1887

Abstract

The spread of antibiotic-resistant bacteria has become a large problem in most countries including Kuwait. This antibiotic resistance is usually due to the production of extended-spectrum -lactamase (ESBL) enzymes such as SHV, TEM and CTX-M. This study reports the emergence and spread of an ESBL-producing e clone in a neonatal intensive care unit (NICU) in a Kuwaiti hospital. Eight ESBL-producing isolates were from blood cultures of seven neonates, and two were from the fingers of two healthcare workers in a NICU in Al Jahra Hospital, Kuwait. All isolates were obtained in February–March 2006, except for one, which was obtained in August 2005. Identification of the bacteria was based on traditional bacteriological and biochemical tests using the Vitek system. Antibiotic susceptibility was tested by the disc diffusion method using 16 different antibiotics. ESBLs were detected using disc approximation and double-disc synergy methods and confirmed as ESBLs using Etest. PCR and DNA sequencing were performed to determine the genotypes and mutations in the -lactamase genes ( , and ). Genetic relatedness was determined by PFGE. All isolates were confirmed to have ESBLs by the Vitek system, disc approximation test, double-disc diffusion test and Etest, being resistant to cefotaxime, ceftazidime, cefepime, gentamicin, tobramycin and ciprofloxacin but susceptible to tetracycline and trimethoprim–sulfamethoxazole. Molecular studies showed the isolates to have TEM-1 -lactamase, a CTX-M-15-like ESBL and the newly discovered SHV-112 ESBL. PFGE showed that all isolates had identical banding patterns. The results indicate that a single clone of ESBL-producing caused bloodstream infections among babies in a NICU of a Kuwaiti hospital, and may have emerged at least 5 years ago. This clone was also present on the hands of healthcare workers, suggesting that they may have been involved in its transmission. Further studies are recommended to determine whether this clone is also spreading in other Kuwaiti hospitals.

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2010-06-01
2019-12-12
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References

  1. Al-Zarouni, M., Senok, A., Rashid, F., Al-Jesmi, S. M. & Panigrahi, D. ( 2008; ). Prevalence and antimicrobial susceptibility pattern of extended-spectrum β-lactamase-producing Enterobacteriaceae in the United Arab Emirates. Med Princ Pract 17, 32–36.[CrossRef]
    [Google Scholar]
  2. Ben-Ami, R., Schwaber, M. J., Navon-Venezia, S., Schwartz, D., Giladi, M., Chmelnitsky, I., Leavitt, A. & Carmel, Y. ( 2006; ). Influx of extended-spectrum β-lactamase-producing Enterobacteriaceae into the hospital. Clin Infect Dis 42, 925–934.[CrossRef]
    [Google Scholar]
  3. Bonnet, R. ( 2004; ). Growing group of extended-spectrum β-lactamases: the CTX-M enzymes. Antimicrob Agents Chemother 48, 1–14.[CrossRef]
    [Google Scholar]
  4. Bradford, P. A. ( 2001; ). Extended-spectrum β-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 14, 933–951.[CrossRef]
    [Google Scholar]
  5. Canton, R. & Coque, T. M. ( 2006; ). The CTX-M β-lactamase pandemic. Curr Opin Microbiol 9, 466–475.[CrossRef]
    [Google Scholar]
  6. Cormican, M. G., Marshall, S. A. & Jones, R. N. ( 1996; ). Detection of extended spectrum β-lactamase (ESBL)-producing strains by the Etest ESBL screen. J Clin Microbiol 34, 1880–1884.
