Sylvia M Maveke, Gabriel O Aboge, Laetitia W Kanja, Alfred O Mainga, Naftaly Gachau, Beatrice W Muchira, Gervason A Moriasi
{"title":"肯尼亚两家医疗机构中产广谱β-乳酰胺酶大肠埃希菌和肺炎克雷伯菌临床分离菌的表型和基因型特征：一家国家转诊医院和一家五级医院。","authors":"Sylvia M Maveke, Gabriel O Aboge, Laetitia W Kanja, Alfred O Mainga, Naftaly Gachau, Beatrice W Muchira, Gervason A Moriasi","doi":"10.1155/2024/7463899","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The emergence of antimicrobial resistance (AMR) and multidrug resistance (MDR) among <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i>, especially through the production of extended spectrum <i>β</i>-lactamases (ESBLs), limits therapeutic options and poses a significant public health threat.</p><p><strong>Objective: </strong>The aim of this study was to assess the phenotypic and genetic determinants of antimicrobial resistance of ESBL-producing <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> isolates from patient samples in two Kenyan Hospitals.</p><p><strong>Methods: </strong>We collected 138 <i>E. coli</i> and 127 <i>K. pneumoniae</i> isolates from various clinical specimens at the two health facilities from January 2020 to February 2021. The isolates' ESBL production and antibiotic susceptibility were phenotypically confirmed using a standard procedure. Molecular analysis was done through conventional polymerase chain reaction (PCR) with appropriate primers for <i>gad</i>A, <i>rpo</i>B, <i>bla</i><sub>TEM</sub>, <i>bla</i><sub>SHV</sub>, <i>bla</i><sub>OXA</sub>, <i>bla</i><sub>CTX-M-group-1</sub>, <i>bla</i><sub>CTX-M-group-2</sub>, <i>bla</i><sub>CTX-M-group-9</sub>, and <i>bla</i><sub>CTX-M-group-8/25</sub> genes, sequencing and BLASTn analysis.</p><p><strong>Results: </strong>Most <i>E. coli</i> (82.6%) and <i>K. pneumoniae</i> (92.9%) isolates were ESBL producers, with the highest resistance was against ceftriaxone (69.6% among <i>E. coli</i> and 91.3% among <i>K. pneumoniae</i>) and amoxicillin/clavulanic acid (70.9% among <i>K. pneumoniae</i>). The frequency of MDR was 39.9% among <i>E. coli</i> and 13.4% among <i>K. pneumoniae</i> isolates. The commonest MDR phenotypes among the <i>E. coli</i> isolates were CRO-FEP-AZM-LVX and CRO-AZM-LVX, while the FOX-CRO-AMC-MI-TGC-FM, FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI and CRO-AMC-TZP-AZM-MI were the most frequent among <i>K. pneumoniae</i> isolates. Notably, the FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI phenotype was observed in ESBL-positive and ESBL-negative <i>K. pneumoniae</i> isolates. The most frequent ESBL genes were <i>bla</i><sub>TEM</sub> (42%), <i>bla</i><sub>SHV</sub> (40.6%), and <i>bla</i><sub>OXA</sub> (36.2%) among <i>E. coli</i>, and <i>bla</i><sub>TEM</sub> (89%), <i>bla</i><sub>SHV</sub> (82.7%), <i>bla</i><sub>OXA</sub> (76.4%), and <i>bla</i><sub>CTX-M-group-1</sub> (72.5%) were most frequent ESBL genes among <i>K. pneumoniae</i> isolates. The <i>bla</i><sub>SHV</sub> and <i>bla</i><sub>OXA</sub> and <i>bla</i><sub>TEM</sub> genotypes were predominantly associated with FOX-CRO-FEP-MEM and CRO-FEP multidrug resistance (MDR) and CRO antimicrobial resistance (AMR) phenotypes, among <i>E. coli</i> isolates from Embu Level V (16.7%) and Kenyatta National Hospital (7.0%), respectively.</p><p><strong>Conclusions: </strong>The high proportion of ESBL-producing <i>E. coli</i> and <i>K. pneumoniae</i> isolates increases the utilization of last-resort antibiotics, jeopardizing antimicrobial chemotherapy. Furthermore, the antimicrobial resistance patterns exhibited towards extended-spectrum cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, fluoroquinolones, and macrolides show the risk of co-resistance associated with ESBL-producing isolates responsible for MDR. Hence, there is a need for regular surveillance and implementation of infection prevention and control strategies and antimicrobial stewardship programs.</p>","PeriodicalId":14098,"journal":{"name":"International Journal of Microbiology","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10881238/pdf/","citationCount":"0","resultStr":"{\"title\":\"Phenotypic and Genotypic Characterization of Extended Spectrum Beta-Lactamase-Producing Clinical Isolates of <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> in Two Kenyan Facilities: A National Referral and a Level Five Hospital.\",\"authors\":\"Sylvia M Maveke, Gabriel O Aboge, Laetitia W Kanja, Alfred O Mainga, Naftaly Gachau, Beatrice W Muchira, Gervason A Moriasi\",\"doi\":\"10.1155/2024/7463899\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The emergence of antimicrobial resistance (AMR) and multidrug resistance (MDR) among <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i>, especially through the production of extended spectrum <i>β</i>-lactamases (ESBLs), limits therapeutic options and poses a significant public health threat.</p><p><strong>Objective: </strong>The aim of this study was to assess the phenotypic and genetic determinants of antimicrobial resistance of ESBL-producing <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> isolates from patient samples in two Kenyan Hospitals.</p><p><strong>Methods: </strong>We collected 138 <i>E. coli</i> and 127 <i>K. pneumoniae</i> isolates from various clinical specimens at the two health facilities from January 2020 to February 2021. The isolates' ESBL production and antibiotic susceptibility were phenotypically confirmed using a standard procedure. Molecular analysis was done through conventional polymerase chain reaction (PCR) with appropriate primers for <i>gad</i>A, <i>rpo</i>B, <i>bla</i><sub>TEM</sub>, <i>bla</i><sub>SHV</sub>, <i>bla</i><sub>OXA</sub>, <i>bla</i><sub>CTX-M-group-1</sub>, <i>bla</i><sub>CTX-M-group-2</sub>, <i>bla</i><sub>CTX-M-group-9</sub>, and <i>bla</i><sub>CTX-M-group-8/25</sub> genes, sequencing and BLASTn analysis.</p><p><strong>Results: </strong>Most <i>E. coli</i> (82.6%) and <i>K. pneumoniae</i> (92.9%) isolates were ESBL producers, with the highest resistance was against ceftriaxone (69.6% among <i>E. coli</i> and 91.3% among <i>K. pneumoniae</i>) and amoxicillin/clavulanic acid (70.9% among <i>K. pneumoniae</i>). The frequency of MDR was 39.9% among <i>E. coli</i> and 13.4% among <i>K. pneumoniae</i> isolates. The commonest MDR phenotypes among the <i>E. coli</i> isolates were CRO-FEP-AZM-LVX and CRO-AZM-LVX, while the FOX-CRO-AMC-MI-TGC-FM, FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI and CRO-AMC-TZP-AZM-MI were the most frequent among <i>K. pneumoniae</i> isolates. Notably, the FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI phenotype was observed in ESBL-positive and ESBL-negative <i>K. pneumoniae</i> isolates. The most frequent ESBL genes were <i>bla</i><sub>TEM</sub> (42%), <i>bla</i><sub>SHV</sub> (40.6%), and <i>bla</i><sub>OXA</sub> (36.2%) among <i>E. coli</i>, and <i>bla</i><sub>TEM</sub> (89%), <i>bla</i><sub>SHV</sub> (82.7%), <i>bla</i><sub>OXA</sub> (76.4%), and <i>bla</i><sub>CTX-M-group-1</sub> (72.5%) were most frequent ESBL genes among <i>K. pneumoniae</i> isolates. The <i>bla</i><sub>SHV</sub> and <i>bla</i><sub>OXA</sub> and <i>bla</i><sub>TEM</sub> genotypes were predominantly associated with FOX-CRO-FEP-MEM and CRO-FEP multidrug resistance (MDR) and CRO antimicrobial resistance (AMR) phenotypes, among <i>E. coli</i> isolates from Embu Level V (16.7%) and Kenyatta National Hospital (7.0%), respectively.</p><p><strong>Conclusions: </strong>The high proportion of ESBL-producing <i>E. coli</i> and <i>K. pneumoniae</i> isolates increases the utilization of last-resort antibiotics, jeopardizing antimicrobial chemotherapy. Furthermore, the antimicrobial resistance patterns exhibited towards extended-spectrum cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, fluoroquinolones, and macrolides show the risk of co-resistance associated with ESBL-producing isolates responsible for MDR. Hence, there is a need for regular surveillance and implementation of infection prevention and control strategies and antimicrobial stewardship programs.</p>\",\"PeriodicalId\":14098,\"journal\":{\"name\":\"International Journal of Microbiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-02-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10881238/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Microbiology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1155/2024/7463899\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"MICROBIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Microbiology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2024/7463899","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"MICROBIOLOGY","Score":null,"Total":0}
Phenotypic and Genotypic Characterization of Extended Spectrum Beta-Lactamase-Producing Clinical Isolates of Escherichia coli and Klebsiella pneumoniae in Two Kenyan Facilities: A National Referral and a Level Five Hospital.
