Prevalence and association of the presence of blaTEM، blaSHV، and blaCTX-M beta-lactamase genes in multiple drug resistance (MDR) Uropathogenic Escherichia coli resistant and susceptible isolated from patients with urinary tract infections in Chalus

Authors
Neda Merikhi 1
Jamileh Nowroozi 1
Ali Nazemi 2
Mehrdad Hashemi 3
Robab Rafiei Tabatabaei 1
1 Department of Microbiology, North Tehran Branch, Islamic Azad University, Tehran, Iran
2 Department of Biology, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
3 Department of genetics, Faculty of advanced sciences and technology, Islamic Azad University, Tehran medical sciences branch, Tehran, Iran
Abstract
Introduction

This study was performed to investigate the prevalence and association of blaCTX-M, blaTEM, and blaSHV beta-lactamase genes in multiple drug resistance (MDR) uropathogenic Escherichia coli resistant and susceptible isolated from patients with urinary tract infections in Chalus, Iran.

Materials and Methods

In the cross-sectional study a total of 437 samples were obtained from December 2018 to November 2019. Identification of Uropathogenic Escherichia coli strains was performed using standard microbiological and biochemical tests. Drug susceptibility to cefepime, ceftazidime, cefotaxime, cefixime, ceftriaxone, nalidixic acid, ciprofloxacin, trimethoprim, sulfamethoxazole, gentamicin, nitrofurantoin, and ampicillin was done by Kirby–Bauer disk diffusion method. Molecular identification of blaCTX-M, blaTEM و blaSHV was conducted by PCR (polymerase chain reaction) assay. The relationship between the presence of beta-lactamase genes in MDR strains was measured. Data analysis was performed using an appropriate statistical test.

Results

It was observed that among the 437 positive urine culture samples of the patient, there were 106 UPEC strains (24.3%). The highest level of drug resistance was recognized toward ampicillin (99%), and the highest level of drug susceptibility was against cefepime (83%), and norfloxacin (82%). Multiple drug resistance (MDR) resistance was observed in 46 (43%) isolates. The blaTEM gene was more common among MDR-positive isolates (51.5%), and the blaCTX-M gene was more seen among MDR-positive isolates (65.8%).

