Molecular epidemiology and antimicrobial susceptibility of AmpC- and/or extended-spectrum (ESBL) ß-lactamaseproducing Proteus spp. clinical isolates in Zenica-Doboj Canton, Bosnia and Herzegovina
By
Selma Uzunović
,
Selma Uzunović
Department for Laboratory Diagnostics,
Institute for Public Health and Food Safety
, Zenica
, Bosnia and Herzegovina
Aim To investigate prevalence, antimicrobial susceptibility, molecular characteristics, and genetic relationship of AmpC- and/ or extended spectrum beta lactamase (ESBL)- producing Proteus spp. clinical isolates in Zenica-Doboj Canton, Bosnia and Herzegovina. Methods Antibiotic susceptibility was determined by disc diffusion and broth microdilution methods according to CLSI guidelines. Double-disk synergy test was performed in order to screen for ESBLs, and combined disk test with phenylboronic acid to detect AmpC β -lactamases. PCR was used to detect blaESBL/blacarb genes. Genetic relatedness of the strains was determined by pulsed-fieldgel-electrophoresis (PFGE). Results Eleven ESBL-producing isolates were included in the study (six inpatients and five outpatients). Susceptibility rate to amoxicillin-clavulanic acid, imipenem and meropenem was 100%. Resistance rate to cefuroxime was 100%, gentamicine 90.9%, piperacillin/tazobactam 81.8%, cefotaxim, ceftriaxone and ceftazidime 72.7%, cefoxitine and ciprofloxacine 63.6% and to cefepime 45.5%. In five (out of 11) isolates multi-drug resistance (MDR) to cephalosporins, cefamicines, amynocligosides and fluoroquinolones was detected. Besides TEM-1 which was detected in all isolates, CTX-M+OXA-1 β-lactamases were detected in seven (out of 11; 63.6%) isolates (five blaCTX-M-1 and two blaCTX-M-15 genes), and CMY-2 β-lactamase in two isolates. PFGE showed no genetic relatedness. Conclusion Because of high prevalence of MDR strains in epidemiologically unrelated patients with AmpC- and/or ESBL producing Proteus spp. infection, further surveillance is needed. Molecular characterization and strain typing, or at least phenotypic test for AmpC/ESBL production is important for appropriate therapy and the detection of sources and modes of spread, which is the main step in order to design targeted infection control strategies.
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Molekularna epidemiologija i antimikrobna osjetljivost kliničkih izolata Proteus spp. koji produciraju AmpC-i/ili beta-laktamaza proširenog spektra djelovanja u Zeničko-Dobojskom kantonu. Bosna i Hercegovina Selma Uzunović 1 , Amir Ibrahimagić. :3.
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Institut za zdravlje i sigurnost hrane Zenica, 2 Medicinski fakultet, Sveučilište u Zagrebu, 3 Klinički zavod za kliničku i molekularnu mikrobiologiju, Klinički bolnički centar Zagreb, Zagreb, Hrvatska SAŽETAK Cilj Istražiti prevalenciju, molekularne karakteristike i klonsku pripadnost kliničkih izolata Proteus spp. koji produciraju AmpC-i(li) beta (β)-laktamaze proširenog spektra (ESBL).
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Za potvrdu lučenja ESBL-a i AmpC-a korišten je PCR. Klonska pripadnost izolata ispitivana je uz pomoć elektroforeze u pulsirajućem polju (PFGE).
45.
AmpC-i(li) ESBL-producirajućih Proteus spp. izolata. Svi izolati su pokazali 100% osjetljivost na amoksicilin/klavulansku kiselinu, imipenem i meropenem. Rezistencija na cefuroksim zabilježena je u 100%, na gentamicin 90,9%, piperacilin/tazobaktam 81,8%, cefotaksim, ceftriakson i ceftazidim 72,7%, cefoksitin i ciprofloksacin 63,6% i na cefepim u 45,5% slučajeva. TEM-1 β-laktamaza detektirana je kod svih izolata. (7).
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6%) izolata dodatno iCTX-M (pet CTX-M-1 i dvije CTX-M-15) i OXA-1 β-laktamaze. Dva izolata su producirala CMY-2 β-laktamazu, dok SHV beta-laktamaze nisu zabilježene. Nije zabilježena klonska pripadnost. Zaključak Molekularna karakterizacija i tipizacija, te fenotipski testovi za detekciju AmpC i ESBLproducirajućih Proteus spp. izolata, kao i drugih gram-negativnih bakterija, važni su koraci u dizajniranju i primjeni terapije, u detekciji izvora i širenju izolata, kao i za pripremu strategije u sprečavanju širenja ovih infekcija.
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