Infection and Drug Resistance (May 2020)
Prevalence of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Causing Bloodstream Infections in Cancer Patients from Southwest of Iran
Abstract
Effat Abbasi Montazeri,1,2,* Azar Dokht Khosravi,1,2,* Morteza Saki,1– 3 Mehrandokht Sirous,2,4 Bijan Keikhaei,5 Sakineh Seyed-Mohammadi1– 3 1Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 2Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 3Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 4Department of Microbiology and Parasitology, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran; 5Thalassemia and Hemoglobinopathy Research Center, Health Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran*These authors contributed equally to this workCorrespondence: Morteza Saki; Sakineh Seyed-Mohammadi Tel +98 9364221187; +98 9352655807Fax +98 6133332036Email [email protected]; [email protected]: This study aimed to evaluate the frequency rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) causing bloodstream infections (BSIs) in cancer patients referred to one of the major referral hospitals in Ahvaz city, southwest Iran.Materials and Methods: In this study, 1700 blood cultures were collected from 610 cancer patients suspected to have BSI from October 2016 to August 2017 referred to the Shafa cancer hospital, Ahvaz, southwest of Iran. The blood culture bottles were incubated aerobically at 35– 37ºC for 24 hours and then sub-cultured on routine microbiology culture media. The bacterial colonies were identified using standard tests. The antibiotic susceptibility testing was achieved by the disc-diffusion method. The phenotypic detection of ESBLs was carried out by the combination disc-diffusion test (CDDT). Finally, the polymerase chain reaction (PCR) was performed to investigate the presence of blaTEM, blaCTX, blaSHV, and blaPER genes.Results: The prevalence of BSI in cancer patients was 16.4% (100/610). Gram-negative rods with rate of 74% (74/100) were the most prevalent bacteria. The frequency of Enterobacteriaceae family was 21% including Escherichia coli (n: 8), Klebsiella pneumoniae (n: 6), Enterobacter spp. (n: 5), Citrobacter freundii (n: 1), and Serratia marcescens (n: 1). All isolates were multidrug-resistant (resistance to three or more antibiotics). The results of CDDT showed that 42.8% (9/21) of Enterobacteriaceae isolates had a positive ESBL test of which 100% (9/9) indicated positive band for at least one of the ESBL genes by PCR method. The blaCTX-M and blaTEM genes were detected in 38% (8/21) and 23.8% (5/21) of isolates, respectively, while the blaSHV and blaPER were not detected in any isolates.Conclusion: Based on the results, surveillance, and antibiotic stewardship programs should be implemented for cancer patients to prevent the spread of more ESBL-PE that have limited therapeutically choices.Keywords: extended-spectrum beta-lactamase, ESBL, cancer patients, Enterobacteriaceae, hematological malignancies, Iran
