Characterization and molecular epidemiology of Extended-Spectrum-ß-Lactamase-Producing Escherichia coli derived from University Hospitals of Egypt and Germany
Extended-spectrum ß-lactamases (ESBLs) production is the major clinical and public health problem in Egyptian Hospitals. However, little data are available on the prevalence and the types of ESBLs in Egypt. This study aimed to determine the prevalence and the probable types of ESBL among E. coli and K. pneumoniae clinical isolates obtained from Egyptian Hospitals. It was carried out on a total of 248 clinical enterobacterial isolates collected during six months period from October 2008 to March 2009 from different clinical specimens obtained from different medical wards of the University Hospitals in Egypt and Germany including: 184 isolates (102 K. pneumoniae and 82 Escherichia coli) derived from Egyptian University Hospitals and 64 E. coli isolates derived from a German University Hospital (Giessen University Hospital). Phenotypic and molecular characterization was performed, results were compared.The prevalence of ESBL-producing isolates among E. coli and K. pneumoniae derived from Egyptian University Hospitals was as high as 78.8% and 82.4% respectively. CTX-M + TEM was the most prevalent ß lactamase profile that has been detected among the ESBL-producing E. coli and K. pneumoniae. BlaCTX-M-15 was the only detected blaCTX-M allele among Egyptian isolates and the most predominant allele among German isolates.The molecular characterization of the bacterial host background revealed the prevalence of D phylogenetic group type among Egyptian isolates and the competitive prevalence of both A and B2 phylogenetic type among German isolates. PFGE analysis revealed a high degree of genetic diversity of the isolates derived from both countries. Presence of a clonal pair composed of an Egyptian isolate and a German isolate which could represent a case of clonal importation from one country to another was also detected.In addition to ß-lactam resistance, the great majority of the isolates derived from both countries were multiple resistant to one or more of non ß-lactam antimicrobial classes including tetracycline, sulfamethoxazole/ trimethoprim, aminoglycosides and quinolones. CTX-M production was associated with IncFI plasmids most commonly with FIA-FIB multi replicon plasmids. Plasmids sizing and subsequent DNA hybridization revealed the location of blaCTX-M on ~ 97 kb FIA-FIB and ~ 170 kb FIA-FIB conjugative plasmids in common among the isolates derived from both countries suggesting emergence of a suspected trans-continental epidemic plasmid.This study highlights the high prevalence of ESBL production among E. coli and K. pneumoniae in the clinical setting in Egypt as well as the presence an epidemiological relation between Egypt and Germany evidenced by the presence common epidemic plasmids, sharing of an identical clone which in turn harbor one of the epidemic plasmids. The dominance of plasmids of an identical replicon type and molecular size in both countries as well as the presence of other diverse large CTX-M-encoding plasmids in genetically heterogeneous strains proves that, horizontal transfer of multiple epidemic plasmids is the major driving force behind the spread of blaCTX-M in the clinical setting of both countries.
Verknüpfung zu Publikationen oder weiteren Datensätzen
