Antimicrobial Susceptibility and Genetic Prevalence of Extended-Spectrum β-Lactamases in Gram-Negative Rods Isolated from Clinical Specimens in Pakistan

Muhammad Mubashar Idrees; Rimsha Rimsha; Muhammad Daoud Idrees; Ali Saeed

doi:10.3390/antibiotics12010029

Antimicrobial Susceptibility and Genetic Prevalence of Extended-Spectrum β-Lactamases in Gram-Negative Rods Isolated from Clinical Specimens in Pakistan

Antibiotics (Basel). 2022 Dec 24;12(1):29. doi: 10.3390/antibiotics12010029.

Authors

Muhammad Mubashar Idrees^{1

2

3}, Rimsha Rimsha⁴, Muhammad Daoud Idrees⁵, Ali Saeed^{1

6}

Affiliations

¹ Institute of Molecular Biology and Biotechnology, Bahauddin Zakariya University, Multan 60800, Pakistan.
² Multan Institute of Kidney Diseases (MIKD), Multan 60800, Pakistan.
³ Department of Medical Laboratory Technology, Faculty of Medicine and Allied Health Sciences, The Islamia University of Bahawalpur, Bahawalpur 63100, Pakistan.
⁴ National Institute of Food Science and Technology, University of Agriculture, Faisalabad 38000, Pakistan.
⁵ Department of Biochemistry, Bahauddin Zakariya University, Multan 60800, Pakistan.
⁶ Department of Pediatric Oncology & Medical Microbiology, University Medical Center Groningen, University of Groningen, P.O. Box 72, 9700 AB Groningen, The Netherlands.

Abstract

The prevalence of extended-spectrum β-lactamase (ESBL) genes has increased remarkably, resulting in multidrug-resistant gram-negative rods (GNRs) in clinical specimens. This cross-sectional study aimed to determine the antimicrobial susceptibility of ESBL-producing GNRs and its correlation with corresponding genes. Two hundred and seventy-two (n = 272) samples were evaluated for the molecular identification of ESBL genes by polymerase chain reaction after confirmation with the modified double-disc synergy test. E. coli 64.0% (n = 174) was the most prevalent ESBL producer, followed by Klebsiella species 27.2% (n = seventy-four), Acinetobacter species 6.6% (n = eighteen) and others 2.2% (n = six). These ESBL-producing isolates showed resistance to β-lactam antibiotics, i.e., sulbactam/cefoperazone (41.5%), piperacillin/tazobactam (39.3%), meropenem (36.0%), imipenem (34.2%) and non- β-lactam antibiotics, i.e., nalidixic acid (89.0%), co-trimoxazole (84.9%), ciprofloxacin (82.4%), gentamicin (46.3%), nitrofurantoin (24.6%), amikacin (19.9%) and fosfomycin (19.9%). The incidences of the ESBLs-producing genes bla_CTX-M, bla_TEM, bla_OXA and bla_SHV were 91.2%, 61.8%, 39.3% and 17.6%, respectively. Among nine multiple-gene combinations, bla_CTX-M + bla_TEM (30.5%) was the most prevalent combination, followed by bla_CTX-M + bla_OXA + bla_TEM (14.0%), bla_CTX-M + bla_OXA (13.6%), bla_CTX-M + bla_TEM + bla_SHV (7.0%), bla_CTX-M + bla_SHV (2.2%), bla_CTX-M + bla_OXA + bla_SHV (2.2%) and bla_OXA + bla_TEM (1.8%). ESBLs producing GNRs carrying bla_CTX-M, bla_TEM, bla_OXA and bla_SHV showed resistances to β-lactam antibiotics, i.e., ampicillin, amoxillin-clavulanic acid, cefotaxime and ceftazidime but were susceptible to carbapenems (meropenem and imipenem), β-lactam-β-lactamase inhibitor combination (piperacillin/tazobactam) and non-β-lactam antibiotics i.e., aminoglycoside (amikacin and gentamicin), nitrofurantoin and fosfomycin. These antibiotics that demonstrated activity may be used to treat infections in clinical settings.

Keywords: CTX-M; OXA; SHV; TEM; disk diffusion method; extended-spectrum β-lactamases (ESBLs); gram-negative bacteria; polymerase chain reaction (PCR).

Grants and funding

The study was funded and supported by the departmental budget of the Institute of Molecular Biology and Biotechnology, Bahauddin Zakariya University & Multan Institute of Kidney Diseases (MIKD), Multan, Pakistan. The authors further appreciate the support provided by ORIC, Bahauddin Zakariya University, Multan, Pakistan, through Project No. ORIC/2021/143.