    [Google Scholar]
  7. Dashti, A. A. & West, P. W. ( 2007; ). Extended-spectrum β-lactamase-producing Escherichia coli isolated in the Al-Amiri hospital in 2003 and compared with isolates from the Farwania hospital outbreak in 1994–96 in Kuwait. J Chemother 19, 271–276.[CrossRef]
    [Google Scholar]
  8. Dashti, A. A., West, P., Paton, R. & Amyes, S. G. ( 2006; ). Characterization of extended-spectrum β-lactamase (ESBL)-producing Kuwait and UK strains identified by the VITEK system, and subsequent comparison of the VITEK system with other commercial ESBL-testing systems using these strains. J Med Microbiol 55, 417–421.[CrossRef]
    [Google Scholar]
  9. Dimitrov, T. S., Udo, E. E., Emara, M., Awni, F. & Passadilla, R. ( 2004; ). Etiology and antibiotic susceptibility patterns of community-acquired urinary tract infection in a Kuwait hospital. Med Princ Pract 13, 334–339.[CrossRef]
    [Google Scholar]
  10. Du Bois, S. K., Marriott, M. S. & Amyes, S. G. B. ( 1995; ). TEM- and SHV-derived extended-spectrum β-lactamases: relationship between selection, structure and function. J Antimicrob Chemother 35, 7–22.[CrossRef]
    [Google Scholar]
  11. El-Khizzi, N. A. & Bakheshwain, S. M. ( 2006; ). Prevalence of extended-spectrum β-lactamases among Enterobacteriaceae isolated from blood culture in a tertiary care hospital. Saudi Med J 27, 37–40.
    [Google Scholar]
  12. Hanson, N. D., Thomson, K. S., Moland, E. S., Sanders, C. C., Berthold, G. & Penn, R. G. ( 1999; ). Molecular characterization of a multiply resistant Klebsiella pneumoniae encoding ESBLs and a plasmid-mediated AmpC. J Antimicrob Chemother 44, 377–380.[CrossRef]
    [Google Scholar]
  13. Heritage, J., M'Zali, F. H., Gascoyne-Binzi, D. & Hawkey, P. M. ( 1999; ). Evolution and spread of SHV extended-spectrum β-lactamases in Gram-negative bacteria. J Antimicrob Chemother 44, 309–318.[CrossRef]
    [Google Scholar]
  14. Huang, S.-S., Lee, M.-H. & Leu, H.-S. ( 2006; ). Bacteremia due to extended-spectrum β-lactamase-producing Enterobacteriaceae other than Escherichia coli and Klebsiella. J Microbiol Immunol Infect 39, 496–502.
    [Google Scholar]
  15. Jacoby, G. A. ( 2006; ). β-Lactamase nomenclature. Antimicrob Agents Chemother 50, 1123–1129.[CrossRef]
    [Google Scholar]
  16. Jain, A., Roy, I., Gupta, M. K., Kumar, M. & Agarwal, S. K. ( 2003; ). Prevalence of extended-spectrum β-lactamase-producing Gram-negative bacteria in septicaemic neonates in a tertiary care hospital. J Med Microbiol 52, 421–425.[CrossRef]
    [Google Scholar]
  17. Jamal, W., Rotimi, V. O., Khodakhast, F., Saleem, R., Pazhoor, A. & Al Hashim, G. ( 2005; ). Prevalence of extended-spectrum β-lactamase in Enterobacteriaceae, Pseudomonas and Stenotrophomonas as determined by the VITEK 2 and Etest systems in a Kuwait teaching hospital. Med Princ Pract 14, 325–331.[CrossRef]
    [Google Scholar]
  18. Jonathan, N. ( 2005; ). Screening for extended-spectrum β-lactamase-producing pathogenic enterobacteria in district general hospitals. J Clin Microbiol 43, 1488–1490.[CrossRef]
    [Google Scholar]
  19. Kader, A. A. & Angamuthu, K. ( 2005; ). Extended-spectrum β-lactamases in urinary isolates of Escherichia coli, Klebsiella pneumoniae and other Gram-negative bacteria in a hospital in Eastern Province, Saudi Arabia. Saudi Med J 26, 956–959.
