title: Increasing secondary bacterial infections with Enterobacteriaceae harboring bla(CTX-M-15) and bla(CMY-6) in patients with bronchogenic carcinoma: an emerging point of concern.
abstract: OBJECTIVE
  To look for secondary bacterial infections in bronchogenic carcinoma (BC(A)) with resistant organisms harboring bla genes considering the paucity of relevant studies.
  
  
  METHODS
  A total of 137 confirmed cases of BC(A) and 34 healthy volunteers were studied for the occurrence and prevalence of bla(CTX-M) and and bla(AmpC) harboring-enterobacteriaceae. A subset of these patients (n=69) was previously reported for the secondary infection with the Aspergillus species. Bronchoalveolar lavages (BAL) were subjected for bacterial and fungal cultures and the bacterial isolates were screened by multiplex PCRs for the presence of bla(CTX-M) and bla(AmpC). The isolates were also screened for the association of insertion sequence (IS26) by PCR and characterized by RAPD for any clonal relatedness.
  
  
  RESULTS
  A total of 143 bacterial isolates were obtained from 137 BAL specimens of BC(A) patients. The Enterobacteriaceae-isolates were multidrug-resistant showing concomitant resistance to fluoroquinolones and aminoglycosides. Both bla(CTX-M) and bla(AmpC) of CIT family were detected in 77.4% and 27.4% isolates, respectively. Sequencing revealed the presence of bla(CTX-M-15) and bla(CMY-6). Twenty one percent of the isolates were simultaneously harboring bla(ampC) and bla(CTX-M-15). IS26 PCR and RAPD typing revealed the presence of diverse bacterial population but no predominant clone was identified. The present study also suggests strong association of aspergillosis with lung cancer and further strengthens the potential use of non-validated serological tests suggested earlier.
  
  
  CONCLUSIONS
  We emphasize that all patients of bronchogenic carcinoma should also be screened for secondary bacterial infections, along with secondary fungal infections, so as to introduce early and specific antimicrobial therapy and to prevent unwanted deaths.
authors.affiliation: Section of Bacteriology & Molecular Biology, Department of Medical Microbiology, JN Medical College & Hospital, Aligarh Muslim University, Aligarh-202 002, UP, India. shahidsahar@yahoo.co.in
authors.forename: Mohammed
authors.initials: M
authors.lastname: Shahid
authors.forename: Abida
authors.initials: A
authors.lastname: Malik
authors.forename: Rakesh
authors.initials: R
authors.lastname: Bhargava
mesh_terms: D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D002283:Carcinoma, Bronchogenic / Q000150:complications*; D004251:DNA Transposable Elements; D004269:DNA, Bacterial / Q000235:genetics / Q000302:isolation & purification; D004755:Enterobacteriaceae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D015995:Prevalence; D019105:Random Amplified Polymorphic DNA Technique; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D004251:DNA Transposable Elements; D004269:DNA, Bacterial; D001618:beta-Lactamases