Prevalence and Risk Factors associated with Extended Spectrum Beta Lactamase Producing Escherichia coli and Klebsiella pneumoniae Isolates in Hospitalized Patients in Kashan (Iran)
Keywords:
Escherichia coli, Klebsiella pneumoniae, ESBL, risk factorsAbstract
Introduction: Production of extended spectrum beta lactamase (ESBL) is an important mechanism of antimicrobial resistance in Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) isolates. This study was performed to determine the prevalence and risk factors associated with ESBL producing strains of E. coli and K. pneumoniae.
Methods: In this cross-sectional study, 250 strains (134 E. coli and 116 K. pneumoniae) were obtained, and ESBL producing isolates were detected by the combination disk test in Shahid Beheshti Hospital in Kashan, Iran, from February 2012 to June 2013. Antimicrobial resistance was screened by the disk diffusion method and was confirmed by E-test. Furthermore, risk factors of ESBL producing E. coli and K. pneumoniae microorganisms were determined. Data were analyzed by SPSS version 16, using descriptive statistics, chi-squared, independent-samples t-test, and logistic regression analysis.
Results: One hundred and two (40.8%) of all strains were ESBL producers, of which 54 (52.9%) were E. coli and 48 (47.1%) were K. pneumoniae (p = 0.86). Furthermore, 40.3% of E. coli and 41.4% of K. pneumoniae isolates were ESBL producers (p = 0.86). The most antimicrobial resistance was to ampicillin, and no imipenem resistance was detected. Risk factors for ESBL producing E. coli included admission duration exceeding 7 days (p = 0.011) and antibiotic use in the last month (p < 0.001), and the associated risk factor for ESBL producing K. pneumoniae was antibiotic use during the recent month (p = 0.002).
Conclusion: This study identified a relatively high prevalence of ESBL production among E. coli and K. pneumoniae strains. Furthermore, anti-bimicrobial use and admission duration were risk factors for ESBL producing isolates. Therefore, more comprehensive investigations are needed for the development of new strategies to control the dissemination of these microbes.
References
Pitout JD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging
public-health concern. Lancet Infect Dis. 2008; 8(3): 159-66. doi: 10.1016/s1473-3099(08)70041-0, PMID:
Paterson DL. Resistance in gram-negative bacteria: enterobacteriaceae. Am J Med. 2006; 119(6 Suppl 1):
S20-8. doi: 10.1016/j.amjmed.2006.03.013, PMID: 16735147.
Bradford PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and
detection of this important resistance threat. Clin Microbiol Rev. 2001; 14(4): 933-51. doi:
1128/cmr.14.4.933-951.2001, PMID: 11585791, PMCID: PMC89009.
Roh KH, Uh Y, Kim JS, Kim HS, Shin DH, Song W. First outbreak of multidrug-resistant Klebsiella
pneumoniae producing both SHV-12-type extended-spectrum beta-lactamase and DHA-1-type AmpC betalactamase at a Korean hospital. Yonsei Med J. 2008; 49(1): 53-7. doi: 10.3349/ymj.2008.49.1.53, PMID:
, PMCID: PMC2615262.
Nicolau DP. Carbapenems: a potent class of antibiotics. Expert Opin Pharmacother. 2008; 9(1): 23-37. doi:
1517/14656566.9.1.23, PMID: 18076336.
Nordmann P, Dortet L, Poirel L. Carbapenem resistance in Enterobacteriaceae: here is the storm! Trends
Mol Med. 2012; 18(5): 263-72. doi: 10.1016/j.molmed.2012.03.003, PMID: 22480775.
Bazzaz BS, Naderinasab M, Mohamadpoor AH, Farshadzadeh Z, Ahmadi S, Yousefi F. The prevalence of
extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae among clinical
isolates from a general hospital in Iran. Acta Microbiol Immunol Hung. 2009; 56(1): 89-99. doi:
1556/AMicr.56.2009.1.7, PMID: 19388560.
Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev.
; 18(4): 657-86. doi: 10.1128/cmr.18.4.657-686.2005, PMID: 16223952, PMCID: PMC1265908.
Khanfar HS, Bindayna KM, Senok AC, Botta GA. Extended spectrum beta-lactamases (ESBL) in
Escherichia coli and Klebsiella pneumoniae: trends in the hospital and community settings. J Infect Dev
Ctries. 2009; 3(4): 295-9. doi: 10.3855/jidc.127, PMID: 19759493.
