ESBL-producing Escherichia coli and Klebsiella pneumoniae from health-care institutions in Mexico

Abstract

We investigated the phenotypic and molecular characteristics of Extended-Spectrum-β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae clinical isolates from four health-care institutions in Hermosillo, Sonora, Mexico. ESBL-producing isolates were collected from February to August 2016. The prevalence of ESBL-producing E. coli and K. pneumoniae was 11.9 and 8.7%, respectively. High dissemination of resistance to ciprofloxacin (88%), trimethoprim/sulfamethoxazole (72%) and aminoglycosides (59%) were detected, as well as susceptibility to meropenem, amikacin and tigecycline. The ESBL found variants were CTX-M-1 (88%) and CTX-M-9 (5%). The plasmid-mediated quinolone resistance (PMQR) gene aac(6´)-Ib-cr was identified in 62% of a representative sample, whereas the qnrB and qnrS genes were detected in 49% of the isolates. PFGE analyses detected many unrelated clones among the hospital or community isolates. A constant programme of epidemiological surveillance is recommended to understand the dynamics of bacterial resistance to both cephalosporin as well as the fluoroquinolone family of antibiotics.

Keywords:

• β-lactamases
• quinolone resistance
• PMQR
• PFGE
• aac(6´)-Ib-cr
• qnrB
• qnrS

Acknowledgements

We would like to thank the participant health-care institutions as well as their laboratory technicians for their constant support. Q.B. Manuel L. Rodríguez Vega and Q.B. Claudia Lizeth Navarro Cano obtained support from Hospital San José; Q.B. Alma Denia López Vázquez, Q.B. Lizbeth Soraya Duarte Miranda and Q.B.C. Elihu Pérez Frías from Centro Integral de Atención a la Salud (CIAS) Sur (ISSSTESON); Q.B. Amada Gortárez Castro, Q.B. Juan de Dios Castañeda Duarte, Q.B. Clara Guadalupe Castro Sánchez, Q.B. Rosalva Miranda Coronado from Hospital Dr. Ignacio Chávez (ISSSTESON); and M.C. Irma Elena Barroso Herrera y Cairo, Q.B. Rode García Robles, Q.B. Alejandra Guadalupe Benítez Arriola and Q.B.C. Oddry Guadalupe Euan Berrelleza from Hospital Fernando Ocaranza (ISSSTE). Q. Alejandro Sánchez Pérez (INSP). We thank Dr. Michael Dunn from the Center for Genomic Science-UNAM for reviewing the manuscript.

Additional information

Funding

This study was supported by Consejo Nacional de Ciencia y Tecnología (CONACYT), grant numbers 256,927 and 256,988 (Mexican Council for Science and Technology/Basic Science).

Notes on contributors

Viridiana Gallegos-Miranda

Viridiana Gallegos-Miranda is a M. Sc. in Microbiology from Universidad de Sonora.

Ulises Garza-Ramos

Ulises Garza-Ramos earned his PhD in Biochemical Sciences at Biotechnology Institute from National Autonomous University of Mexico. He is a currently the Director of the area of innovation in surveillance and control of infectious diseases and researcher in Medical Sciences from the National Institute of Public Health. His main areas of interest are antimicrobial resistance in Gram-negative bacterium, bacterial pathogens and genomic epidemiology of Klebsiella genus.

Enrique Bolado-Martínez

Enrique Bolado Martínez, PhD, Clinical laboratory chemistry with training in Clinical Pathology and a PhD degree. Dr. Bolado has attended 45 National and International updating courses and conferences, has participated with 100 conferences or presentations in events of academic updating, has taught 11 courses for professionals and teachers and has participated in the Organization of 10 scientific events. For 15 years he worked at the Clinical Laboratory of the Hospital General del Estado “Dr. Ernesto Ramos Bours”. Since 2009 he is in Universidad de Sonora as a full-time professor. Within his academic productivity, Dr. Bolado has directed or co-directed 11 undergraduate theses, 11 of master's degree (two in process) and one of PhD (in process); He is the author or co-author of 34 articles published in journals of national or international circulation, he has also participated as a researcher in 14 local and 5 international research protocols, in agreement with different institutions, including the Center for Disease Prevention and Control (CDC). Currently he is a member of the National System of Researchers Level I and is the Head of the Department of Ciencias Químico Biológicas at Universidad de Sonora. Dr. Bolado is working with genotypic characterisation of bacteria and the surveillance of antimicrobial resistance.

Moisés Navarro-Navarro

Moisés Navarro Navarro, Master's degree, Mexico, Sonoran University retired professor. Research areas developed include medical bacteriology, infection, community and hospitalary epidemiological studies of bacterial antibiotic resistance, phenotypic detection of antibiotic resistance mechanisms of medical importance. Aditionally, natural products biological activities including antioxidant, antibacterial, antiparasitic activity from propolis, vegetables extracts and its constituents. As well as purification and identification of chemical compounds from natural products with biological activity.

Katya Rocío Félix-Murray

M.C. Katya Rocío Félix Murray currently works at the Universidad de Sonora, in Mexico as Academic Technician. Obtained a master's of science degree from the Centro de Investigacion en Alimentación y Desarrollo A.C. Her areas of interest are microbiology and molecular biology.

Maria del Carmen Candia-Plata

Maria del Carmen Candia Plata, PhD, MD is a full-time professor in the Department of Medicine and Health Sciences of the University of Sonora. Her interest in research focuses on health problems of high prevalence in Mexico, including infectious and chronic diseases.

Guillermina Sanchez-Martinez

Guillermina Sanchez-Martinez is a PhD in Biochemestry at the Universidad Nacional Autonoma de Mexico. Her research field is in quinolone resistance mechanisms in E. coli from human and porcine.

Josefina Dúran-Bedolla

Josefina Duran-Bedolla is a Medical Doctor and PhD in Biomedical Science from National Autonomous University of Mexico. She is currently a researcher in the laboratory of bacterial resistance in the National Institute of Public Health in Mexico.

Jesús Silva-Sánchez

Jesus Silva-Sanchez is a PhD in molecular Biology at the National Politecnica Institute. He is currently head of the Bacterial Resistance group at the National Institute of Public Health at the Center for Infectious Diseases Research. His research focuses on characterizing the main mechanisms of resistance to ß-lactam, carbapenemic, and quinolone antibiotics in clinical isolates of Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii as the main pathogens that cause health care-associated infections (IAAS).