<p>Prevalence of Extended-Spectrum Beta-Lactamase-Producing <em>Enterobacteriaceae</em> Causing Bloodstream Infections in Cancer Patients from Southwest of Iran</p>

Abstract

This study aimed to evaluate the frequency rate of extended-spectrum betalactamase-producing Enterobacteriaceae (ESBL-PE) causing bloodstream infections (BSIs) in cancer patients referred to one of the major referral hospitals in Ahvaz city, southwest Iran. Materials and Methods: In this study, 1700 blood cultures were collected from 610 cancer patients suspected to have BSI from October 2016 to August 2017 referred to the Shafa cancer hospital, Ahvaz, southwest of Iran. The blood culture bottles were incubated aerobically at 35-37ºC for 24 hours and then sub-cultured on routine microbiology culture media. The bacterial colonies were identified using standard tests. The antibiotic susceptibility testing was achieved by the disc-diffusion method. The phenotypic detection of ESBLs was carried out by the combination disc-diffusion test (CDDT). Finally, the polymerase chain reaction (PCR) was performed to investigate the presence of bla TEM , bla CTX , bla SHV, and bla PER genes. Results: The prevalence of BSI in cancer patients was 16.4% (100/610). Gram-negative rods with rate of 74% (74/100) were the most prevalent bacteria. The frequency of Enterobacteriaceae family was 21% including Escherichia coli (n: 8), Klebsiella pneumoniae (n: 6), Enterobacter spp. (n: 5), Citrobacter freundii (n: 1), and Serratia marcescens (n: 1). All isolates were multidrug-resistant (resistance to three or more antibiotics). The results of CDDT showed that 42.8% (9/21) of Enterobacteriaceae isolates had a positive ESBL test of which 100% (9/9) indicated positive band for at least one of the ESBL genes by PCR method. The bla CTX-M and bla TEM genes were detected in 38% (8/21) and 23.8% (5/21) of isolates, respectively, while the bla SHV and bla PER were not detected in any isolates. Conclusion: Based on the results, surveillance, and antibiotic stewardship programs should be implemented for cancer patients to prevent the spread of more ESBL-PE that have limited therapeutically choices.

Epidemiological Profile and Detection of Resistance Genes in Bloodstream Infection in Cancer Patients: High Occurrence of Metallo-β-lactamases in Enterobacteriales

“…Mexico (72,8%) 51 , Korea (55,6%) 52 , Iran (84,9%) 50 and Brazil, (71,4%) 48 . The main genes detected were bla TEM (58%) and bla CTX (42,1%), in addition, 18,4% (7/38) co-housed the bla TEM and bla CTX genes, corroborating with other studies 53,36 .…”

“…The most commonly found BGN were Escherichia coli (25,4%), Klebsiella pneumoniae (20%) and Pseudomonas aeruginosa (12,7%), as well as reported in recent studies 34,35,36,37 . Evidence has suggested the phenomenon of bacterial translocation, where enterobacteria cross the intestine wall, migrating into the bloodstream, causing bacteremia in patients receiving cancer chemotherapy 38,39 , explaining in the greater frequency of this group of bacteria is part of the etiology of bloodstream infection.…”

Resistotyping and extended-spectrum beta-lactamase genes among Escherichia coli from wastewater treatment plants and recipient surface water for reuse in South Africa

“…The interpretation criteria (sensitive/resistant) for the antibiotics were determined on the basis of the zone diameters provided in CLSI 2017 [ 17 ]. An isolate was designated multiple antibiotic resistant if it was resistant to at least three antibiotics classes [ [18] , [19] , [20] , [21] ]. The antibiotics used in this study were selected on the basis of their clinical and agricultural significance.…”

Molecular Characterization of Carbapenemase-Producing Klebsiella pneumoniae Isolated from Egyptian Pediatric Cancer Patients Including a Strain with a Rare Gene-Combination of β-Lactamases

“…Carbapenem resistance is considered a great threat as they are usually combined with other resistance mechanisms for a wide range of antimicrobial agents; thus, infections with carbapenemase-producing Enterobacteriaceae are associated with high mortality rates. Hospital-acquired infection outbreaks are also associated with Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs) that have been identified as a major cause of the MDR phenotype, because of their wide diversity of enzymes, including TEM, SHV, and CTX-M. 3 , 7 , 11 , 12 Investigation of infection outbreaks, the transmission of microorganisms between the environment and the patients, and epidemiological surveillance have become an important tool in monitoring local dissemination of resistant bacterial strains within the healthcare facilities. 1 , 13 , 14 Accordingly, phenotypic methods have been replaced by molecular typing methods that examine the relatedness of microorganisms at the genomic level.…”