PREVALENCE OF CTX-M-PRODUCING GRAM-NEGATIVE UROPATHOGENS IN SOKOTO, NORTH-WESTERN NIGERIA
Objective: Infections of the urinary tract remains one of the most common bacterial infections with many implicated organisms being Gram-negative, which are increasingly resistant to antimicrobial agents. The aim of the study was to evaluate the resistance of ESBL producing Gram-negative enterobacteriaceae to commonly prescribed antibiotics and the prevalence of CTX-M genes from these isolates using polymerase chain reaction (PCR).
Methods: The isolates were collected from urine over a period of 4 mo and studied, and were identified using Microgen Identification Kit (GN-ID). Susceptibility testing was performed by the modified Kirby Bauer disc diffusion method, and results were interpreted according to Clinical and Laboratory Standard Institute (CLSI). Extended-Spectrum Beta-Lactamase (ESBL) production was detected by the double-disc synergy test (DDST). Molecular characterization was based on the isolates that were positive for the phenotypic detection of ESBL.
Results: Sixty one (61) isolates of Gram-negative uropathogens were identified. Of these, 19 (31.2%) were E. coli, 15 (24.6%) were Salmonella arizonae, Klebsiella pneumoniae were 7 (11.5%), Klebsiella oxytoca were 3 (4.9%), Enterobacter gergoviae were 6 (9.8%), 4 (6.6%) were Citrobacter freundii, 4 (6.6%) were Serratia marscence, and 1 (1.6%) were Enterobacter aerogenes, Proteus mirabilis, and Edwardsiella tarda each. Analysis of the bacterial susceptibility to antibiotics revealed most of them to be generally resistant to cotrimoxazole (73.3%), nalidixic acid (66.7%), norfloxacin (53.5%), ciprofloxacin (50.5%), gentamicin (48.6%), amoxicillin/clavulanate (45%), and the least resistant was displayed in nitrofurantoin (30%). Of the 15 ESBL producers, 11 (73.3%) were harbouring bla CTX-M genes.
Conclusion: The study revealed a high susceptibility to nitrofurantoin, whereas susceptibility to cotrimoxazole was lowest. It further portrays a high prevalence of enterobacteriaceae isolates harbouring bla CTX-M genes in Sokoto metropolis.
2. Angima BK, Usha R. Modification of urinary catheters using antimicrobials from Streptomyces sp. ABK 07 for urinary tract infection resistance. Asian J Clin Res 2018;11:158-62.
3. Khalifa AAF, Harb AO, Alkout AM. Urinary tract infection in sobrata, algmel cities in libya 2013. J Clin Microbiol 2014;3:1000163.
4. Wagenlehner FME, Naber KG. Treatment of bacterial urinary tract infections: present and future. J Euro Assoc Urol 2006;49:235-44.
5. Chom Tompkins NH. Multidrug-resistant gram-negative infections bringing back the old. J Crit Care Nurs 2011;34:87-100.
6. Dominika O, Pawel S, Piotr W, Slawomir C, Anna M, Jadwiga J, et al. The occurrence of blaCTX-M, blaSHV, and blaTEM genes in extended-spectrum beta-lactamase positive strains of Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis in poland. Int J Antibiotics 2014:1-7. http://dx.doi.org/10.1155/2014/ 935842.
7. Song S, Lee EY, Koh EM, Ha HS, Jeong HJ, Bae IK, et al. Antibiotic resistance mechanisms of Escherichia coli isolates from urinary specimens. Korean J Lab Med 2009;29:17-24.
8. Dhillon RH, Clark J. ESBLs: a clear and present danger? Crit Care Res Pract 2012:625170. Doi:10.1155/2012/625170
9. Sridhar Rao PN. Extended-spectrum beta-lactamases-a comprehensive review. Available from: www.microrao.com. [Last accessed on 15 Feb 2017].
10. Mathur P, Kapil A, Das B, Dhawan B. Prevalence of extended-spectrum beta-lactamase-producing gram-negative bacteria in tertiary care hospital. Indian J Med Res 2002;115:153-7.
11. David ML, Canton R, Gniakowski M, Nordmann P, Rossolini GM, Ayala J, et al. CTX-M: changing the face of ESBLs in Europe. J Antmicr Chem 2007;59:165-74.