Conclusion

Based on the present study results, the blaTEM gene was the dominant gene between beta-lactamase genes. Moreover, we found that the blaCTX-M gene's presence could be playing a role in MDR development.
Keywords
Uropathogenic Escherichia coli
Urinary tract infections
blaCTX-M
blaTEM
blaSHV
1. Ishino Y، Shinagawa H، Makino K، Amemura M، Nakata A. Nucleotide sequence of the iap gene، responsible for alkaline phosphatase isozyme conversion in Escherichia coli، and identification of the gene product. J Bacteriol Res. 1987;169(12):5429-33.
2. Brumbaugh AR، Smith SN، Mobley HL. Immunization with the yersiniabactin receptor، FyuA، protects against pyelonephritis in a murine model of urinary tract infection. Infection and immunity. 2013;81(9):3309-16.
3. Micali S، Isgro G، Bianchi G، Miceli N، Calapai G، Navarra M. Cranberry and recurrent cystitis: more than marketing? Critical reviews in food science and nutrition. 2014;54(8):1063-75.
4. Hof H. [Candiduria! What now?: Therapy of urinary tract infections with Candida]. Der Urologe Ausg A. 2017;56(2):172-9.
5. Mann R، Mediati DG، Duggin IG، Harry EJ، Bottomley AL. Metabolic Adaptations of Uropathogenic E. coli in the Urinary Tract. Frontiers in cellular and infection microbiology. 2017; 7:241.
6. Tabasi M، Karam MR، Habibi M، Mostafavi E، Bouzari S. Genotypic Characterization of Virulence Factors in Escherichia coli Isolated from Patients with Acute Cystitis، Pyelonephritis and Asymptomatic Bacteriuria. Journal of clinical and diagnostic research: JCDR. 2016;10(12): Dc01-dc7.
7. Bartoletti R، Cai T، Wagenlehner FM، Naber K، Johansen TEB. Treatment of urinary tract infections and antibiotic stewardship. European Urology Supplements. 2016;15(4):81-7.
8. Dehbanipour R، Rastaghi S، Sedighi M، Maleki N، Faghri J. High prevalence of multidrug-resistance uropathogenic Escherichia coli strains، Isfahan، Iran. Journal of natural science، biology، and medicine. 2016;7(1):22.
9. Ochoa SA، Cruz-Córdova A، Luna-Pineda VM، Reyes-Grajeda JP، Cázares-Domínguez V، Escalona G، et al. Multidrug-and extensively drug-resistant uropathogenic Escherichia coli clinical strains: phylogenetic groups widely associated with integrons maintain high genetic diversity. Frontiers in microbiology. 2016; 7:2042.
10. Ortega B، Groeneveld AJ، Schultsz C. Endemic multidrug-resistant Pseudomonas aeruginosa in critically ill patients. Infection Control & Hospital Epidemiology. 2004;25(10):825-31.
11. Chong Y، Shimoda S، Shimono N. Current epidemiology، genetic evolution and clinical impact of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae. Infection، Genetics and Evolution. 2018; 61:185-8.
12. Musa HA، Osman MA، Abdelaziz YH، Mohamed S، Ibrahim-Saeed M. Distribution of extended-spectrum beta-lactamase TEM and CTX-M resistance genes among Proteus species isolated in Sudan. VacciMonitor. 2019;28(2):80-4.
13. Ugbo E، Anyamene C، Moses I، Iroha I، Babalola O، Ukpai E، et al. Prevalence of blaTEM، blaSHV، and blaCTX-M genes among extended spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae of clinical origin. Gene Reports. 2020; 21:100909.
14. Ejikeugwu C، Ikegbunam M، Ugwu C، Eze P، Iroha I، Esimone C. Phenotypic detection of Klebsiella pneumoniae strains-producing extended spectrum β-lactamase (ESBL) enzymes. Scholars Acad J Biosci. 2013;1(1):20-3.
15. Maharjan A، Bhetwal A، Shakya S، Satyal D، Shah S، Joshi G، et al. Ugly bugs in healthy guts! Carriage of multidrug-resistant and ESBL-producing commensal Enterobacteriaceae in the intestine of healthy Nepalese adults. Infection and drug resistance. 2018; 11:547.
16. Michael GB، Freitag C، Wendlandt S، Eidam C، Feßler AT، Lopes GV، et al. Emerging issues in antimicrobial resistance of bacteria from food-producing animals. Future microbiology. 2015;10(3):427-43.
17. Shaikh S، Fatima J، Shakil S، Rizvi SMD، Kamal MA. Antibiotic resistance and extended spectrum beta-lactamases: Types، epidemiology and treatment. Saudi journal of biological sciences. 2015;22(1):90-101.
18. Terlizzi ME، Gribaudo G، Maffei ME. UroPathogenic Escherichia coli (UPEC) infections: virulence factors، bladder responses، antibiotic، and non-antibiotic antimicrobial strategies. Frontiers in microbiology. 2017; 8:1566.
19. XIONG Y، FOWLER JR V، YEAMAN M، PERDREAU-REMINGTON F. Watts، A.، Ke، D.، Wang، Q.، Pillay، A.، Nicholson-Weller، A. & Lee، JC 2005. Staphylococcus aureus strains that express serotype 5 or serotype 8 capsular polysaccharides differ in virulence. Infection and immunity، 73، 3502-3511. WAYNE، P. 2014. Clinical and Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing: Twenty-fourth informational. DEPARTAMENT DE MICROBIOLOGÍA I ECOLOGÍA. 2019; 25:167.
