International Journal of Science and Technology

International Journal of Science and Technology>> Volume 7, Number 6, June 2017

International Journal of Science and Technology


MOLECULAR AND PHENOTYPIC CHARACTERIZATION OF CARBAPENEM RESISTANCE AND EXTENDED SPECTRUM BETA-LACTAMASES AMONG URINARY ESCHERICHIA COLI ISOLATES

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Author Musa Hassan Muhammad, Samer Swedan
Volume No. 5
Issue No. 9
Issue Date September 01, 2015
Publishing Date September 01, 2015
Keywords carbapenem, extended spectrum beta-lactamases, antimicrobial resistance, KPC, NDM, VIM, SHV, TEM, CTX, PCR urinary escherichia coli, urinary tract infection


Abstract

Uropathogenic Escherichia coli isolates are responsible for around 90% of urinary tract infections (UTIs) and are becoming more-commonly associated with extended-spectrum beta-lactamases (ESBL) and carbapenemase production, leading to failure of antimicrobial treatment, with resultant increases in the rates of morbidity and mortality. The aims of this study were to determine the prevalence of ESBL and carbapenemase producing E. coli from UTI patients, to determine their antibiotic susceptibility, characterize genes responsible for ESBL and carbapenem resistance and to identify the co-associations between these two types of genes. One hundred clinical isolates of E. coli were collected from patients suffering from UTIs from King Abdallah University Teaching Hospital, Jordan. Antimicrobial susceptibility was performed using the Kirby Bauer disk diffusion method and phenotypic identification of ESBLs and carbapenemase production was confirmed by the double disk synergy test and the modified Hodge test, respectively. Conventional and multiplex PCR were conducted for detection of ESBL and carbapenem resistance genes, respectively. The highest rates of resistance were observed against ampicillin (85%), followed by sulfamethoxazole/trimethoprim (73%), ceftriaxone (58%), cefotaxime (57%), ciprofloxacin (53%), and ceftizoxime (50%). All isolates were sensitive to imipenem and meropenem. Furthermore, 96% of the isolates were sensitive to ertapenem, 84% to tigecycline, 79% to nitrofurantoin, 77% to doripenem, 51% to ceftazidime, 48% to aztreonam and levofloxacin each, and 41% to amoxicillin/clavulanic acid. The prevalence of ESBL and carbapenemase producers was 54% and 23%, respectively. Aztreonam, alone identified the most ESBL isolates, while ertapenem, alone identified the most carbapenemase isolates. Having a carbapenemase phenotype was associated with resistance to most antimicrobial agents used, but not imipenem and meropenem. The co-expression of ESBLs and carbapenemases was seen among20% of the isolates. The blaTEM gene was the most prevalent (69%), followed by blaCTX (55%), blaNDM (53%), blaVIM (41%), and blaSHV (1%). None of the isolates harbored blaKPC. A statistically significant association of resistance genes was observed between blaTEM and blaVIM, as 41% of E. coli isolates had both blaTEM and blaVIM. The ESBL phenotype was correlated with the presence of blaTEM and blaCTX genes. BlaCTX gene was significantly associated with resistance to almost all cephalosporins, levofloxacin, ciprofloxacin, and doripenem, and the presence of carbapenemase phenotype. Overall, a high prevalence of blaTEM type ESBL and co-presence of ESBLs and carbapenemase genes, was observed. The prompt detection of these multi-resistant organisms ultimately enhances patient prognosis and limits the further spread of these organisms in the hospitals and community settings.

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