In addition, ESBL infections can cause serious complications, especially in patients with functional structural anomalies of the urinary tract, patients who have undergone a kidney transplant, patients with polycystic kidneys, or diabetic patients [ 4 ]. Unfortunately, because of excessive application of antibiotics at different hospitals especially in developing countries , antimicrobial resistance to uropathogenic bacteria across the globe is emerging [ 5 , 6 ].
The common misuse, underuse, or overuse, as well as neglected local community susceptibility profiles of these agents, invariably resulted in the emergence of multi-drug resistant MDR isolates among pathogenic bacteria [ 7 , 8 ].
Worldwide data shows that there is increasing resistance among UTI pathogens to conventional drugs. Resistance has emerged even to newer and more potent antimicrobial agents. The sensitivity of screening for ESBLs can vary depending on the type of antimicrobial agent tested [ 9 , 10 ]. In the research field i. Antimicrobial resistance surveillance is necessary to determine the problem and to guide empirical selection of antimicrobial agents for treating infected patients.
The aim of this study was to determine the current prevalence, clinical and laboratory profile of ESBL producing E. Inclusion criteria for this study were patients with suspected UTI. Exclusion criteria were patients who received antimicrobial therapy during two weeks prior to visiting the hospital and clinical symptoms or physical signs indicating any disease other than UTI. The control group was 45 healthy individuals who did not have signs or symptoms of UTI or any other disease and with no previous hospitalization or history of UTI during last year.
Early morning mid-stream urine was collected in a sterile container. The pour plate method was used for viable bacterial count. USA was used in laboratory identification. Minimum inhibitory concentrations MICs obtained for ceftriaxone and cefotaxime are interpreted according to CLSI breakpoints [ 10 ], and results may also trigger rules which alert users to possible ESBL production. These results were considered a positive ESBL screening result for the purpose of our study.
The turbidity was adjusted to 0. Written informed consent was obtained from participants or the parent or the legal guardian of participants less than 18 years old. The qualitative data were shown in the form of number and percentage. Two by two tables are used to evaluate the relation between a possible risk factor Exposure and an outcome Disease. Among specimens, males and females were culture positive on CLED agar.
Patient ages ranged from 12 months to 60 years. Demographic presentations of enrolled patients were shown in Table 1. All specimens of control group did not show any growth. The most common isolated microorganisms were E. Antibiotic susceptibility test showed ful resistance of K. Antibiotics susceptibility results were shown in Table 3. The results showed The results showed 70 isolates out of the total ESBL pattern of isolated E.
UTI is one of the most common bacterial infections causing a significant amount of morbidity and mortality due to the invasion of urinary tract, often by pathogens belonging to the family Enterobacteriacae. In our study, isolated organisms were E. Similar results were reported by Kader et al. In Saudi Arabia, hey found that E.
Also, many studies reported that E. Periodic antimicrobial susceptibility surveillance in hospitals is an essential aspect of antimicrobial stewardship, as it prevents urosepsis, gives an idea about the most effective antibiotics that should be used in routine therapy, and possible emergence of multiple antibiotic resistant MDR strains of bacteria.
Antimicrob Agents Chemother ; 45 : — Antimicrob Agents Chemother ; 46 : — 9. Antimicrob Agents Chemother ; 45 : — 8. Antimicrob Agents Chemother ; 46 : — Antimicrob Agents Chemother ; 46 : — 5. J Antimicrob Chemother ; 50 : — 4. Clin Microbiol Infect ; 14 : 33 — J Antimicrob Chemother ; 52 : 29 — J Antimicrob Chemother ; 76 : — Clin Microbiol Rev ; 27 : — False extended-spectrum b-lactamase phenotype in clinical isolates of Escherichia coli associated with increased expression of OXA-1 or TEM-1 penicillinases and loss of porins.
J Antimicrob Chemother ; 66 : — Antimicrob Agents Chemother ; 44 : — 8. Antimicrob Agents Chemother ; 47 : — 1. J Antimicrob Chemother ; 58 : — 5. J Antimicrob Chemother ; 74 : — Protein Sci ; 12 : 82 — Antimicrob Agents Chemother ; 55 : — Antimicrob Agents Chemother ; 59 : — 8. J Antimicrob Chemother ; 69 : — 6. Antimicrob Agents Chemother ; 53 : — Antimicrob Agents Chemother ; 58 : — J Antimicrob Chemother ; 48 : — J Antimicrob Chemother ; 74 : — 9.
J Antimicrob Chemother ; 72 : — Antimicrob Agents Chemother ; 59 : — Antimicrob Agents Chemother ; 37 : — 9. Jacoby GA. Antimicrob Agents Chemother ; 50 : — 9.
