Extended-Spectrumβ-Lactamases among Enterobacteriaceae Isolated from Urinary Tract Infections in Gaza Strip, Palestine

Abstract

Background Extended-spectrum β-lactamase-producing organisms causing urinary tract infections are increasing in incidence and pose a major impendence to health-care facility, having limited therapeutic options. This study aimed to assess the prevalence of ESBLs in Enterobacteriaceae isolates causing urinary tract infections in Gaza strip, Palestine, and to characterize β-lactamase types and associated resistance genes. Methods Eighty-five Enterobacteriaceae isolates were recovered from urinary tract infections within three months in Gaza Strip hospitals. The characterization of β-lactamase genes and the genetic environments of CTX-M, the identification of associated resistance genes, and the presence and characterization of integrons were tested by PCR and sequencing. Results The occurrence rate of ESBL among tested isolates was 30 (35.3%), and among ESBL-positive isolates, blaCTX-M was the highest followed by blaTEM. ESBL-CTX-M-1 group was confirmed in 93.3%, and the remaining carried CTX-M-9 group. CTX-M-15, CTX-M-3, CTX-M-1, CTX-M-14, CTX-M-27, and CTX-M-37 enzymes were demonstrated among the isolates with the majority (73%) being CTX-M-15. ISEcp-1 was demonstrated in 27 (90%, high incidence) of ESBL isolates. Class 1 integrons have been detected in higher rates (53.3%) in ESBL-positive isolates in comparison with non-ESBL isolates (6, 33.3%). Cassettes of integron-1 contain (aadA1, aadA2, aadA5, dfrA5, dfrA7, dfrA12, and dfrA17) genes. The aac(6′)-Ib-cr gene was demonstrated in 36.7% of ESBL-positive isolates. Conclusions This study indicates that blaCTX-M-15 was the most prevalent β-lactamase in this region. Our study demonstrates for the first time in Palestine the identification of blaCTX-M-15 in P. rettgeri and S. liquefaciens, also blaCTX-M-37 in E. cloacae. The coexpression of multiple β-lactamase genes with aac(6′)-Ib-cr and qnr in the presence of ISEcp-1 and integrons in individual strains will increase the dissemination of highly resistant strains. ESBL producers were more resistant than non-ESBLs producers for almost all tested antibiotics.

Retrospective Analysis on Antimicrobial Resistance Trends and Prevalence of β-lactamases in Escherichia coli and ESKAPE Pathogens Isolated from Arabian Patients during 2000–2020

“…The molecular studies shown in Table 2 indicate that bla CTX-M was the most predominant ESBL trait among E. coli and ESKAPE pathogens, which evolved from 71.4% to 100%. A similar upward trend was also observed for bla TEM , bla OXA and bla SHV ESBL traits [ 82 , 83 ].…”

“…The results shown in Table 1 indicate that in Palestine during 2000 to 2020, resistance to 3rd-generation cephalosporins, i.e., cefuroxime, cefotaxime, ceftazidime, was higher. Interestingly, lower resistance was reported against amoxicillin-clavulanic acid, aminoglycosides (gentamicin and amikacin), quinolones (ciprofloxacin), and imipenem [ 82 , 83 ]. Isolates expressing various ESBLs, characterized by double-disk potentiation method, showed relatively low ESBL rates 20 years ago (35.3%), which increased dramatically to 85.3% [ 82 , 83 ].…”

“…Interestingly, lower resistance was reported against amoxicillin-clavulanic acid, aminoglycosides (gentamicin and amikacin), quinolones (ciprofloxacin), and imipenem [ 82 , 83 ]. Isolates expressing various ESBLs, characterized by double-disk potentiation method, showed relatively low ESBL rates 20 years ago (35.3%), which increased dramatically to 85.3% [ 82 , 83 ]. The molecular studies shown in Table 2 indicate that bla CTX-M was the most predominant ESBL trait among E. coli and ESKAPE pathogens, which evolved from 71.4% to 100%.…”

Colistin Resistance among Enterobacteriaceae Isolated from Clinical Samples in Gaza Strip

“…The lowest antimicrobial resistance was for amikacin (19%); this percent is higher than the percent reported years ago, where the percent of amikacin resistance among GNB responsible for nosocomial bacteremia was 3.9%, while among community-acquired isolates, it was 1.8% [ 10 ]. On the other hand, it is lower than amikacin resistance among ESBL-producing isolates of Enterobacteriaceae in a study performed by Tayh et al in 2019 [ 11 ] which was 33.3%…”

CTX-M Group Distribution and Positivity of Extended-Spectrum β-Lactamase (ESBL)-Producing Enterobacteriaceae in Urinary Tract Infections in a Tertiary Metropolitan Hospital in Japan

“…Among ESBL genotypes, the Verigene ® system can detect CTX-M-1, CTX-M-2, CTX-M-8, CTX-M-9, and CTX-M-25, but not the remaining ESBL genotypes, SHV and TEM 11) . Based on a comprehensive review of several observational studies on ESBL-E genotype distribution in other countries [12][13][14] , CTX-M genotype groups are the predominant genotype group that constitute ESBL-E. However, there are no sufficient preceding reports regarding genotype distribution in clinical isolates from severe cases of adult UTI in Japan to anticipate the current genotype distribution precisely.…”