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. 2019 Apr-Jun;11(2):192-201.

Antibiotic Susceptibility Patterns and Prevalence of Some Extended Spectrum Beta-Lactamases Genes in Gram-Negative Bacteria Isolated from Patients Infected with Urinary Tract Infections in Al-Najaf City, Iraq

Heba Takleef Majeed  1 , Ahmed Abduljabbar Jaloob Aljanaby  1
Affiliations

Antibiotic Susceptibility Patterns and Prevalence of Some Extended Spectrum Beta-Lactamases Genes in Gram-Negative Bacteria Isolated from Patients Infected with Urinary Tract Infections in Al-Najaf City, Iraq

Heba Takleef Majeed et al. Avicenna J Med Biotechnol. 2019 Apr-Jun.

Abstract

Background: Urinary Tract Infection (UTI) in patients with Chronic Kidney Disease (CKD) caused by multi-drug resistance and Extended Spectrum Beta Lactamase (ESBL)-producing gram-negative bacteria has been increased in different countries. The aim of the present study was to detect the antibiotic susceptibility patterns and the distribution of Bla-TEM, Bla-SHV and Bla-CTX-M genes in gram-negative bacteria isolated from outpatients infected with UTI, with and without CKD in Al-Najaf city, Iraq.

Methods: A total of 120 non-duplicate urine samples were collected from outpatients (37 male and 83 female) infected with UTI in Al-Najaf city, Iraq; 60 samples from patients Without Kidney Disease (WKD) and 60 samples from patients with CKD. The antibiotic susceptibility testing was done according to Kirby-Bauer method. PCR technique was performed to investigate the prevalence of Bla-TEM, Bla-SHV and Bla-CTX-M genes.

Results: A total of 126 different gram-negative bacterial strains were isolated. Escherichia coli (E. coli) was the most prevalent bacterium (49 isolates) followed by Idebsiella pneumonia (K. pneumonia) (35 isolates), Pseudomonas aeruginosa (P. aeruginosa) (18 isolates), Citrobacter freundii (C. freundii) (12 isolates), Enterobocter aerogenes (E. aerogenes) (8 isolates) and Proteus mirabilis (P. mirabilis) (4 isolates). All bacterial isolates from UTI patients with CKD were resistant to antibiotics and carried Bla-TEM, Bla-SHV and Bla-CTX-M genes more than isolates from UTI patients with WKD.

Conclusion: This study demonstrated that all bacterial isolates from UTI patients with CKD were more virulent than isolates from UTI patients with WKD.

Keywords: Chronic kidney disease; Iraq; SHV; TEM; Urinary tract infections.

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Conflict of interest statement

Conflict of Interest There was not any conflict of interest in this work.

Figures

Figure 1.
Figure 1.
Distribution of 120 outpatients infected with urinary tract infection according to gender. WKD: Without kidney disease, CKD: Chronic kidney disease.
Figure 2.
Figure 2.
Numbers and percentages of gram-negative bacteria isolated from 120 urine samples of outpatients infected with urinary tract infection.
Figure 3.
Figure 3.
Gram-negative bacteria on CHROMagar surface after 24 hr of incubation at 37°C isolated from urine of outpatients infected with urinary tract infection. 1- K. pneumoniae 2- P. aeruginosa 3- Proteus 4- E. coli 5- C. freundii 6- E. aerogenes.
Figure 4.
Figure 4.
MDR, XDR and PDR gram-negative bacteria isolated from outpatients infected with urinary tract infection. MDR: Multidrug resistance; XDR: Extensive drug resistance; PDR: Pandrug resistance, WKD: Without kidney disease, CKD: Chronic kidney disease.
Figure 5.
Figure 5.
Prevalence of extended spectrum beta-lactamase-producing gram-negative bacteria isolated from outpatients infected with urinary tract infection. WKD: Without kidney disease, CKD: Chronic kidney disease.
Figure 6.
Figure 6.
Positive result of ESBL-producing K. pneumoniae by DDST on Muller Hinton agar surface after 24 hr of incubation at 37°C. CRO: Ceftriaxone 30 μg., CTX: Cefotaxime 30 μg, CAZ: Ceftazidime 30 μg AMC: Amoxi/Clavulanic acid 30 μg.
Figure 7.
Figure 7.
Distribution of ESBLs-genes of 126 gram-negative bacteria isolated from outpatients infected with urinary tract infections. WKD: Without kidney disease, CKD: Chronic kidney disease.
Figure 8.
Figure 8.
PCR amplification of Bla-TEM gene in E. coli isolates from urine of outpatients infected with UTI with chronic kidney disease showing positive results at 643 bp. L: DNA size marker. 1–10: number of isolates.
Figure 9.
Figure 9.
PCR amplification of Bla-SHV gene in K. pneumoniae isolates from urine of outpatients infected with UTI with chronic kidney disease showing positive results at 714 bp. L: DNA size marker. 1–10: number of isolates.
Figure 10.
Figure 10.
PCR amplification of Bla-CTXM gene in C. freundii isolates from urine of outpatients infected with UTI with chronic kidney disease showing positive results at 766 bp. L: DNA size marker. 1–10: number of isolates
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