Frequency assessment of β-lactamase enzymes in Escherichia coli and Klebsiella isolates in patients with urinary tract infection

Background: Production of β-lactamase enzymes is the most common and important mechanism of resistance in Gram-negative bacteria. The objective of this study was to assess frequency of three main β-lactamase enzymes, including extended spectrum β-lactamases (ESBLs), metallo-β-lactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC) enzymes in Escherichia coli and Klebsiella spp. isolated from nosocomial and community urinary tract infections (UTI). Materials and Methods: In a cross-sectional study from March to December 2012, midstream urine samples were obtained from patients suspicious of UTI who were hospitalized or referred to Al-Zahra Hospital, Isfahan, Iran. Samples were cultured and E. coli and Klebsiella spp. were isolated. Prevalence of ESBLs, KPC, and MBLs producing E. coli and Klebsiella spp. were studied by double-disk (combined-disk), the modified Hodge test and imipenem-ethylenediaminetetraacetic acid combined disc methods respectively. In addition, their antimicrobial susceptibility patterns determined and resistant to carbapenem drugs confirmed by minimum inhibitory concentrations based on E-test method. Results: A total of 1080 E. coli and 484 Klebsiella strains were isolated during study period. Among 720 E. coli and 384 Klebsiella isolates from hospitalized patients, 300 (41.7%) and 198 (51.5%) were ESBLs producers, respectively. In out-patients samples, the rate of ESBLs production was 25% (90/360) and 40% (40/100) in E. coli and Klebsiella isolates, respectively. Prevalence of MBLs producing in hospital E. coli and Klebsiella isolates were 0.3% (2/720) and 2.6% (10/384), and for KPC data were 1.4% (10/720) and 48.4% (186/384), respectively. No MBLs and KPC producing isolate was seen in non-hospital E. coli and Klebsiella isolates except for one non-hospital KPC producing Klebsiella isolate. Conclusion: The result of our study showed high prevalence of ESBLs and KPC, but low prevalence of MBLs in cultured bacteria from urine samples of patients with acute UTI. In addition, KPC was the main carbapenem resistance mechanism in Klebsiella and E. coli isolates.

[1]  N. Woodford,et al.  CTX-M: changing the face of ESBLs in Europe. , 2006, The Journal of antimicrobial chemotherapy.

[2]  D. Landman,et al.  Carbapenemase-producing Klebsiella pneumoniae in Brooklyn, NY: molecular epidemiology and in vitro activity of polymyxin B and other agents. , 2005, The Journal of antimicrobial chemotherapy.

[3]  P. Bradford.  Extended-Spectrum β-Lactamases in the 21st Century: Characterization, Epidemiology, and Detection of This Important Resistance Threat , 2001, Clinical Microbiology Reviews.

[4]  S. Mobasherizadeh,et al.  Antimicrobial resistance surveillance among hospitalized and non-hospitalized extend-spectrum beta-lactamase producing Escherichia coli from four tertiary-care hospitals in Isfahan, Iran; 2008-2011 , 2012 .

[5]  P. Nordmann,et al.  Metallo-beta-lactamases: the quiet before the storm? , 2005, Clinical microbiology reviews.

[6]  G. Jacoby,et al.  More extended-spectrum beta-lactamases , 1991, Antimicrobial Agents and Chemotherapy.

[7]  A. Vatopoulos,et al.  Extended-spectrum beta-lactamase types in Klebsiella pneumoniae and Escherichia coli in two Greek hospitals. , 2003, International journal of antimicrobial agents.

[8]  B. Kazemi,et al.  PREVALENCE OF EXTENDED SPECTRUM Β-LACTAMASE-PRODUCING ENTEROBACTERIACEAE BY PHENOTYPIC AND GENOTYPIC METHODS IN INTENSIVE CARE UNITS IN TEHRAN, IRAN , 2008 .

[9]  P. Fey,et al.  Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae: considerations for diagnosis, prevention and drug treatment. , 2003, Drugs.

[10]  Farzaneh Aminpour,et al.  Academic contribution to the scientific productivity: a case study , 2009, Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences.

[11]  M. Inoue,et al.  [Extended-spectrum beta-lactamase (ESBL) produced by Escherichia coli and Klebsiella pneumoniae isolated from Teikyo University Hospital--the second report]. , 1999, Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases.

[12]  Patrick Legrand,et al.  TRANSFERABLE ENZYMATIC RESISTANCE TO THIRD-GENERATION CEPHALOSPORINS DURING NOSOCOMIAL OUTBREAK OF MULTIRESISTANT KLEBSIELLA PNEUMONIAE , 1987, The Lancet.

[13]  Z. Salehi,et al.  Candiduria in children and susceptibility patterns of recovered Candida species to antifungal drugs in Ahvaz. , 2013, Journal of nephropathology.

[14]  Ronald N. Jones,et al.  Regional variation in the prevalence of extended-spectrum beta-lactamase-producing clinical isolates in the Asia-Pacific region (SENTRY 1998-2002). , 2005, Diagnostic microbiology and infectious disease.

