Countrywide Spread of Community- and Hospital-Acquired Extended-Spectrum β-Lactamase (CTX-M-15)-Producing Enterobacteriaceae in Lebanon

Abstract

A prospective study was carried out to assess the extent of carriage of extended-spectrum ␤-lactamase (ESBL)-producing Enterobacteriaceae at both hospital and community levels in Lebanon. A total of 1,442 fecal samples were collected from hospital-based patients and 58 from health care workers of six Lebanese tertiary care general hospitals located in different areas of Lebanon between January and March 2003. A total of 382 fecal samples were also collected from healthy subjects between April and June 2003. The samples analysis led to the identification of 118 strains as ESBL producers based on the synergistic effects between clavulanate and selected ␤-lactams (ceftazidime and cefotaxime). These strains were isolated from 72 subjects: 61 patients, 2 health care workers, and 9 healthy subjects. One representative strain per subject was selected, and a total of 72 nonduplicate ESBL producers, including a high majority of Escherichia coli (n ‫؍‬ 56), Klebsiella pneumoniae (n ‫؍‬ 9), Enterobacter cloacae (n ‫؍‬ 6), and Citrobacter freundii (n ‫؍‬ 1), were characterized. The molecular analysis revealed that the majority of the strains (83%) express CTX-M-15 ESBL (pI 8.6). SHV-5a ESBL (pI 8.2) was produced by 18% of the strains. DNA macrorestriction analysis of ESBL-producing E. coli presented 38 different genotypes, revealing the absence of clonal link among these strains. In addition to the fact that the present study highlights the emergence and the countrywide dissemination of CTX-M-15-producing E. coli in Lebanon, it represents the first report of an SHV-5a-producing C. freundii.

Prevalence of extended spectrum &#946-lactamases (ESBLs) among clinical <i>Enterobacteriaceae</i> isolates obtained from private diagnostic laboratory in Kano - Nigeria

“…Although the occurrence and distribution of ESBLs differs from country to country and from hospital to hospital (Bradford, 2001), the percentage prevalence of ESBLs among the isolates screened was higher in Klebsiella pneumoniae than other genera isolated in the present study, which conforms to the findings of Hanberger et al (1999) and Moubareck et al (2005). The high occurrence of ESBLs in Klebsiella pneumoniae observed in this research is of great concern since infections caused by this bacterium (particularly respiratory tract infections) are very common in this part of Nigeria due to the contagious nature and resistance of the organism to harsh conditions, which may be due to the presence of capsules that gives some level of protection to the cells (Paterson and Bonomo, 2005).…”

382 CTX-M-15 extended-spectrum β-lactamases in Enterobacteriaceae in the intensive care unit of Tlemcen Hospital, Algeria

“…The presence of CTX-M-15 enzyme in the west of Algeria indicates a countrywide spread of the CTX-M β-lactamases. This situation is comparable to those reported in numerous countries, such as Argentina, Poland and Lebanon where CTX-M-producing Enterobacteriaceae have been described to be endemic [15][16][17][18].…”

CTX-M β-Lactamase-Producing Escherichia coli in French Hospitals: Prevalence, Molecular Epidemiology, and Risk Factors

“…These CTX-M-producing strains have emerged and spread in most parts of the world (6, 9, 13, 18, 23, 34, 37-39, 46, 48). During this period, the proportion of CTX-M strains among ESBL-producing E. coli isolates has dramatically increased from 38.2% to 87% (8,38,41,43,44,46). The CTX-M-15 enzyme seems to be the most common, as previously described (3,8,17,22,25,26,29,31,34,38).…”

“…During this period, the proportion of CTX-M strains among ESBL-producing E. coli isolates has dramatically increased from 38.2% to 87% (8,38,41,43,44,46). The CTX-M-15 enzyme seems to be the most common, as previously described (3,8,17,22,25,26,29,31,34,38). Length of hospital stay, severity of illness, time in the intensive care unit, intubation and mechanical ventilation, urinary or arterial catheterization, and previous exposure to antibiotics have been described as the main risk factors associated with acquiring ESBL-producing strains (4).…”