    [Google Scholar]
  20. Kader, A. A., Kumar, A. & Kamath, K. A. ( 2007; ). Faecal carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in patients and asymptomatic healthy individuals. Infect Control Hosp Epidemiol 28, 1114–1116.[CrossRef]
    [Google Scholar]
  21. Kristof, K., Szabo, D., Marsh, J. W., Cser, V., Janik, L., Rozgonyi, F., Nobilis, A., Nagy, K. & Paterson, D. L. ( 2007; ). Extended-spectrum β-lactamase-producing Klebsiella spp. in a neonatal intensive care unit: risk factors for the infection and the dynamics of molecular epidemiology. Eur J Clin Microbiol Infect Dis 26, 563–570.[CrossRef]
    [Google Scholar]
  22. Lavollay, M., Mamlouk, K., Frank, T., Akpabie, A., Burghoffer, B., Ben Redjeb, S., Bercion, R., Gautier, V. & Arlet, G. ( 2006; ). Clonal dissemination of a CTX-M-15 β-lactamase-producing Escherichia coli strain in the Paris area, Tunis and Bangui. Antimicrob Agents Chemother 50, 2433–2438.[CrossRef]
    [Google Scholar]
  23. Lee, S. Y., Kotapati, S., Kuti, J. L., Nightingale, C. H. & Nicolau, D. P. ( 2006; ). Impact of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species on clinical outcomes and hospital costs: a matched cohort study. Infect Control Hosp Epidemiol 27, 1226–1232.[CrossRef]
    [Google Scholar]
  24. Livermore, D. M. & Hawkey, P. M. ( 2005; ). CTX-M: changing the face of ESBLs in the UK. J Antimicrob Chemother 56, 451–454.[CrossRef]
    [Google Scholar]
  25. Livermore, D. M. & Yuan, M. ( 1996; ). Antibiotic resistance and production of extended-spectrum β-lactamases amongst Klebsiella spp. from intensive care units in Europe. J Antimicrob Chemother 38, 409–424.[CrossRef]
    [Google Scholar]
  26. Mantilla, J. R., Reguero, M. T., González, E. B., García, I. A., Leal, A. L., Espinal, P. A., Alpuche, C., Valderrama, I. A., Garzón, M. I. & Olarte, N. M. ( 2006; ). Molecular characterization of an outbreak caused by CTX-M-12 producing Klebsiella pneumoniae in a Colombian hospital's neonatal intensive care unit. Biomedica 26, 408–414 (in Spanish).[CrossRef]
    [Google Scholar]
  27. Mendonça, N., Leitão, J., Manageiro, V. & Ferreira, E. ( 2007; ). Spread of extended-spectrum β-lactamase CTX-M-producing Escherichia coli clinical isolates in community and nosocomial environments in Portugal. Antimicrob Agents Chemother 51, 1946–1955.[CrossRef]
    [Google Scholar]
  28. Naseer, U., Natås, O. B., Haldorsen, B. C., Bue, B., Grundt, H., Walsh, T. R. & Sundsfjord, A. ( 2007; ). Nosocomial outbreak of CTX-M-15-producing E. coli in Norway. APMIS 115, 120–126.[CrossRef]
    [Google Scholar]
  29. Panhotra, B. R., Saxena, A. K. & Al-Ghamdi, A. M. ( 2004; ). Extended-spectrum β-lactamase-producing Klebsiella pneumoniae acquired bacteremia. Risk factors and clinical outcome. Saudi Med J 25, 1871–1876.
    [Google Scholar]
  30. Paterson, D. L. & Bonomo, R. A. ( 2005; ). Extended-spectrum β-lactamases: a clinical update. Clin Microbiol Rev 18, 657–686.[CrossRef]
    [Google Scholar]
  31. Paterson, D. L., Hujer, K. M., Hujer, A. M., Yeiser, B., Bonomo, M. D., Rice, L. B. & Bonomo, R. A., the International Klebsiella Study Group ( 2003; ). Extended-spectrum β-lactamases in Klebsiella pneumoniae bloodstream isolates from seven countries: dominance and widespread prevalence of SHV- and CTX-M-type β-lactamases. Antimicrob Agents Chemother 47, 3554–3560.[CrossRef]
    [Google Scholar]
  32. Pitout, J. D., Nordman, P., Laupland, K. B. & Poirel, L. ( 2005; ). Emergence of Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs) in the community. J Antimicrob Chemother 56, 52–59.[CrossRef]
    [Google Scholar]
  33. Rafay, A. M., Al-Muharrmi, Z. & Toki, R. ( 2007; ). Prevalence of extended-spectrum β-lactamases producing isolates over a 1-year period at a university hospital in Oman. Saudi Med J 28, 22–27.
