CTX-M-15 Positive Escherichia coli and Klebsiella pneumoniae Outbreak in the Neonatal Intensive Care Unit of a Maternity Hospital in Ha’il, Saudi Arabia

• Main Authors: Almogbel M, Altheban A, Alenezi M, Al-Motair K, Menezes GA, Elabbasy M, Hammam S, Hays JP, Khan MA
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-07-01
• Series: Infection and Drug Resistance
• Subjects: extended spectrum beta lactamases; nicu outbreak; ctx-m-15; e. coli; k. pneumoniae
• Online Access: https://www.dovepress.com/ctx-m-15-positive-escherichia-coli-and-klebsiella-pneumoniae-outbreak--peer-reviewed-fulltext-article-IDR

Mohammed Almogbel,1 Ahmed Altheban,2 Mohammed Alenezi,3 Khalid Al-Motair,1 Godfred A Menezes,4 Mohammed Elabbasy,1 Sahar Hammam,3 John P Hays,5 Mushtaq A Khan6 1Molecular Diagnostic and Personalized Therapeutics Unit, College of Applied Medical Sciences, University of Ha’il, Ha’il, Saudi Arabia; 2College of Nursing, University of Ha’il, Ha’il, Saudi Arabia; 3Maternity Hospital, Ha’il, Saudi Arabia; 4Department of Medical Microbiology and Immunology, RAK College of Medical Sciences, RAK Medical & Health Sciences University, Ras Al Khaimah, United Arab Emirates; 5Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre (Erasmus MC), Rotterdam, The Netherlands; 6Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab EmiratesCorrespondence: Mushtaq A KhanDepartment of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab EmiratesTel [phone]Email [e-mail]: The aim of this study was to retrospectively characterize E. coli and K. pneumoniae isolates obtained from neonates during a suspected NICU outbreak of infection in Ha’il, Saudi Arabia during a period of one month (April 2014).Methods: Antibiotic susceptibility patterns, molecular characterization for antibiotic-resistant genes (blaTEM, blaSHV, and blaCTX-M), and genotyping by PFGE and MLST were performed.Results: A total of 24 E. coli and 48 K. pneumoniae isolates were cultured from neonates that had been admitted to the NICU. Among E. coli, the majority of isolates (19/24) were ESBL-positive and all of these nineteen (100%) harbored the CTX-M-15 gene. A total of 15% (3/19) were co-producers of CTX-M-15 and SHV-12, and 68.4% (13/19) were co-producers of CTX-M-15 and TEM-1. Among K. pneumoniae isolates, 87.5% (42/48) were ESBL positive with 92.85% (39/42) of these isolates containing the CTX-M-15 gene. A total of 97% (38/39) of K. pneumoniae were co-producers of CTX-M-15 and SHV-12, and 88% (37/42) were positive for TEM-1. Furthermore, 85.7% (36/42) K. pneumoniae were co-producers of CTX-M-15 and TEM-1. The majority of E. coli isolates (18/19 isolates) were grouped into two genetic clusters by pulsed field gel electrophoresis (PFGE) and all the isolates were found to be ST-131 type. In contrast, K. pneumoniae (31/42) isolates belonged to a single genotypic lineage, and all (100%) isolates belonged to the ST-14 type.Conclusion: This is the first report of CTX-M-15-positive, ESBL E. coli, and K. pneumoniae isolates recovered from an outbreak in an NICU in Ha’il, Saudi Arabia. It is alarming to note the high rate of outbreak isolates with simultaneous production of CTX-M-15 and SHV-12 conferring high-level resistance to oxyimino-cephalosporins.Keywords: extended spectrum β-lactamases, NICU outbreak, CTX-M-15, E. coli, K. pneumoniae