Background: The emergence of antimicrobial resistance (AMR) and multidrug resistance (MDR) among Escherichia coli and Klebsiella pneumoniae, especially through the production of extended spectrum β-lactamases (ESBLs), limits therapeutic options and poses a significant public health threat.
Objective: The aim of this study was to assess the phenotypic and genetic determinants of antimicrobial resistance of ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates from patient samples in two Kenyan Hospitals.
Methods: We collected 138 E. coli and 127 K. pneumoniae isolates from various clinical specimens at the two health facilities from January 2020 to February 2021. The isolates' ESBL production and antibiotic susceptibility were phenotypically confirmed using a standard procedure. Molecular analysis was done through conventional polymerase chain reaction (PCR) with appropriate primers for gadA, rpoB, blaTEM, blaSHV, blaOXA, blaCTX-M-group-1, blaCTX-M-group-2, blaCTX-M-group-9, and blaCTX-M-group-8/25 genes, sequencing and BLASTn analysis.
Results: Most E. coli (82.6%) and K. pneumoniae (92.9%) isolates were ESBL producers, with the highest resistance was against ceftriaxone (69.6% among E. coli and 91.3% among K. pneumoniae) and amoxicillin/clavulanic acid (70.9% among K. pneumoniae). The frequency of MDR was 39.9% among E. coli and 13.4% among K. pneumoniae isolates. The commonest MDR phenotypes among the E. coli isolates were CRO-FEP-AZM-LVX and CRO-AZM-LVX, while the FOX-CRO-AMC-MI-TGC-FM, FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI and CRO-AMC-TZP-AZM-MI were the most frequent among K. pneumoniae isolates. Notably, the FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI phenotype was observed in ESBL-positive and ESBL-negative K. pneumoniae isolates. The most frequent ESBL genes were blaTEM (42%), blaSHV (40.6%), and blaOXA (36.2%) among E. coli, and blaTEM (89%), blaSHV (82.7%), blaOXA (76.4%), and blaCTX-M-group-1 (72.5%) were most frequent ESBL genes among K. pneumoniae isolates. The blaSHV and blaOXA and blaTEM genotypes were predominantly associated with FOX-CRO-FEP-MEM and CRO-FEP multidrug resistance (MDR) and CRO antimicrobial resistance (AMR) phenotypes, among E. coli isolates from Embu Level V (16.7%) and Kenyatta National Hospital (7.0%), respectively.
Conclusions: The high proportion of ESBL-producing E. coli and K. pneumoniae isolates increases the utilization of last-resort antibiotics, jeopardizing antimicrobial chemotherapy. Furthermore, the antimicrobial resistance patterns exhibited towards extended-spectrum cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, fluoroquinolones, and macrolides show the risk of co-resistance associated with ESBL-producing isolates responsible for MDR. Hence, there is a need for regular surveillance and implementation of infection prevention and control strategies and antimicrobial stewardship programs.
期刊介绍：
International Journal of Microbiology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies on microorganisms and their interaction with hosts and the environment. The journal covers all microbes, including bacteria, fungi, viruses, archaea, and protozoa. Basic science will be considered, as well as medical and applied research.
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