Forbes BA, Sahm DF, Weissfeld AS. Bailey & Scott's Diagnostic Microbiology. 12th ed. St.Louis: Mosby;
Performance Standards for Antimicrobial Susceptibility Testing. 17th Informational Supplement. 2007.
Available from: http://www. microbiolab-bg.com/CLSI.pdf.
Sharma M, Pathak S, Srivastava P. Prevalence and antibiogram of Extended Spectrum beta-Lactamase
(ESBL) producing Gram negative bacilli and further molecular characterization of ESBL producing
Escherichia coli and Klebsiella spp. J Clin Diagn Res. 2013; 7(10): 2173-7. doi:
7860/jcdr/2013/6460.3462, PMID: 24298468.
Mehrgan H, Rahbar M, Arab-Halvaii Z. High prevalence of extended-spectrum beta-lactamase-producing
Klebsiella pneumoniae in a tertiary care hospital in Tehran, Iran. J Infect Dev Ctries. 2010; 4(3): 132-8.
doi: 10.3855/jidc.488, PMID: 20351452.
Mokaddas EM, Abdulla AA, Shati S, Rotimi VO. The technical aspects and clinical significance of
detecting extended-spectrum beta-lactamase-producing Enterobacteriaceae at a tertiary-care hospital in
Kuwait. J Chemother. 2008; 20(4): 445-51. doi: 10.1179/joc.2008.20.4.445, PMID: 18676224.
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. doi: 10.1159/000109587, PMID: 18059098.
Shakil S, Ali SZ, Akram M, Ali SM, Khan AU. Risk factors for extended-spectrum beta-lactamase
producing Escherichia coli and Klebsiella pneumoniae acquisition in a neonatal intensive care unit. J Trop
Pediatr. 2010; 56(2): 90-6. doi: 10.1093/tropej/fmp060, PMID: 19608665. 17) Shaikh S, Fatima J, Shakil S, Rizvi SM, Kamal MA. Risk factors for acquisition of extended spectrum beta
lactamase producing Escherichia coli and Klebsiella pneumoniae in North-Indian hospitals. Saudi J Biol
Sci. 2015; 22(1): 37-41. doi: 10.1016/j.sjbs.2014.05.006, PMID: 25561881, PMCID: PMC4281604.
Aminzadeh Z, Sadat Kashi M, Sha'bani M. Bacteriuria by extended-spectrum Beta-lactamase-producing
Escherichia coli and Klebsiella pneumoniae: isolates in a governmental hospital in South of Tehran, Iran.
Iran J Kidney Dis. 2008; 2(4): 197-200, PMID: 19377237.
Wang X, Chen G, Wu X, Wang L, Cai J, Chan EW, et al. Increased prevalence of carbapenem resistant
Enterobacteriaceae in hospital setting due to cross-species transmission of the bla NDM-1 element and
clonal spread of progenitor resistant strains. Front Microbiol. 2015; 6: 595. doi: 10.3389/fmicb.2015.00595,
PMID: 26136735, PMCID: PMC4468908.
Kateregga JN, Kantume R, Atuhaire C, Lubowa MN, Ndukui JG. Phenotypic expression and prevalence of
ESBL-producing Enterobacteriaceae in samples collected from patients in various wards of Mulago
Hospital, Uganda. BMC Pharmacol Toxicol. 2015; 16:14. doi: 10.1186/s40360-015-0013-1, PMID:
, PMCID: PMC4451872.
Kiratisin P, Apisarnthanarak A, Laesripa C, Saifon P. Molecular characterization and epidemiology of
extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates causing
health care-associated infection in Thailand, where the CTX-M family is endemic. Antimicrob Agents
Chemother. 2008; 52(8): 2818-24. doi: 10.1128/aac.00171-08. PMID: 18505851, PMCID: PMC2493136.
Seni J, Najjuka CF, Kateete DP, Makobore P, Joloba ML, Kajumbula H, et al. Antimicrobial resistance in
hospitalized surgical patients: a silently emerging public health concern in Uganda. BMC Res Notes. 2013;
:298. doi: 10.1186/1756-0500-6-298, PMID: 23890206, PMCID: PMC3729663.
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