Naslov
High prevalence of CTX-M-15 and first report of CTX-M-3, CTX-M-22, CTX-M-28 and plasmid-mediated AmpC beta-lactamase producing Enterobacteriaceae causing urinary tract infections in Bosnia and Herzegovina in hospital and community settings

Autori
Ibrahimagić, Amir ; Bedenić, Branka ; Kamberović, Farah ; Uzunović, Selma

Izvornik
JOURNAL OF INFECTION AND CHEMOTHERAPY (1341-321X) 21 (2015), 5; 363-369

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
extended-spectrum beta-lactamases; CTX-M beta-lactamases; plasmid-mediated ampC beta-lactamases; urinary tract infections

Sažetak
ABSTRACT Objectives To investigate molecular epidemiology of extended-spectrum (ESBL) and plasmid-mediated AmpC β-lactamase producing Gram-negative bacteria causing urinary tract infections (UTI) in hospital and outpatient settings in Bosnia and Herzegovina, during December 2009–May 2010. Methods Antibiotic susceptibility to a wide range of antibiotics was determined by disc diffusion and broth microdilution according to CLSI guidelines. Double- disk test was used to screen for ESBLs and combined disk-test with EDTA and phenylboronic acid to screen for carbapenemases. PCR was used to detect blaESBL, blaampCand blaMBLgenes. Genetic relatedness ofthe strains was determined by pulsed-field gel electrophoresis (PFGE). Results Among 85 UTIs with ESBL-producing Gram- negative bacteria, 44 (51.8%) were from in- patients and 41 (48.2%) from outpatients. Most of hospital UTIs were registered at Pediatric and Neurology departments, 14 (out of 44, 31.8%) cases in each. ESBL-producing Klebsiella spp. were the most frequently isolated Gram-negative bacteria, in 28 (out of 44, 63, 6%) of all hospital UTIs (eleven and nine out of fourteen ESBL-producing organism from Pediatric and Neurology departments were Klebsiellaspp.In outpatient settings, Klebsiellaspp.andE. coli were the most frequently isolated pathogens, in nineteen (46.3%) and sixteen (39.0%) cases, respectively. Resistance rates to gentamicin and ciprofloxacin in hospital and outpatient isolates were 40% and 100%, and 50% and 80%, respectively. Twenty-one (75.0%) hospital and nine (47.4%) outpatient Klebsiella spp. yielded amplicons with primers specific for blaTEM, whereas 27 (96.4%) hospital and 6 (31.6%) outpatient isolates were positive for blaCTX-M (eighteen hospital isolates encoding blaCTX- M15). PCR reactions with SHV-specific primers were positive indicating the presence of intrinsic SHV-1 beta lactamase, except one Klebsiella spp. hospital isolate which possessed SHV-5 alongside with DHA beta- lactamase. One Klebsiella spp. and one Enterobacter cloacae inpatient isolates yielded amplicons with primers specific for CTX-Mand the sequencing revealedblaCTX-M28. Four (out of 7 ; 57.1%) E. coli inpatient isolates were positive for the blaCTX-M15. Plasmid-mediated - AmpC beta-lactamase were detected by combined disk test with phenylboronic acid phenotypic test in 20 (out of 44 ; 45.5%) hospital and 21 (out of 41 ; 51.2%) outpatient specimens. One hospital strain were positive for blaCMY and two for blaDHA group of plasmid-mediated AmpC beta-lactamases, whereas four outpatient strains were positive for blaCMY and one forblaFOX. Conclusion:The findings documented the high prevalence of CTX-M-15 in the hospital and community settings. The carriage of ESBL genes is a novel finding ; identification of blaCTX- M28 among Enterobacter spp. and Klebsiella spp. is uncommon ; identification of blaCMY, DHA, FOXfrom ESBL-producing Enterobacteriaceae and this is the first report from Bosnia and Herzegovina. High resistance rates observed for gentamicin and ciprofloxacin are probably due to the fact that plasmids encoding ESBLs also contain resistance genes for non beta-lactam antibiotics. According to the results of this study, carbapenems remain the antibiotics of choice for the treatment of infections caused by ESBL-producing Enterobacteriacae.

Izvorni jezik
Engleski

Znanstvena područja
Temeljne medicinske znanosti

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