Prevalence of Extended Spectrum Beta Lactamase and molecular detection of blaTEM, blaSHV and blaCTX-M genotypes among Gram Negative Bacilli Isolates from Pediatric Patient Population in Gaza strip

Abstract

Background: Extended-spectrum β lactamases (ESBLs) have the ability to hydrolyze and cause resistance to types of the β-lactam antibiotics, including the extended-spectrum (or third generation) cephalosporins (e.g., cefotaxime, ceftriaxone, ceftazidime) and monobactams (e.g., aztreonam).Objectives: To assess the prevalence and molecular characteristics of ESBL producing Gram negative bacilli, isolated from a cohort of pediatric patients in Gaza hospitals.Methods: A total of 322 isolates of Gram-negative bacilli were collected from four referral pediatric hospitals in Gaza, namely: Al-Nasr, Al-Rantisi, Al-Durra and Beit Hanoun hospitals. These isolates were tested for ESBL production using the double disk synergy and CHROMagar phenotypic methods. Molecular characterization of the ESBL producing strains was performed using PCR targeting the CTX-M, TEM and SHV genes. The antibiotic profile was determined using the Kirby Bauer method according to the Clinical and Laboratory Standard Institute standards.Results: Out of 322 isolates tested by phenotypic methods, 166 (51.6%) were ESBL positive. The prevalence of ESBL production in Al-Nasr, Al-Rantisi, Al-Durra and Beit Hanoun hospitals was 54.0%, 52.5%, 45.5% and 52.8%, respectively. The prevalence of ESBL production among Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp., Proteus mirabilis, Enterobacter spp., Citrobacter spp., and Serratia marcescens was 55.3%, 63.4%, 17.8%, 57.1%, 33.3%, 28.5%, 38.4%, and 4.0%, respectively. ESBL production for urine, pus, blood, CSF and sputum was 53.3%, 55.2%, 47.4%, 33.3%, and 25%, respectively. Out of the 322 isolates, 144 were screened for CTX-M, TEM and SHV production. Using PCR, 85 (59%) was shown to be positive for at least one gene. The overall prevalence of CTX-M, TEM and SHV genes was 60.0%, 57.6%, and 38.3%, respectively.Meropenem and amikacin were the most effective antibiotics against the ESBLs producers (83.1% and 82.5% of susceptible isolates, respectively), while the least effective antibiotics were amoxicillin (3.1%) and cephalexin (13.9%). Moreover, ESBLs producers showed a high resistance rate to cefotaxime, ceftriaxone and ceftazidime (79.5%, 78.9% and 79.5%, respectively). Conclusion: Our results show high prevalence of ESBL production among Gram negative bacilli isolated from children in different pediatric hospitals in Gaza strip. A substantial level of resistance to first and second generation cephalosporins was also observed. This emphasizes the need for a rational antibiotic prescription and consumption policy.

Assessment of Beta-lactamases and Integrons Genes among Bacteria Isolated From Bladder Cancer Patients with Urinary Tract Infections

“…(17.65%), and E. coli (14.71%), followed by S. aureus (13.72%). Bla SHV in our findings was around 18(47.3%) from total isolates ,several previous studies in compatible with our results , in a study conducted for Clinical Isolates of Enterobacteriaceae in Sudan by (30) , they revealed that 44% of the isolates produced bla SHV gene ; another study similar in some extent to our findings including : (31), in which SHV (43.1%) ; other study which conducted in Gaza by (32),they reported that 38.3% of Enterobacteriaceae isolates were harbored bla SHV gene ; (33) incompatible with our findings ,they summarized that much lower percentage than our findings around 5.1% .…”

“…The recent study reported that blaSHV from all E.coli isolates about 26.3% and ( 29.4%,27.27,20%) in all groups respectively , this is in agreement with a study conducted in Erbil City, Iraqi Kurdistan Region by (34),they reported the presence of blaSHV in about (28.5%) of E.coli isolates ; Another study supported our findings was done by (32) investigated that around 20.6% of E. coli isolates had blaSHV; Additionally, (35)revealed that the rate of blaSHV around 20% ; The rate of blaSHV in this study was higher than that reported by (36) in an Iranian hospital (5.5%) which were E. coli isolates.…”

Analysis of Extended Spectrum Beta Lactamase Frequency in Klebsiella spp Isolates

“…Plasmidderived beta-lactamases such as TEM-1, TEM-2, and SHV-1 are common enzymes among members of the Enterobacteriaceae and are transferred to other bacteria via plasmids. Although ESBL enzymes are mainly derived from TEM and SHV enzymes, new plasmid-derived ESBLs such as CTX-M, OXA-1, PER-1, and PER-2, which are not from TEM and SHV, have also been identified [22][23][24].…”