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      CTX-M-15 is Established in Most Multidrug-Resistant Uropathogenic Enterobacteriaceae and Pseudomonaceae from Hospitals in Nigeria

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          Abstract

          β-Lactam antibiotics are widely used to treat urinary tract infections in Nigeria. This study aimed to determine the presence and characteristics of extended spectrum β-lactamases in commonly isolated uropathogenic Gram-negative bacteria (GNB) in Nigeria.

          Fifty non-duplicate GNB isolates consisting of Escherichia coli, 19; Klebsiella pneumoniae, 21; and Pseudomonas aeruginosa, 10 were obtained from three tertiary hospitals in Nigeria. The antibiotic susceptibility testing of all isolates to a panel of antibiotics including minimum inhibitory concentrations (MICs) and extended spectrum β-lactamases was determined. Polymerase chain reactions and sequencing were used to detect β-lactam genes.

          Polymerase chain reactions and sequencing identified varying extended spectrum β-lactamases (ESBLs) encoding genes for 24 isolates (48.0%). Cefotaximase-Munich (CTX-M) 15 was the dominant gene with 20/24 of the isolates positive at 83.3%; multiple genes (2 to 6 ESBL genes) were found in 20 of the isolates. The isolates encoded other genes such as CTX-M-14, 33.3%; sulfhydryl variable (SHV) variants, 58.3%; oxacillinase (OXA) variants, 70.8%; OXA-10, 29.2%; and Vietnamese extended β-lactamase (VEB) 1, 25.0%. There was no difference between the MIC 50 and MIC 90 of all the isolates.

          The high-level multidrug resistance of uropathogens to third generation cephalosporins including other antibiotics used in this study is strongly associated with carriage of ESBLs, predominantly CTX-M-15, as well as CTX-X-M-14, OXA-10, and VEB-1.

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          Most cited references21

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          Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern.

          The medical community relies on clinical expertise and published guidelines to assist physicians with choices in empirical therapy for system-based infectious syndromes, such as community-acquired pneumonia and urinary-tract infections (UTIs). From the late 1990s, multidrug-resistant Enterobacteriaceae (mostly Escherichia coli) that produce extended-spectrum beta lactamases (ESBLs), such as the CTX-M enzymes, have emerged within the community setting as an important cause of UTIs. Recent reports have also described ESBL-producing E coli as a cause of bloodstream infections associated with these community-onset UTIs. The carbapenems are widely regarded as the drugs of choice for the treatment of severe infections caused by ESBL-producing Enterobacteriaceae, although comparative clinical trials are scarce. Thus, more rapid diagnostic testing of ESBL-producing bacteria and the possible modification of guidelines for community-onset bacteraemia associated with UTIs are required.
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            Resistance plasmid families in Enterobacteriaceae.

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              Epidemiological expansion, structural studies, and clinical challenges of new β-lactamases from gram-negative bacteria.

              β-Lactamase evolution presents to the infectious disease community a major challenge in the treatment of infections caused by multidrug-resistant gram-negative bacteria. Because over 1,000 of these naturally occurring β-lactamases exist, attempts to correlate structure and function have become daunting. Although new enzymes in the extended-spectrum β-lactamase (ESBL) families are frequently identified, the older CTX-M-14 and CTX-M-15 enzymes have become the most prevalent ESBLs in global surveillance. Carbapenemases with either serine-based or zinc-facilitated hydrolysis mechanisms are posing some of the most critical problems. Most geographical regions now report KPC serine carbapenemases and the metallo-β-lactamases VIM, IMP, and NDM-1, even though NDM-1 was only recently identified. The rapid emergence of these newer enzymes, with multiple β-lactamases appearing in a single organism, makes the design of new β-lactamase inactivators or β-lactamase-stable β-lactams all the more difficult. Combination therapy will likely be required to counteract the continuing evolution of these insidious enzymes in multidrug-resistant pathogens.
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                Author and article information

                Journal
                Eur J Microbiol Immunol (Bp)
                Eur J Microbiol Immunol (Bp)
                EUJMI
                European Journal of Microbiology & Immunology
                Akadémiai Kiadó (Budapest )
                2062-509X
                2062-8633
                07 March 2018
                April 2018
                : 8
                : 1
                : 20-24
                Affiliations
                [1 ]Department of Biomedical Sciences, Ladoke Akintola University of Technology , Ogbomoso, Osogbo Campus, Nigeria
                [2 ]Antimicrobials Research Group, Immunity and Infection, Institute of Microbiology and Infection, University of Birmingham , Birmingham, United Kingdom
                Author notes
                * Corresponding author: David Olusoga Ogbolu; Department of Biomedical Science, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, PMB 4000, Nigeria; +2347055776547; doogbolu@ 123456lautech.edu.ng or olusogadave@ 123456yahoo.com
                Article
                10.1556/1886.2017.00012
                5944422
                35ae44d4-efdb-4e51-811f-1e686bd57935
                © 2018, The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                History
                : 21 May 2017
                : 27 June 2017
                Page count
                Figures: 1, Tables: 4, Equations: 0, References: 22, Pages: 5
                Categories
                Original Research Paper

                extended spectrum β-lactamases,uropathogens,antibiotics,resistance,nigeria

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