[15]  Henk F. Moed,et al.  Handbook of Quantitative Science and Technology Research , 2005 .

[16]  Loet Leydesdorff,et al.  Betweenness centrality as a driver of preferential attachment in the evolution of research collaboration networks , 2011, J. Informetrics.

[17]  P. Hawkey.  Prevalence and clonality of extended-spectrum β-lactamases in Asia , 2008 .

[18]  I. Gould,et al.  Extended spectrum beta-lactamases. , 1998, The Journal of infection.

[19]  G. Jacoby,et al.  Extended-spectrum beta-lactamases , 1989, Antimicrobial Agents and Chemotherapy.

[20]  R A Weinstein,et al.  Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. , 1999, JAMA.

[21]  Clinical,et al.  Performance standards for antimicrobial disk susceptibility tests : approved standard , 2006 .

[22]  Jie Wu,et al.  Small Worlds: The Dynamics of Networks between Order and Randomness , 2003 .

[23]  R. Koncan,et al.  Metallo-beta-lactamases as emerging resistance determinants in Gram-negative pathogens: open issues. , 2007, International journal of antimicrobial agents.

[24]  Hafez Mohammadhassanzadeh,et al.  Mapping of co-authorship network of Iranian emergency medicine using cluster analysis. , 2012 .

[25]  Vala Ali Rohani,et al.  Co-authorship network of scientometrics research collaboration , 2012 .

[26]  Ronald N. Jones,et al.  Emergence of serine carbapenemases (KPC and SME) among clinical strains of Enterobacteriaceae isolated in the United States Medical Centers: report from the MYSTIC Program (1999-2005). , 2006, Diagnostic microbiology and infectious disease.

[28]  Timothy R. Walsh,et al.  Metallo-β-Lactamases: the Quiet before the Storm? , 2005, Clinical Microbiology Reviews.

[29]  M. Rahbar,et al.  Prevalence of extended-spectrum β-lactamase-producing Escherichia coli in a tertiary care hospital in Tehran, Iran , 2008 .

[30]  H M Hasanzadeh Esfanjani,et al.  SCIENTIFIC PRODUCTS OF IRAN UNIVERSITY OF MEDICAL SCIENCES' AUTHORS WITH CO-AUTHORSHIP NETWORKS IN WEB OF SCIENCE (WOS) DATABASE, UP TO 2007 , 2009 .

[31]  Zaida Chinchilla-Rodríguez,et al.  Analysis and visualization of the dynamics of research groups in terms of projects and co-authored publications. A case study of library and information science in Argentina , 2012, Inf. Res..

[32]  M. Ardalan.  Mycobacterial disease in renal allograft recipients , 2013, Journal of renal injury prevention.

[33]  Francesco Giuliani,et al.  Assessing scientific collaboration through coauthorship and content sharing , 2010, Scientometrics.

[34]  Francisco J. Acedo,et al.  Co-Authorship in Management and Organizational Studies: An Empirical and Network Analysis , 2006 .

[35]  Mohammad Hassanzadeh,et al.  Analysis of Co-Authorship Indicators, Betweenness Centrality and Structural Holes of the Iranian Nanotechnology Researchers in Science Citation Index (1991-2011) , 2012 .

[36]  A. Ehsanpour,et al.  Alterations in antibiotic susceptibility of urinary tract infection pathogens. , 2012, Journal of nephropathology.

[37]  Pierre Benckendorff,et al.  Exploring the limits of tourism research collaboration: a social network analysis of co-authorship patterns in Australian and New Zealand tourism research , 2010 .

[38]  S. Miyakis,et al.  Microbiological and molecular characteristics of carbapenemase-producing Klebsiella pneumoniae endemic in a tertiary Greek hospital during 2004-2010. , 2012, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[39]  P. Hawkey.  Prevalence and clonality of extended-spectrum beta-lactamases in Asia. , 2008, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[40]  R. Hasan,et al.  Frequency and sensitivity pattern of Extended Spectrum beta Lactamase producing isolates in a tertiary care hospital laboratory of Pakistan. , 2005, JPMA. The Journal of the Pakistan Medical Association.

[41]  Hildrun Kretschmer,et al.  Author productivity and geodesic distance in bibliographic co-authorship networks, and visibility on the Web , 2004, Scientometrics.

[42]  A. Oliver,et al.  CTX-M-10 Linked to a Phage-Related Element Is Widely Disseminated among Enterobacteriaceae in a Spanish Hospital , 2005, Antimicrobial Agents and Chemotherapy.

[43]  Zaida Chinchilla-Rodríguez,et al.  Analysis and visualization of the dynamics of research groups in terms of projects and co-authored publications , 2012 .

[44]  A. Sundsfjord,et al.  Genetic methods for detection of antimicrobial resistance , 2004, APMIS : acta pathologica, microbiologica, et immunologica Scandinavica.