Distribution of Extended-Spectrum β-Lactamase (ESBL)-Encoding Genes among Multidrug-Resistant Gram-Negative Pathogens Collected from Three Different Countries

Abstract

The incidence of Extended-spectrum β-lactamase (ESBL)-encoding genes (blaCTX-M and blaTEM) among Gram-negative multidrug-resistant pathogens collected from three different countries was investigated. Two hundred and ninety-two clinical isolates were collected from Egypt (n = 90), Saudi Arabia (n = 162), and Sudan (n = 40). Based on the antimicrobial sensitivity against 20 antimicrobial agents from 11 antibiotic classes, the most resistant strains were selected and identified using the Vitek2 system and 16S rRNA gene sequence analysis. A total of 85.6% of the isolates were found to be resistant to more than three antibiotic classes. The ratios of the multidrug-resistant strains for Egypt, Saudi Arabia, and Sudan were 74.4%, 90.1%, and 97.5%, respectively. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa showed inconstant resistance levels to the different classes of antibiotics. Escherichia coli and Klebsiella pneumoniae had the highest levels of resistance against macrolides followed by penicillins and cephalosporin, while Pseudomonas aeruginosa was most resistant to penicillins followed by classes that varied among different countries. The isolates were positive for the presence of the blaCTX-M and blaTEM genes. The blaCTX-M gene was the predominant gene in all isolates (100%), while blaTEM was detected in 66.7% of the selected isolates. This work highlights the detection of multidrug-resistant bacteria and resistant genes among different countries. We suggest that the medical authorities urgently implement antimicrobial surveillance plans and infection control policies for early detection and effective prevention of the rapid spread of these pathogens.

Genetic Analysis, Population Structure, and Characterisation of Multidrug-Resistant Klebsiella pneumoniae from the Al-Hofuf Region of Saudi Arabia

“…As in our study, findings regarding genetic diversity in isolates have varied among researchers [69][70][71][72]. Additionally, the PFGE results in the present study revealed no specific pattern of association between pulsotype cluster analyses and the resistant phenotypes of the isolates, which may be a reflection of the genomic characteristics of this Gram-negative opportunistic pathogen in which the plasmid genome and chromosomal genes are large (as previously documented [59]). It is possible that MDR could be more plasmid-based than chromosomal.…”

“…Polyclonal ESBL-KP was also reported [ 58 ] in a non-outbreak hospital environment and was attributed to possible importation into hospital settings. Generally, the numbers of ESBL-producing bacterial pathogens have increased in the past few decades, with geographical and regional disparity [ 59 ]. Thus, K. pneumoniae isolates such as those in this report pose immense challenges to clinicians in the management of multidrug-resistant infections by these isolates.…”

A Multi-Point Surveillance for Antimicrobial Resistance Profiles among Clinical Isolates of Gram-Negative Bacteria Recovered from Major Ha’il Hospitals, Saudi Arabia

“…A recent surveillance of resistant pathogens in Egypt, Sudan, and Saudi Arabia revealed the ratios of the multidrugresistant strains as 74.4%, 90.1%, and 97.5%, respectively. E. coli and K. pneumoniae were the most resistant to macrolides followed by penicillins and cephalosporin, while P. aeruginosa showed the highest resistance to penicillins followed by classes that varied among different countries [44]. Nevertheless, this potent opportunistic pathogen has a common virulence and adaptation regulatory system that operates in environmental and clinical settings.…”

Whole Genome Characterization of the High-Risk Clone ST383 Klebsiella pneumoniae with a Simultaneous Carriage of blaCTX-M-14 on IncL/M Plasmid and blaCTX-M-15 on Convergent IncHI1B/IncFIB Plasmid from Egypt

“…In Mediterranean countries, an endemic prevalence of multidrug-resistant K. pneumoniae (MDR-KP) has been recorded [1] and, as a part of this area, Egypt has witnessed a significant spread of MDR-KP with several reports being issued [2,3]. What renders the problem more complicated is that the proper treatment choice for MDR-KP infections is not well determined yet, thus, making the control of such infections a serious challenge for healthcare professionals [4].…”

“…Expanded-spectrum cephalosporins are still among the most globally prescribed antimicrobial agents [5]. This extensive usage has been mirrored by a global expansion of extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae showing resistance to ceftriaxone, cefotaxime, ceftazidime, and monobactams (as aztreonam), reaching 50% in some countries [4,6]. At a national level, a surveillance study carried out in five hospitals in Cairo, from 1999 to 2000, showed reduced susceptibility of Klebsiella spp.…”