Molecular Characterization of Extended-Spectrum β-Lactamase Enterobacteriaceae Isolated from Egyptian Patients with Community- and Hospital-Acquired Urinary Tract Infection

Abstract

Extended-spectrum β-lactamases (ESβLs) pose a serious problem in the treatment of urinary tract infections (UTIs). The ESβL-producing organism is an expanding global health problem. Therefore, screening for ESβL, detection of their drug-resistance pattern, and molecular characterization should be a continuous process. The present study was performed to determine the antibiotic resistance profile and the genetic characterization of ESβL isolates from hospital-and community-acquired UTIs. Two hundred fifty Enterobacteriaceae isolates were obtained from urine samples of outpatient clinic attendants and hospitalized patients at Kasr Al-Aini Hospital. By phenotypic screening tests, 100 ESβL isolates were detected among the studied groups. Furthermore, detection of beta-lactamase (bla) cefotaxime (CTX)-M, sulfhydryl variable, and temoneira ESβL genes was investigated by polymerase chain reaction. A subset of 25 CTX-M-positive isolates was further identified by gene sequencing technology. Among the 100 ESβL isolates, 66% were Escherichia coli and 34% were Klebsiella spp. There was no statistical difference in the prevalence of ESβL Enterobacteriaceae in community-acquired versus hospital-acquired UTIs. The susceptibility of all ESβL isolates to carbapenems was the most prevalent finding. In addition, all ESβL E. coli isolates were susceptible to fosfomycin, whereas all community-acquired ESβL isolates were susceptible to nitrofurantoin. A total of 98% of the ESβL isolates harbored bla-CTX-M genes, with CTX-M-15 being the most prevalent. It could be concluded that ESβL production is present at a high rate among Egyptian patients with hospital-and community-acquired UTI. The high prevalence of bla-CTX-M may suggest it as a candidate for molecular screening of ESβL.

Prevalence of extended-spectrum β-lactamases, AmpC, and carbapenemases in Proteus mirabilis clinical isolates

“…1 a, Supplementary Figure S 3 ), which is in line with other studies [ 39 , 54 – 56 ]. In contrast, our prevalence rate was higher than that reported in earlier Egyptian studies, namely, 17% by [ 57 ] and 38.8% by [ 58 ]. Therefore, an increase in the ESBL production rate has emerged over time in Egypt due to the uncontrolled use of antimicrobials, mostly third-generation cephalosporins, as routine therapy against UTIs [ 59 , 60 ].…”

Prevalence and molecular characteristics of ESBL and AmpC β -lactamase producing Enterobacteriaceae strains isolated from UTIs in Egypt

“…This high frequency is comparable to a recent data reported by Hassuna et al, 2020 in our region, where 57.9% of E. coli isolated from community-acquired UTIs were ESBL producers [ 30 ]. On the other hand, our prevalence of ESBL-producing isolates is quite higher than that reported in several previous Egyptian studies; 17% by Fam et al, 2011 [ 28 ] and 38.8%, by Shash et al, 2019 [ 31 ], suggesting an increasing rate of ESBLs-producing Enterobacteriaceae spread in Egypt, that may be caused by extensive use of 3rd generation cephalosporines as empiric treatment in Egypt. The prevalence of ESBL production varies according to species, geographical areas, variations in infection control programs, different patterns of empiric antibiotic regimens and even over time .…”

“…Global spread of β-lactamases-producing strains gives a great importance to the study of these strains in community and hospitals for reassessment of the existing treatment protocols. In Egypt, multiple studies have investigated the prevalence of ESBLs among Enterobacteriaceae isolated from hospital and community acquired-UTIs [28][29][30] [31], suggesting an increasing rate of ESBLsproducing Enterobacteriaceae spread in Egypt, that may be caused by extensive use of 3rd generation cephalosporines as empiric treatment in Egypt. The prevalence of ESBL production varies according to species, geographical areas, variations in infection control programs, different patterns of empiric antibiotic regimens and even over time.…”

Expression of bla-CTX-M and fimH genes in uropathogenic Escherichia coli isolated from Egyptian catheterized patients

“…coli isolates from catheterized patients in the present study are not only characterized by high rates of resistance and biofilm formation but there is also a high rate of expression of bla-CTX-M (100%). This is in agreement with some studies as that of the Egyptian study who detected the bla-CTX-M gene in 98% of isolates 41 . Also, an Indonesian study reported CTX-M-15 gene in more than 89% of isolates 42 .…”