12. Ogbolu DO, Terry Alli OA, Webber MA, Oluremi AS, Oloyede OM. CTX-M-15 is established in most multidrug-resistant uropathogenic enterobacteriaceae and Pseudomonaceae from Hospitals in Nigeria. Euro J Microbiol Immun 2018;8:20–4.
13. Aibinu I, Odugbemi T, Koenig W, Ghebremedhin B. Sequence type ST131 and ST10 complex (ST617) predominant among CTX-M-15-producing Escherichia coli isolates from Nigeria. J Clin Microbiol Infect 2012;18:E49-E51.
14. Bajpai T, Pandey M, Varma M, Bhatambare GS. Prevalence of TEM, SHV, and CTX-M beta lactamase genes in the urinary isolates of a tertiary care hospital. Avicenna J Med 2017;7:12-6.
15. Naseer U, Sundsfjord A. The CTX-M conundrum: dissemination of plasmids and Escherichia coli clones. J Microbiol Drug Resist 2011;17:83-97.
16. Canton R, Gonzalez Alba JM, Galan JC. CTX-M enzymes: origin and diffusion. Front Microbiol 2012;3:110.
17. Clinical Laboratory Standard Institute (CLSI). Perfomance standards of antimicrobial disc and dilution susceptibility tests for bacteria isolated from animal, approved standard. 3rd edition; 2012.
18. Agamy GT, Tharwat RE, Maggie AI, Adel EA. Detection of extended-spectrum beta-lactamases produced by E. coli urinary pathogens at Assiut University Hospital. Bull Pharm Sci Assiut University 2011;34:93-103.
19. Colodner R. Extended-spectrum beta lactamses: a challenge for clinical microbiologists and infection control specialists. Am J Infect Control 2005;33:104-7.
20. El-Kersh TA, Marie MA. Al-Sheikh YA, Al-Kahtani SA. Prevalence and risk factors of community-acquired urinary tract infections due to ESBL-producing Gram negative bacteria in an armed forces hospital in Southern Saudi Arabia. Glo Adv Res J Med Med Sci 2015;4:321-30.
21. Hawkey PM. Prevalence and clonality of extended spectrum beta lactamases in Asia. J Clin Microbiol Infect 2008;14(Suppl 1):159-63.
22. Fernandes R, Amador P, Oliveira C, Prudencio C. Molecular characterization of ESBL-producing Enterobacteriaceae in Northern Portugal. Sci World J 2014. Doi:10.1155/2014/ 782897.
23. Bali EB, Accedil L, Sultan N. Phenotypic and molecular characterization of SHV, TEM CTX-M and extended spectrum beta-lactamase produced by E. coli, Acinetobacter baumanii and Klebsiella isolates in a Turkish hospital. Afr J Microbiol Res 2010;4:650-4.
24. Nisha KV, Veena SA, Rathika SD, Vijaya SM, Avinash SK. Antimicrobial susceptibility; risk factors and prevalence of bla cefotaximase, temoneira, and sulfhydryl variable genes among E. coli in community-acquired pediatric urinary tract infection. J Lab Phys 2017;9:156-62.
25. Rezai MS, Salehifar E, Rafiei A, Langee T, Rafati M, Shafahi K, et al. Characterization of multidrug-resistant extended-spectrum beta-lactamase-producing E. coli among uropathogens of pediatrics on North of Iran. Biomed Res Int 2015. http://dx.doi.org/10.1155/2015/309478
26. Shahid M, Singh A, Sobia F, Rashid M, Malik A, Shukla I, et al. Bla (CTX-M), bla (TEM), and bla (SHV) in enterobacteriaceae from North-Indian tertiary hospital: High occurrence of combination genes. Asian Pac J Trop Med 2011;4:101-5.
27. Sima SS, Mehdi G, Fattaneh S. Relation between blaTEM, blaSHV and blaCTX-M genes and acute urinary tract infections. J Acute Dis 2016;5:71-6.
28. Muhammad NU, Bature M, Nuhu T, Nafiu A. Antibiotic susceptibility testing for Escherichia coli causing urinary tract infections in sokoto metropolis. Asian J Pharm Clin Res 2018;11:373-6.
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