20. Ojdana D، Sacha P، Wieczorek P، Czaban S، Michalska A، Jaworowska J، et al. The occurrence of blaCTX-M، blaSHV، and blaTEM genes in extended-Spectrum β-lactamase-positive strains of Klebsiella pneumoniae، Escherichia coli، and Proteus mirabilis in Poland. International Journal of Antibiotics. 2014;2014.
21. Issazadeh K، Naghibi SN، Khoshkholgh-Pahlaviani MRM. Drug resistance and serotyping of uropathogenic Escherichia coli among Patients with urinary tract infection in Rasht، Iran. Zahedan J Res Med Sci. 2015;17(6):1-5.
22. Pourzare M، Derakhshan S، Roshani D. Distribution of uropathogenic virulence genes in Escherichia coli isolated from children with urinary tract infection in Sanandaj، Iran. Arch Pediatr Infect Dis. 2017;5(3): e41995.
23. Tabasi M، Karam MRA، Habibi M، Yekaninejad MS، Bouzari S. Phenotypic assays to determine virulence factors of uropathogenic Escherichia coli (UPEC) isolates and their correlation with antibiotic resistance pattern. Osong public health and research perspectives. 2015;6(4):261-8.
24. Foxman B، Barlow R، D'Arcy H، Gillespie B، Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Annals of epidemiology. 2000;10(8):509-15.
25. Hooton TM. Recurrent urinary tract infection in women. International journal of antimicrobial agents. 2001;17(4):259-68.
26. Kostakioti M، Hultgren SJ، Hadjifrangiskou M. Molecular blueprint of uropathogenic Escherichia coli virulence provides clues toward the development of anti-virulence therapeutics. Virulence. 2012;3(7):592-3.
27. Goudarzi H، Aghamohammad S، Hashemi A، Nikmanesh B، Noori M. Distribution of blaTEM، blaSHV and blaCTX-M genes among Escherichia coli isolates causing urinary tract infection in children. 2013.
28. Lesani SS، Soleimani M، Shakib P، Zolfaghari MR. Prevalence of bla CTX-M، bla SHV، and bla TEM Genes in Escherichia coli Strains Isolated from Urinary Tract Infection Samples of Patients in the Intensive Care Unit in Qom، Iran. Gene، Cell and Tissue. 2020;7(2).
29. Foxman B. The epidemiology of urinary tract infection. Nature Reviews Urology. 2010;7(12):653-60.
30. Foxman B. Urinary tract infection syndromes: occurrence، recurrence، bacteriology، risk factors، and disease burden. Infectious disease clinics of North America. 2013;28(1):1-13.
31. Pishtiwan AH، Khadija KM. Prevalence of blaTEM، blaSHV، and blaCTX-M Genes among ESBL-Producing Klebsiella pneumoniae and Escherichia coli Isolated from Thalassemia Patients in Erbil، Iraq. Mediterr J Hematol Infect Dis. 2019;11(1): e2019041-e.
32. Sanchez GV، Babiker A، Master RN، Luu T، Mathur A، Bordon J. Antibiotic resistance among urinary isolates from female outpatients in the United States in 2003 and 2012. Antimicrobial agents and chemotherapy. 2016;60(5):2680-3.
33. Chen Y-H، Ko W-C، Hsueh P-R. Emerging resistance problems and future perspectives in pharmacotherapy for complicated urinary tract infections. Expert opinion on pharmacotherapy. 2013;14(5):587-96.
34. Paterson DL. Resistance in gram-negative bacteria: Enterobacteriaceae. American journal of infection control. 2006;34(5): S20-S8.
35. Hassuna NA، Khairalla AS، Farahat EM، Hammad AM، Abdel-Fattah M. Molecular characterization of Extended-spectrum β lactamase-producing E. coli recovered from community-acquired urinary tract infections in Upper Egypt. Scientific reports. 2020;10(1):1-8.
36. Zhao R، Shi J، Shen Y، Li Y، Han Q، Zhang X، et al. Phylogenetic distribution of virulence genes among ESBL-producing uropathogenic Escherichia coli isolated from long-term hospitalized patients. Journal of clinical and diagnostic research: JCDR. 2015;9(7): DC01.
37. Seyedjavadi SS، Goudarzi M، Sabzehali F. Relation between blaTEM، blaSHV and blaCTX-M genes and acute urinary tract infections. Journal of Acute Disease. 2016;5(1):71-6.
38. Gundran RS، Cardenio PA، Villanueva MA، Sison FB، Benigno CC، Kreausukon K، et al. Prevalence and distribution of blaCTX-M، blaSHV، blaTEM genes in extended- spectrum β- lactamase- producing E. coli isolates from broiler farms in the Philippines. BMC Veterinary Research. 2019;15(1):227.
39. Liu H، Wang Y، Wang G، Xing Q، Shao L، Dong X، et al. The prevalence of Escherichia coli strains with extended spectrum beta-lactamases isolated in China. Frontiers in microbiology. 2015; 6:335.
Journal of Netshabur University of Medical Sciences
Volume 9, Issue 4 - Serial Number 33
Autumn 2021
Pages 121-132