title: Extended-Spectrum β-Lactamase- and Carbapenemase-Producing Enterobacteriaceae Isolated from Egyptian Patients with Suspected Blood Stream Infection.
abstract: OBJECTIVE
  The aim of the study was to investigate the prevalence of extended-spectrum β-lactamase and carbapenemase production among Enterobacteriaceae isolated from Egyptian patients with suspected blood stream infection.
  
  
  METHODS
  Ninety-four Enterobacteriaceae blood culture isolates from Egyptian patients with suspected blood stream infection were collected, one isolate per patient. Identification of bacterial isolates was performed with MALDI-TOF (MS-based Vitek MS system, bioMerieux). Screening for ESBLs and carbapenemases production was done with the Vitek 2 system (bioMérieux). ESBL production was confirmed using the combined disk diffusion method for cefotaxime, ceftazidime, and cefepime, all with and without clavulanic acid (Rosco). Real-time PCR and sequencing were used to characterize the resistance genes. The phylogenetic groups of E. coli were identified by a PCR-based method.
  
  
  RESULTS
  Of the 94 Enterobacteriaceae isolates 46 (48.93%) showed an ESBL phenotype. One Enterobacter spp isolate was ESBL-producer and meropenem-resistant. The genetic analysis showed that CTX-M was present in 89.13% (41/46) of the ESBL-producing Enterobacteriaceae, whereas TEM and SHV were detected in 56.52% (26/46) and 21.74% (10/46) respectively (47.83%) of the ESBL-producing isolates were multidrug resistant (MDR). Eleven out of 30 ESBL-producing E-coli isolates were assigned to phylogroup B2, followed by groups B1 (8 isolates), A (6 isolates) and D (5 isolates).
  
  
  CONCLUSIONS
  The high ESBL-E rates (48.93%) found in this study together with the identification of one carbapenem-resistant Enterobacter spp isolate is worrisome. Our results indicate that systems for monitoring and detection of ESBL-producing bacteria in Egyptian hospitals have to be established. Also strict hospital infection control policies with the restriction of the consumption of extended-spectrum cephalosporins are necessary.
authors.affiliation: Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands; Department of Bacteriology, Mycology and Immunology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: H M
authors.initials: HM
authors.lastname: Abdallah
authors.affiliation: Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: B B
authors.initials: BB
authors.lastname: Wintermans
authors.affiliation: Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: E A
authors.initials: EA
authors.lastname: Reuland
authors.affiliation: Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Koek
authors.affiliation: Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands; Laboratory for Medical Microbiology and Public Health, Hengelo, the Netherlands; Microbiology and Infection Control, Ziekenhuisgroep Twente, Almelo, Amsterdam, the Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: al Naiemi
authors.affiliation: Department of Bacteriology, Mycology and Immunology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: A M
authors.initials: AM
authors.lastname: Ammar
authors.affiliation: Department of Bacteriology, Mycology and Immunology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: A A
authors.initials: AA
authors.lastname: Mohamed
authors.affiliation: Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: C M J E
authors.initials: CM
authors.lastname: Vandenbroucke-Grauls
mesh_terms: D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology; D001426:Bacterial Proteins / Q000378:metabolism*; D004534:Egypt; D004755:Enterobacteriaceae / Q000302:isolation & purification* / Q000378:metabolism*; D004756:Enterobacteriaceae Infections / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase