Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Biol Chem. Nov 27, 2020; 11(3): 112-118
Published online Nov 27, 2020. doi: 10.4331/wjbc.v11.i3.112
Prevalence, serotyping and drug susceptibility patterns of Escherichia coli isolates from kidney transplanted patients with urinary tract infections
Atefeh Najafi Khah, Mojdeh Hakemi-Vala, Shiva Samavat, Mohammad Javad Nasiri
Atefeh Najafi Khah, Mojdeh Hakemi-Vala, Mohammad Javad Nasiri, Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran
Shiva Samavat, Department of Adult Nephrology, School of Medicine, Shahid Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1666694516, Iran
Author contributions: Hakemi-Vala M proposed the subject of the project, supervised the proposal, practical steps, revised the draft, and submitted the article to this journal; Samavat S, as the urologist in Labafi Nejad Hospital, introduced the patients who were compatible with this subject; Najafi Khah A is an MSc student in medical microbiology and this paper is part of her thesis, she also carried out all practical processes such as sampling, cooperated with two private clinical laboratories and drafted the paper; Nasiri MJ, a consultant, contributed to statistical analysis, paper preparation, and revision, data collection and analysis.
Supported by Research Department of School of Medicine Shahid Beheshti University of Medical Sciences, No. 17920, and accepted by the ethic committee, Code. IR.SBMU. MSP.REC.1398.349.
Institutional review board statement: This paper is extracted from a project which was accepted by the research committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: This project has received a grant from the Research Department of School of Medicine Shahid Beheshti University of Medical Sciences, No. 17920, Tehran, Iran.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mojdeh Hakemi-Vala, PhD, Associate Professor, Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Kodakyar St, Daneshjo Blvd, Velenjak Tehran, Tehran 1985717443, Iran. m.hakemi@sbmu.ac.ir
Received: April 26, 2020
Peer-review started: April 26, 2020
First decision: June 7, 2020
Revised: August 24, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: November 27, 2020
Processing time: 198 Days and 18.4 Hours
Abstract
BACKGROUND

Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) are among the main pathogens in urinary tract infections (UTIs) among kidney transplant patients (KTPs).

AIM

To estimate the prevalence of ESBL-producing E. coli in KTPs and to evaluate the most prevalent serotypes and antibacterial susceptibility patterns of isolated bacteria in Tehran, Iran.

METHODS

A total of 60 clinical isolates of uropathogenic E. coli were collected from 3 kidney transplant centers from April to May 2019. Antimicrobial susceptibility testing was performed by the disk diffusion method as recommended by the Clinical Laboratory and Standards Institute. The serotyping of E. coli isolates was performed by the slide agglutination method. The presence of blaTEM, blaSHV, and blaCTX-M genes was evaluated by polymerase chain reaction.

RESULTS

The frequency of ESBL-producing E. coli in KTPs was found to be 33.4%. All of the 60 E. coli isolates were found to be susceptible to doripenem (100%) and ertapenem (100%). High resistance rates to ampicillin (86%), cefotaxime (80%), and cefazolin (77%) were also documented. The most frequent serotypes were serotype I (50%), serotype II (15%), serotype III (25%), and serotype VI (10%). The gene most frequently found was blaTEM (55%), followed by blaCTX-M (51%) and blaSHV (41%).

CONCLUSION

Molecular analysis showed that blaTEM was the most common ESBL-encoding gene. The high resistance to β-lactams antibiotics (i.e., ampicillin, cefotaxime, and cefazolin) found in E. coli from KTPs with UTIs remains a serious clinical challenge. Further efforts to control ESBL-producing E. coli should include the careful use of all antibiotics as well as barrier precautions to reduce spread.

Keywords: Kidney transplantation; Urinary tract infection; Drug resistance; Escherichia coli; Serotyping; β-Lactamase

Core Tip: Extended-spectrum β-lactamases (ESBLs)-producing Escherichia coli (E. coli) are among the main pathogens in urinary tract infections among kidney transplant patients (KTPs). The aims of this study were: To estimate the prevalence of ESBL-producing E. coli in KTPs, and to evaluate the most prevalent serotypes and antibacterial susceptibility patterns of isolated bacteria in Tehran, Iran. The most important findings were: (1) The frequency of ESBL-producing E. coli in KTPs was 33.4%; (2) High resistance rates to ampicillin (86%) and cefotaxime (80%) were documented; (3) The most frequent serotype was serotype I (50%); (4) The most frequently found related gene was blaTEM (55%); and (5) Further efforts to control ESBL-producing E. coli should include the careful use of all antibiotics as well as barrier precautions to reduce spread.