Resistance and clonality in Escherichia coli and Klebsiella spp. and relationship with antibiotic consumption in major Lebanese hospitals

Ziad Daoud; Elie Salem-Sokhn; Elias Dahdouh; Jihad Irani; Ghassan M Matar; Shira Doron

doi:10.1016/j.jgar.2017.07.011

Resistance and clonality in Escherichia coli and Klebsiella spp. and relationship with antibiotic consumption in major Lebanese hospitals

J Glob Antimicrob Resist. 2017 Dec:11:45-51. doi: 10.1016/j.jgar.2017.07.011. Epub 2017 Jul 26.

Authors

Ziad Daoud¹, Elie Salem-Sokhn², Elias Dahdouh², Jihad Irani³, Ghassan M Matar⁴, Shira Doron⁵

Affiliations

¹ Department of Biomedical Sciences-Clinical Microbiology, Faculty of Medicine, University of Balamand, P.O. Box 33, Koura, Lebanon. Electronic address: ziad.daoud@balamand.edu.lb.
² Department of Biomedical Sciences-Clinical Microbiology, Faculty of Medicine, University of Balamand, P.O. Box 33, Koura, Lebanon.
³ Saint George Hospital-UMC, Faculty of Medicine, University of Balamand, Beirut, Lebanon.
⁴ Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
⁵ Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.

PMID: 28756026
DOI: 10.1016/j.jgar.2017.07.011

Abstract

Objectives: Extended-spectrum β-lactamases (ESBLs) are increasingly detected globally among Escherichia coli and Klebsiella spp. Studies show a link between inappropriate use of antibiotics and resistance. In this study, the profiles of ESBLs in E. coli and Klebsiella spp. isolated from three Lebanese hospitals and their relationship to antibiotic consumption were determined.

Methods: A total of 300 E. coli and 91 Klebsiella spp. isolates resistant to third- or fourth-generation cephalosporins were collected between May 2011 and December 2012. Antibiotic susceptibility and consumption data were also collected from 2010-2012. Double-disk synergy and Etest ESBL assays were performed, followed by PCR for ESBL genes. Pulsed-field gel electrophoresis (PFGE) was performed for representative isolates. Statistical analysis for consumption and susceptibility data over 3 years was performed.

Results: Similar to other Lebanese studies, CTX-M-15 was predominant. Among the Klebsiella spp. isolated in hospitals 1 and 2, 43% harboured four different ESBLs. Eight Klebsiella spp. and fourteen E. coli pulsotypes were detected, showing genetic diversity among isolates. A significant correlation was detected between total use of antimicrobial agents and resistance to various antibiotics. A correlation was also detected between use of penicillins and resistance to aztreonam, ceftazidime and ciprofloxacin, and use of third- and fourth-generation cephalosporins and resistance to ceftazidime, cefuroxime, cefoxitin and ciprofloxacin in Klebsiella spp. (P<0.05).

Conclusions: This study shows the predominance of CTX-M-15 among cephalosporin-resistant E. coli and Klebsiella spp. in Lebanese hospitals. It also shows that the heightened use of antibiotics could be a driving factor for resistance emergence.

Keywords: Antibiotic consumption; Cephalosporins; ESBL; Escherichia coli; Extended-spectrum β-lactamase; Klebsiella spp..

MeSH terms

Anti-Bacterial Agents / pharmacology*
Cephalosporins / pharmacology
Drug Resistance, Bacterial / drug effects*
Drug Resistance, Bacterial / genetics
Electrophoresis, Gel, Pulsed-Field / methods
Escherichia coli / drug effects*
Escherichia coli / genetics
Escherichia coli / isolation & purification*
Escherichia coli Infections / microbiology
Hospitals*
Humans
Klebsiella / drug effects*
Klebsiella / genetics
Klebsiella / isolation & purification*
Klebsiella Infections / microbiology
Lebanon
Microbial Sensitivity Tests
Polymerase Chain Reaction / methods
beta-Lactamases / genetics

Substances

Anti-Bacterial Agents
Cephalosporins
beta-lactamase CTX-M-15
beta-Lactamases