Antimicrob Agents Chemother ; 40 : — Reduced susceptibility mechanism to cefiderocol, a siderophore cephalosporin, among clinical isolates from a global surveillance programme SIDERO-WT J Glob Antimicrob Resistance ; 22 : — J Antimicrob Chemother ; 67 : — Antimicrob Agents Chemother ; 43 : — J Antimicrob Chemother ; 65 : — Antimicrob Agents Chemother ; 60 : — 6.
Minor extended-spectrum b-lactamases. Clin Microbiol Infect ; 14 Suppl 1 : 42 — Genetic characterization of a blaVEBcarrying plasmid in Vibrio parahaemolyticus. Antimicrob Agents Chemother ; 60 : — 8. JMM Case Rep ; 3 : e Antimicrob Agents Chemother ; 49 : — Antimicrob Agents Chemother ; 57 : — Mobile genetic elements associated with antimicrobial resistance. Clin Microbiol Rev ; 31 : e — Expert Rev Anti Infect Ther ; 6 : — Evolution of transposons containing bla TEM genes.
Antimicrob Agents Chemother ; 49 : — 8. Transposition of the gene encoding a TEM extended-spectrum b-lactamase. Antimicrob Agents Chemother ; 36 : — 6. Genetically diverse ceftazidime-resistant isolates from a single center: biochemical and genetic characterization of TEM b-lactamases encoded by different nucleotide sequences. Antimicrob Agents Chemother ; 37 : — Mol Gen Genet ; : — Infect Genet Evol ; 12 : — J Antimicrob Chemother ; 63 : 67 — Investigation of diversity of plasmids carrying the blaTEM gene.
Direct involvement of IS26 in an antibiotic resistance operon. J Bacteriol ; : — Genetic support of extended-spectrum b-lactamases. Clin Microbiol Infect ; 14 Suppl 1 : 75 — J Antimicrob Chemother ; 54 : 69 — Plasmid ; 51 : 48 — The bla SHV-5 gene is encoded in a compound transposon duplicated in tandem in Enterobacter cloacae. Clin Microbiol Infect ; 15 : — Front Microbiol ; 7 : Antimicrob Agents Chemother ; 58 : — 7. Antimicrob Agents Chemother ; 47 : — Antimicrob Agents Chemother ; 50 : — 6.
J Antimicrob Chemother ; 57 : 14 — Antimicrob Agents Chemother ; 48 : — 7. IS CR elements: novel gene-capturing systems of the 21st Century?
Microbiol Mol Biol Rev ; 70 : — Antimicrob Agents Chemother ; 55 : — 8. Characterization of plasmids encoding blaESBL and surrounding genes in Spanish clinical isolates of Escherichia coli and Klebsiella pneumoniae. J Antimicrob Chemother ; 63 : 60 — 6. Emerg Infect Dis ; 14 : — Curr Opin Microbiol ; 9 : — Banerjee R , Johnson JR. A new clone sweeps clean: the enigmatic emergence of Escherichia coli sequence type Escherichia coli ST, an intriguing clonal group.
Bacteraemia caused by third-generation cephalosporin-resistant Escherichia coli in France: prevalence, molecular epidemiology and clinical features. Clin Microbiol Infect ; 17 : — Escherichia coli sequence type ST as the major cause of serious multidrug-resistant E. Clin Infect Dis ; 51 : — Open Forum Infect Dis ; 6 : S69 — Antibiotics Basel ; 9 : Phylogenomic analysis of extraintestinal pathogenic Escherichia coli sequence type , an emerging multidrug-resistant clonal group.
Antimicrob Agents Chemother ; 63 : e — Rapid and extensive expansion in the United States of a new multidrug-resistant Escherichia coli clonal group, sequence type Clin Infect Dis ; 68 : — 7. Sci Rep ; 7 : Prevalence of ST and ST among bloodstream isolates of Escherichia coli not susceptible to ciprofloxacin in a tertiary care university hospital in Korea, - Clin Lab ; 63 : — 3.
J Glob Antimicrob Resist ; 17 : — 8. Mantengoli E , Rossolini GM. Antimicrob Agents Chemother ; 55 : — 7. Prevalence and characterization of extended-spectrum b-lactamases in Klebsiella pneumoniae and Escherichia coli isolates from Colombian hospitals.
Diagn Microbiol Infect Dis ; 49 : — Hawkey PM. Prevalence and clonality of extended-spectrum b-lactamases in Asia. Clin Microbiol Infect ; 14 Suppl 1 : — An analysis of the epidemic of Klebsiella pneumoniae carbapenemase-producing K.
J Infect Dis ; : 82 — Health care system. Antimicrob Agents Chemother ; 51 : — Microb Drug Resist ; 14 : — 6. Multidrug-resistant bacterial infections in U.
N Engl J Med ; : — J Clin Microbiol ; 59 : e — J Antimicrob Chemother ; 59 : — J Clin Microbiol ; 48 : — 5. J Clin Microbiol ; 51 : — However, treatment with such antibiotics has been associated with high failure rates. There is substantial debate as to the optimal method to prevent this occurrence. It has been proposed that cephalosporin breakpoints for the Enterobacteriaceae should be altered so that the need for ESBL detection would be obviated.
