Antibiotic susceptibility pattern and identification of extended spectrum β-lactamases (ESBLs) in clinical isolates of Klebsiella pneumoniae from Shiraz, Iran.
OBJECTIVE
Klebsiella pneumoniae, one of the important causes of nosocomial infections, is the most common extended spectrum β-lactamases (ESBLs) producing organism. ESBLs are defined as the enzymes capable of hydrolyzing oxyimino-cephalosporins, monobactams and carbapenems. The aims of this study were to identify ESBL-producing K. pneumoniae isolates and detect their antibiotic susceptibility pattern.


METHODS
This cross-sectional study was conducted from December 2012 to May 2013 in teaching hospitals in Shiraz. Clinical specimens from the urine, sputum, wound, blood, throat, and body fluids were isolated and identified as K. pneumoniae. Antibacterial susceptibility testing was performed for 14 antibiotics using disk diffusion method according to CLSI guidelines. Isolates showing resistant to at least one of the β-lactam antibiotics were then evaluated for production of β-lactamase enzymes using E-test ESBL and combined disk Method. Also, MICs for ceftazidime and imipenem were determined using E-test. The presence of the bla SHV, bla TEM, bla PER and bla CTX-M genes was assessed by PCR.


RESULTS
Of 144 K. pneumoniae isolates from different specimens, 38 (26.3 %) was identified as ESBL producer by phenotypic confirmatory test. All ESBL producing isolates were susceptible to imipenem and meropenem and resistant to aztreonam. The highest rate of resistance belonged to amoxicillin (100%), cefotaxime (50%) and gentamicin (42.3%) and the lowest rates were seen for meropenem (11.8%), imipenem and amikacin (both 15.9%). Sixty-two isolates had MICs≥ 4 μg/mL for ceftazidime, of which 38 were positive for ESBLs in phenotypic confirmatory tests (PCT). The prevalence of bla SHV, bla CTX-M, and bla TEM genes among these isolates were 22.2%, 19% and 16%. bla PER was not detected in the studied isolates.


CONCLUSIONS
Due to the relatively high prevalence of ESBLs-producing K. pneumoniae isolates in the studied population, it seems that screening of infections caused by ESBL producers can lead to the most effective antibiotics therapies.
Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Antimicrobial Resistance Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
Davood
D
Mansury
Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Mohammad
M
Motamedifar
Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Jamal
J
Sarvari
Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Babak
B
Shirazi
Antimicrobial Resistance Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
Azad
A
Khaledi
Combination disk; E-test ESBL; ESBL; Klebsiella pneumoniae; PCR