Background and aims: Carbapenems are the final-line treatments for multidrug-resistant, gram-negative infections. The patterns of resistance to carbapenems among hospital bacterial pathogens vary widely across different hospitals in a country. Considering that Escherichia coli is one of the most important causes of nosocomial infections, it is essential to study its drug resistance. Methods: In this descriptive-analytical study, a total of 80 samples of E. coli isolated from inpatients with urinary tract infections (UTIs) were collected in different wards (i.e., women, urology, infectious, and ICU) of Shahrekord hospitals. After the diagnosis and confirmation of bacteria by standard bacteriological methods, their sensitivity to imipenem and meropenem was investigated by the antibiogram (diskdiffusion) method. Then, the minimum inhibitory concentration (MIC) was determined by the E-test strip according to the Clinical and Laboratory Standards Institute (CLSI) standard. Results: In this study, resistance to meropenem and imipenem by antibiogram (disc diffusion) was observed in 21 (25.26%) and 20 (25%) of the isolates, respectively. Twenty isolates had MIC ≥4 μg/mL for meropenem, 13 isolates demonstrated MIC≥4 μg/mL for imipenem, and 14 isolates had 1≤MIC<4 μg/mL and were semi-sensitive. Conclusion: In general, E. coli had significant resistance to carbapenems. Therefore, rapid and accurate identification of these strains can be a major step to the treatment and control of these strains and prevention of the spread of the resistance.
Background: Klebsiella is one of the Enterobacteriaceae family that causes infections such as pneumonia, urinary tract infections (UTI), and meningitis. Klebsiella strains are capable of producing enzymes that can degrade the third-generation of cephalosporins known as broad-spectrum beta-lactamase enzymes. The resistance of Klebsiella strains to β-lactam antibiotics is related to the presence of β-lactamase genes. Methods:In this study, 90 isolates of Klebsiella were isolated from two inpatient and outpatient groups, each of them was 45 isolates, which were collected from patients with urinary tract infection in educational hospitals of Shahrekord. The isolates were identified using phenotypic agar diffusion, disc phenotypic confirmation tests, and E-test of extended-spectrum beta-lactamase (ESBL). The PCR molecular method was used to diagnose and determine the strains containing broad-spectrum β-lactamases. Results: Thirty (66%) inpatients and 8 (17.8%) outpatients had broad-spectrum β-lactamase enzymes. The frequency of β-lactamase OXA-10 genes and PER in inpatients were 90% and 33%, respectively and also in outpatients were 50% and 12.5%, respectively. Conclusions:This study showed that the prevalence of isolated Klebsiella producing broad-spectrum β-lactamases is higher in inpatients in comparison to outpatients. Therefore, the rapid and accurate identification of bacteria and their resistance genes in clinical microbiology labs are highly recommended.
Extended spectrum β-lactamases (ESBLs) are enzymes that capable of destroying the antibiotics of βlactam, and cephalosporin, and Metallo-β-lactamase enzymes (MBL) can also deactivate all β-lactams and carbapenems. This study aimed to determine ESBLs and MBLs enzymes and the frequency of NDM-1 gene. In this study, 200 Escherichia coli isolates of women with urinary tract infection were collected (100 inpatients and 100 outpatients). Minimum inhibitory concentration (MIC) for ceftazidime and meropenem was determined by E-test. A phenotypic confirmation test was used to detect ESBL enzymes. MBLs production was performed with modified Hodge test (MHT) and EDTA disk synergy (EDS) test. PCR was used for detecting the presence of NDM-1 gene. From 200 isolates, 93 isolates produce ESBL enzymes. Overall, 97 isolates were resistant to ceftazidime, and 38 isolates resistant to meropenem. The results of the MHT and EDS positive tests were 41 and 16 isolates, respectively. NDM-1 was not found in any of the patients. The prevalence of E. coli isolates producing both ESBLs and MBLs enzymes, is a serious threat to clinical infections. Accordingly, for the control and treatment of these strains, rapid and accurate identification can be greatly helpful.
Background and aims: Klebsiella is an opportunistic organism that is the cause of severe diseases such as pneumonia, septicemia, and urinary tract infections (UTIs). In addition, high antibiotic resistance has challenged the treatment of this bacterium. However, carbapenem antibiotics are considered as the therapeutic agents for selecting the treatment of penicillin- and cephalosporin-resistant gram-negative bacterial infections. The present study aimed to determine the resistance and minimum inhibitory concentration (MIC) of meropenem and imipenem. Methods: A total of 80 Klebsiella spp isolated from UTIs were collected in various educational wards (i.e., urology, obstetrics, and gynecology, as well as the units of infectious diseases, internal medicine, and intensive care) in different hospitals of Shahrekord. The isolates were then identified by using biochemical tests. Further, disc diffusion method was employed to determine the antibiotic resistance. Furthermore, MIC was estimated by the Epsilon-test strip. Moreover, P=Q=0.50, an error of 0.05, and an accuracy of 0.11 were considered for determining the sample size (n=80). Results: Based on the results of disc diffusion method, 24 strains were resistant to meropenem and imipenem. Additionally, the MIC was 24 (30%) by the E-test. In addition, 24 isolates had a MIC of ≥4 μg/mL for meropenem and imipenem and thus were resistant while 18 isolates were found to have a MIC of 1≤ MIC<4 μg/mL and therefore, were considered semi-sensitive (P<0.001). Conclusion: In general, Klebsiella strains were found to be resistant to meropenem and imipenem. Therefore, rapid and accurate identification of these strains and the selection of appropriate antibiotics can help quickly eradicate the infections caused by these bacteria. Accordingly, a waste of time, the consumption of medication, or even an increased resistance are prevented.
Background and aims:: Among urine pathogens, Escherichia coli (E. coli) causes 80% of urinary tract infections (UTIs). Due to the destructive nature of penicillins, cephalosporins and carbapenems (except for monobactam such as aztreonam) and carbapenemase enzymes have created many problems for treating infectious diseases. Therefore, this study aimed to investigate the phenotypic and molecular characterization of metallo-beta-lactamase (MBL) genes produced by E. coli isolates in an educational hospital during 2016- 2017. Methods: This cross-sectional study investigated 80 UTI samples affected by E. coli. In addition, antibiotic susceptibility was evaluated by disk diffusion and E-test methods for two antibiotics of meropenem and imipenem. Phenotypic tests containing modified Hodge test, ethylenediaminetetraacetic acid (EDTA) disk synergy test, and AmpC Disk were performed to identify MBL enzyme-producing strains. Finally, the frequency of Verona integron-encoded metallo-β-lactamase (VIM) and imipenemase (IMP) genes was determined by polymerase chain reaction (PCR). Results: Among 80 E. coli samples, 21 (26.25%) isolates were resistant to meropenem and imipenem as detected by the disk-diffusion method and E-test. Further, phenotypic tests including modified Hodge test, EDS test, and AmpC disk test showed the positivity of 15 (18.75%), 15 (18.75%), and 8 (10%) isolates, respectively (P < 0.001). Eventually, polymerase chain reaction (PCR) test results for the VIM gene showed 19 (23.75%) positive isolates of E. coli, but the IMP gene was observed in none of the isolates (P<0.001). Conclusion: In general, the emergence of E. coli producing MBL enzymes is a serious threat among clinical infections. The findings of this study indicated the presence of E. coli producing MBL. These enzymes can degrade carbapenems antibiotics, the last class current treatment of multiple drug-resistance infections.
Background and aim: Klebsiella is an opportunistic organism that is the cause of many nosocomial infections. The present study was designed to investigate the molecular epidemiology of Verona integron-encoded metallo-βlactamase (VIM) and Imipenemase (IMP)-producing Klebsiella isolates in patients with urinary tract infection (UTI) in an educational hospital in Shahrekord, Iran. Methods:In a cross-sectional study, from 234 urine samples, 80 isolates of Klebsiella were identified with biochemical tests. In order to determine the production of Metallo-β-lactamases (MBLs), Modified Hodge Test (MHT), EDTA Disc Synergy (EDS) test and Ampicilin C (AmpC) disc test were performed. The frequency of VIM and IMP genes was determined after DNA-amplification with PCR by electrophoresis technique. As an internal control in PCTR, 16SrRNA was considered.Results: Phenotypic tests showed that out of the 80 isolates, 18 (22. 5%), 18 (22. 5%) and 10 (12.5%) isolates were positive for MHT, EDS and AmpC disc test, respectively. Following DNA amplification by PCR, the genes of interest were analyzed by electrophoresis technique. The findings were as follows: 22 isolates (27.5%) carried the VIM gene, but the IMP gene was not found in any of the isolates.Conclusions: Expansion of Klebsiella strains that produce MBLs is a severe threat to health centers and public health. The findings of this study showed that Klebsiella may produce MBLs. These enzymes can in turn degrade carbapenem antibiotics, which are considered as a last resort in the treatment of multidrug-resistant (MDR) infection.
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