In common to all ESBL detection methods is the general principle that the activity of extended-spectrum cephalosporins against ESBL-producing organisms will be enhanced by the presence of clavulanic acid.
The results indicate that these antibiotics were the most active treatment of choice for ESBL-producing Enterobacteriaceae. In the present study, the levels of co-resistance within different classes of antibiotics among the ESBL-producing Enterobacteriaceae were significantly higher for most antibiotics tested.
These findings indicate that ESBL-producing Enterobacteriaceae were the major cause of resistance to various antibiotics classes, as these bacteria are typically nosocomial. In the present study, high resistance was observed to sulfamethoxazole-trimethoprim This indicates that resistance rate to the commercially available as well as commonly used drugs is becoming alarming.
The resistance level of Escherichia coli to sulfamethoxazole-trimethoprim On the other hand, our findings were lower than the finding in Iran sulfamethoxazole-trimethoprim This shows that the treatment option for the most common cause of nosocomial pathogen is becoming lower. There were also similar findings from studies conducted in Iran sulfamethoxazole-trimethoprim The high resistance rate of Enterobacteriaceae to the antibiotics may be due to the misuse or overuse of the antibiotics coupled with weak infection control measures [ 19 ].
The high resistance rate of K. In the present study, the overall magnitude of MDR among all Enterobacteriaceae isolate The higher proportion of MDR limits the treatment option for hospital-acquired infections caused by Enterobacteriaceae. On the other hand, our result was lower than findings from other studies in Gondar, Ethiopia The difference in magnitude of MDR isolates might be due to the selection of antibiotic from a different class, the definition for MDR, study period and specimen type, and the difference in the study population.
There was an intra-species difference in MDR level. The present study showed that the level of MDR in K. However, our result is lower than studies conducted in Gondar, Ethiopia K. The MDR level among E. The difference in MDR level among K. In this study This multi-centered study can reveal the extent of distribution of ESBLs and MDR among Enterobacteriaceae and the degree of resistance to other non-beta-lactam antibiotics.
We are unable to see possible risk factors, certain clinical features and the outcome of the patients infected with ESBL-producing or MDR bacteria, due to lack of adequate resource. Although most of the study isolates were collected from inpatients, the exact number of nosocomial versus community-acquired bacteria were not differentiated. The isolates were collected from four bacteriology laboratories in Addis Ababa, but the results may not be applied to the entire city or country.
The majority of ESBL-producing isolates were found primarily in blood and urine specimens. The better options for the treatment of ESBL-producing Enterobacteriaceae are meropenem, amikacin, and cefoxitin. ESBL-producing isolates showed a high rate of resistance to ciprofloxacin, cefepime, cotrimoxazole, and gentamicin compared with non-ESBL producers. The rise of MDR and ESBLs necessitates the strengthening of clinical bacteriology research and the diagnostic capacity of laboratory professionals for the detection and surveillance of antibiotic resistance.
We recommend routine screening of ESBLs production of Enterobacteriaceae along with strong infection prevention strategies. Medical Microbiology 5th ed. Philadelphia, Pennsylvania USA; Paterson DL.
Resistance in gram-negative Bacteria: Enterobacteriaceae. Am J Med. Extended-Spectrum Beta-lactamases : a clinical update.
Clin Microbiol Rev. Pitout JDLK. Lancet Infect Dis. Bush K, Fisher JF. Annu Rev Microbilogy. More extended-spectrum beta-lactamases. Antimicrob Agents Chemother. Occurrence and detection of extended-spectrum beta-lactamases in members of the family Enterobacteriaceae at a veterans Medical center.
J Clin Microbiol. Kemeroglou a, Tsakris a. Detection of extended-spectrum beta-lactamases in clinical isolates of Enterobacter cloacae and Enterobacter aerogenes. High levels of antimicrobial Coresistance among extended-Spectrum-beta-lactamase-producing Enterobacteriaceae.
Extended-spectrum b -lactamase-producing gram-negative bacteria causing neonatal sepsis in India in rural and urban settings. J Med Microbiol. Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended-Spectrum Beta-lactamases : implications for the clinical microbiology laboratory.
Int J Antimicrob Agents. CAS Google Scholar. Walsh TR. Emerging carbapenemases : a global perspective. Giamarellou H. Treatment options for multidrug-resistant bacteria. Expert Rev Anti-Infect Ther. Treatment options for Carbapenem-resistant Enterobacteriaceae infections. InOpen forum Infect Dis.
Philadelphia: Lippincott Williams and Wilkins; Colour atlas and text book of diagnostic microbiology. In: Enterobacteriaceae. Performance standards for antimicrobial susceptibility testing. Wayne, PA: clinical and laboratory standards institute. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance.
Google Scholar. Infect Dis Clin N Am.
0コメント