Muhammad Asif Habeeb, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), P.O.Box 577, Jhang Road, Faisalabad, Pakistan, An affiliated Institute of Pakistan Institute of Engineering and Applied Sciences, Nilore, Islamabad, Pakistan.
Yasra Sarwar, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), P.O.Box 577, Jhang Road, Faisalabad, Pakistan, An affiliated Institute of Pakistan Institute of Engineering and Applied Sciences, Nilore, Islamabad, Pakistan.
Pak J Med Sci. 2013 Apr;29(2):540-4. doi: 10.12669/pjms.292.3144.
Production of extended spectrum beta -lactamases (ESBLs) by clinical isolates of pathogenic E. coli is a very serious therapeutic threat. This study was aimed to investigate the prevalence of ESBLs and associated drug resistance in E. coli isolates from urine and pus, and to report the drift from 2005 to 2009-10.
Among 173 E. coli isolates, 82 were phenotypically detected as ESBL producers by standard cefotaxime / clavulanic acid and ceftazidime / clavulanic acid disc diffusion tests. Antimicrobial resistance of all ESBL producers was assessed by disc diffusion method. Presence of CTX-M, TEM, SHV and OXA groups was investigated by PCR.
The prevalence of ESBL producing E. coli increased significantly from 33.7% in 2005 to 60.0% in 2009-10 (urine: 31.8% to 62.9%; pus: 41.1% to 55.5%). Resistance to cefotaxime, ceftazidime, ciprofloxacin, gentamicin, nalidixic acid, ticarcillin-clavulanic acid, and trimethoprim-sulfamethoxazole was above 85% in both sets of isolates. Imipenem and Fosfomycin resistance was non-existent in 2005 but ranged from 3-15% in 2009-10. Remarkable increase from 9.5% to 64.7% in urinary tract isolates and from 0 to 55% in pus isolates was observed in colistin sulphate resistance. The dissemination of genes encoding ESBLs was: CTX-M 3.5%; TEM 10.7%; both CTX-M and TEM 3.5% in 2005, and CTX-M 42.5%; TEM 48.1%; both CTX-M and TEM 29.6% in 2009-10.
Our results showed very rapid emergence of multidrug resistant ESBL producing E. coli in Pakistan posing a very serious threat in the treatment of nosocomial and community acquired infections.
临床分离的致病性大肠杆菌产生超广谱β-内酰胺酶（ESBLs）是一个非常严重的治疗威胁。本研究旨在调查尿和脓液中大肠杆菌分离株中 ESBLs 的流行情况及其耐药性，并报告 2005 年至 2009-10 年的变化情况。
在 173 株大肠杆菌分离株中，通过标准头孢噻肟/克拉维酸和头孢他啶/克拉维酸纸片扩散试验，82 株表型检测为 ESBL 产生菌。所有 ESBL 产生菌的药敏试验采用纸片扩散法。通过 PCR 检测 CTX-M、TEM、SHV 和 OXA 组的存在。
2005 年至 2009-10 年，产 ESBL 大肠杆菌的流行率显著增加，从 33.7%上升至 60.0%（尿液：31.8%至 62.9%；脓液：41.1%至 55.5%）。两组分离株对头孢噻肟、头孢他啶、环丙沙星、庆大霉素、奈啶酸、替卡西林-克拉维酸和复方磺胺甲噁唑的耐药率均高于 85%。2005 年，亚胺培南和磷霉素耐药率为 0，2009-10 年耐药率为 3-15%。在尿液分离株中，从 9.5%显著增加至 64.7%，在脓液分离株中，从 0 增加至 55%，观察到硫酸粘菌素耐药性显著增加。2005 年，编码 ESBLs 的基因传播情况为：CTX-M 3.5%；TEM 10.7%；CTX-M 和 TEM 均为 3.5%。2009-10 年，CTX-M 42.5%；TEM 48.1%；CTX-M 和 TEM 均为 29.6%。
我们的结果表明，巴基斯坦出现了非常快速的多药耐药性产 ESBL 大肠杆菌，这对医院和社区获得性感染的治疗构成了非常严重的威胁。
