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Characterization of Extended-Spectrum β-Lactamase-Producing Uropathogenic Escherichia coli Among Iranian Kidney Transplant Patients

Authors Halaji M, Shahidi S, Atapour A, Ataei B, Feizi A, Havaei SA

Received 6 February 2020

Accepted for publication 5 May 2020

Published 15 May 2020 Volume 2020:13 Pages 1429—1437

DOI https://doi.org/10.2147/IDR.S248572

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony


Mehrdad Halaji,1,2 Shahrzad Shahidi,3 Abdolamir Atapour,3 Behrooz Ataei,4 Awat Feizi,5 Seyed Asghar Havaei1,4

1Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; 2Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; 3Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; 4Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; 5Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

Correspondence: Seyed Asghar Havaei
Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Tel +98 3137922478
Email havaei@med.mui.ac.ir

Introduction: The aim of this study was to investigate the antimicrobial susceptibility pattern and the presence of ESBLs among the uropathogenic Escherichia coli (UPEC) isolated from kidney transplant patients (KTP) and community-acquired urinary tract infections (UTIs) using phenotypic and molecular methods.
Materials and Methods: A total of 111 pure cultures of UPEC isolates were collected from 65 and 46 of non-KTP and KTPs with UTIs. The pattern and ESBL production of the strains were evaluated. PCR reaction to detect the presence of blaSHV, blaTEM, and blaCTX-M genes was performed.
Results: The results revealed that most of UPEC isolates obtained from KTPs and control group were resistant to trimethoprim/sulfamethoxazole (84.8% vs 46.2%), while carbapenems (100% sensitivity) were the most effective against UPEC isolates. ESBL-producing strains were significantly more frequent in KTPs compared with control group (43.5% vs 23.1%, P = 0.021). The molecular results revealed that 53.2% (59/111), 45% (50/111), and 5.4% (6/111) of isolates harbored blaCTX-M, blaTEM, and blaSHV genes, respectively. Of the genes investigated, blaCTX-M and blaTEM genes were significantly higher among KTP than the control group.
Conclusion: Our results showed a high proportion of multidrug-resistant and ESBL-producing isolates, which most of them harbor blaCTX-M. A significant high co-resistance to different classes of antibiotics was reported from ESBL-producing UPEC from KTPs, which remains a serious clinical challenge.

Keywords: UTIs, ESBL, PCR, KTP


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