    [Google Scholar]
  34. Ribot, E. M., Fitzgerald, C., Kubota, K., Swaminathan, B. & Barrett, T. J. ( 2001; ). Rapid pulsed-field gel electrophoresis protocol for subtyping of Campylobacter jejuni. J Clin Microbiol 39, 1889–1894.[CrossRef]
    [Google Scholar]
  35. Rodríguez-Baño, J., Navarro, M. D., Romero, L., Muniain, M. A., de Cueto, M., Ríos, M. J., Hernández, J. R. & Pascual, A. ( 2006; ). Bacteremia due to extended-spectrum β-lactamase-producing Escherichia coli in the CTX-M era: a new clinical challenge. Clin Infect Dis 43, 1407–1414.[CrossRef]
    [Google Scholar]
  36. Sanders, C. C., Barry, A. L., Washington, J. A., Moland, E. S., Traczewski, M. M., Knapp, C. & Mulder, R. ( 1996; ). Detection of extended-spectrum β-lactamase-producing members of the family Enterobacteriaceae with Vitek ESBL test. J Clin Microbiol 34, 2997–3001.
    [Google Scholar]
  37. Schwaber, M. J., Navon-Venezia, S., Kaye, K. S., Ben-Ami, R., Schwartz, D. & Carmeli, Y. ( 2006; ). Clinical and economic impact of bacteremia with extended-spectrum-β-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 50, 1257–1262.[CrossRef]
    [Google Scholar]
  38. Shenoy, S., Hegde, A., Dominic, S. R., Kamath, S. & Arvind, N. ( 2007; ). An outbreak of extended spectrum β-lactamase producing Klebsiella pneumoniae in a neonatal intensive care unit. Indian J Pathol Microbiol 50, 669–670.
    [Google Scholar]
  39. Sonnevend, A., Al Dhaheri, K., Mag, T., Herpay, M., Kolodziejek, J., Nowotny, N., Usmani, A., Sheikh, F. A. & Pal, T. ( 2006; ). CTX-M-15-producing multidrug-resistant enteroaggregative Escherichia coli in the United Arab Emirates. Clin Microbiol Infect 12, 582–585.[CrossRef]
    [Google Scholar]
  40. Tenover, F. C., Arbeit, R. D., Goering, R. V., Mickelsen, P. A., Murray, B. E., Persing, D. H. & Swaminathan, B. ( 1995; ). Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis. J Clin Microbiol 33, 2233–2239.
    [Google Scholar]
  41. Valenzuela de Silva, E. M., Mantilla Anaya, J. R., Reguero Reza, M. T., González Mejía, E. B., Pulido Manrique, I. Y., Dario Llerena, I. & Velandia, D. ( 2006; ). Detection of CTX-M-1, CTX-M-15 and CTX-M-2 in clinical isolates of Enterobacteriaceae in Bogota, Colombia. J Clin Microbiol 44, 1919–1920.[CrossRef]
    [Google Scholar]
  42. Valverde, A., Coque, T. M., Sánchez-Moreno, M. P., Rollan, A., Baquero, F. & Cantón, R. ( 2004; ). Dramatic increase in prevalence of fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriacecae during nonoutbreak situations in Spain. J Clin Microbiol 42, 4769–4775.[CrossRef]
    [Google Scholar]
  43. Wallace, M. R., Johnson, A. P., Daniel, M., Malde, M. & Yousif, A. A. ( 1995; ). Sequential emergence of multi-resistant Klebsiella pneumoniae in Bahrain. J Hosp Infect 31, 247–252.
    [Google Scholar]
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