resistant bacteria.
 

Keywords


Escudero  E, Vinue L ,Teshager  T, Torres  C, Moreno  MA. Resistance  mechanisms and  farm-level  distribution of fecal Escherichia coli isolates resistant to extended-spectrum cephalosporins in pigs in Spain. Res Vet Sci 2010;88(1):83-7.
2-Falagas ME, Karageorgopoulos DE. Extended-spectrum beta-lactamase-producing organisms. J Hospe Infect 2009;73(4):345-54.  
3-Jacoby GA, Munoz-Price LS. Mechanisms of disease: the new β-Lactamases. N Engl J Med 2005;352:380-91. 
4-Rawat D, Nair D. Extended-spectrum β-lactamase in Gram Negative Bacteria. J Glob Infect Dis 2010;2(3):263-74.                                                                                                                                                                                                                                                . 
5-Al-Agamy MH, Shibl AM, Tawfik AF. Prevalence and molecular  characterization of extended-spectrum β-lactamase-producing Klebsiella pneumoniae in Riyadh, Saudi Arabia. Ann Saudi Med 2009;29(4):253-7.
 6-Mohamudha PR, Srinivas AN, Rahul D, Harish BN, Parija SC. Molecular epidemiology of multidrug resistant Extended-Spectrum β-Lactamase producing Klebsiella pneumoniae outbreak in a neonatal intensive care unit. Int J Collaborative Res Internal Med Public Health 2010;2(7):226-38.  
7-Munier GK, Johnson CL, Snyder JW, Moland ES, Hanson ND, Thomson KS. Positive extended-spectrum-beta-lactamase (ESBL) screening results may be due to AmpC beta-lactamases more often than to ESBLs. J Clin Microbiol 2010;48(2):673-4.
8-Bradford PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2005;14(4):933-51.
9-Al-Zarouni M, Senok A, Rashid F, Al-Jesmi SM, Panigrahi D. Prevalence and antimicrobial susceptibility pattern of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the United Arab Emirates. Med Princ Pract 2008;17(1):32-6.
10-Performance standard for antimicrobial susceptibility testing, 20th informational supplement. Clin Laboratory Standard Institue 2010;30(1):40-52.
11-Forbes BA, Sahm  DF, Weissfeld AS. Baily & Scott's diagostic microbiology. 12th ed. Missouri: Mosby Elsevier; 2007. P. 525-32.
 12-Clinical and Laboratory Standards Institute. Performans Standards for Antimicrobial Susceptibility Testing:Informational Supplement  M100-S18. Philadelphia: CLSI; 2008.
13-Quinteros M, Radice M, Gardella N, Rodriguez MM, Costa N, Korbenfeld D, et al. Extended-spectrum ß-Lactamases in Enterobacteriaceae in Buenos Aires, Argentina, Public Hospitals. Antimicrob Agents Chemother 2003;47(9):2864-7.
14-Livermore DM. Beta-lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995;8(4):557-84.
15-Nijssen S, Florijn A, Bonten MJM, Schmitz FJ, Verhoef J, Fluit AC. Beta- lactam susceptibilities and prevalence of ESBL-producing isolates amonge more than 5000 European Enterobacteriaceae isolates. Int J Antimicrob Agents 2004;24:585-90.           
16-Jones RN, Biedenbach DJ, Gales AC. Sustained activity and spectrum of selected extended-spectrum beta-lactams (carbapenems and cefepime) against Enterobacter spp. and ESBL-producing Klebsiella spp.: report from the SENTRY antimicrobial surveillance program (USA, 1997-2000). Int J Antimicrob Agents 2003;21(1):1-7.
17-Moosavian M, Deiham B. Distribution of TEM, SHV and CTX-M Genes among ESBL-producing Enterobacteriaceae isolates in Iran. Afr J Microbiol Res 2012;6(26):5433-9. 
18-Nasehi  L, Shahcheraghi  F, Sadat  NV, Nematzadeh SH. PER,CTX-M,TEM and SHV Beta-lactamases in clinical isolates of Klebsiella pneumoniae isolated from Tehran. Iran J Basic Med Sci 2010;13(3):111-18. [In Persian]
19-Pages JM, Lavigne JP, Leflon-Guibout V, Marcon E, Bert F, Noussair L, et al. Efflux pump, the masked side of beta-Lactam resistance inKlebsiella  pneumoniaeclinical isolates. PLoS One 2009;4(3):e4817.
20-Ananthan S, Subha A. Cefoxitin resistance mediated by loss of a porin in clinical strains of Klebsiella pneumoniaeand Escherichia coli. Indian J Med Microbiol 2005;23(1):20-3.
21-Goossens H. MYSTIC program: summary of European data from 1997 to 2000. Diagn Microbiol Infect Dis 2001;41(4):183-9.                                  
22-Torshizi R, Zamanzad B, Mokhatarian K, Karimi A. Survey of Beta-lactamase gene of CTXM in Extended Spectrum Beta-lactamase producing Enterobacteriaceae from clinical isolates in  hospitalized patients in Shahrekord. Shahrekord Univ Med J 2011;13(3):9-17.                                                 
23-Feizabadi MM, Mohammadi-Yeganeh S, Mirsalehian A, MirAfshar SM, Mahboobi M, Nili F, et al. Genetic characterization of ESBL producing strains of Klebsiella from Tehran hospitals. J Infect Dev Ctries 2010;4(10):609-15.
24-MirSalehian A, Akbari Nakhjavani F, Peymani A, Kazami B, Jabal Ameli F, MirAfshar SM. Prevalence of extended spectrum β-lactamases– Producing Enterobacteriaceae by phenotypic and genotypic methods in intensive care units in Tehran, Iran. Daru 2008;16(3):169-73.