Prevalence of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Causing Bloodstream Infections in Cancer Patients from Southwest of Iran

Figures & data

Table 1 The Primer Sequences Used for Extended-Spectrum Beta-Lactamase Genes Detection

Primer	Oligonucleotide Sequence (5′ to 3′)	Gene	Product Size (bp)	Annealing Temperature (°C)
TEM-F	GTATCCGCTCATGAGACAATAACCCTG	blaTEM	919	60
TEM-R	CCAATGCTTAATCAGTGAGGCACC
SHV-F	CGCCTGTGTATTATCTCCCTGTTAGCC	blaSHV	843	62
SHV-R	TTGCCAGTGCTCGATCAGCG
CTX-M-F	ATGGCGGCCGCGGCGGTGCTTAA	blaCTX-M	158	59
CTX-M-R	AGCGCGGCCGCGCTACAGTACAGC
PER-F	AATTTGGGCTTAGGGCAGAA	blaPER	925	57
PER-R	ATGAATGTCATTATAAAAGC

Table 2 Demographic Features of Cancer Patients with Bloodstream Infections

Patients Characteristics		Patients with Bloodstream Infections (n=100) n (%)
Age (years)		42±18
Male/Female		47 (47%)/53 (53%)
Duration of hospitalization (days)		42±28
Hematological malignancies		75 (75%)
	Acute lymphoblastic leukemia	30 (30%)
	Acute myeloid leukemia	16 (16%)
	Hodgkin lymphoma	10 (10%)
	Non-Hodgkin lymphoma	8 (8%)
	Multiple myeloma	11(11%)
Solid organ malignancies		25 (25%)
	Bone tumor	4 (4%)
	Breast cancer	5 (5%)
	Lung cancer	2 (2%)
	Rectum tumor	1 (1%)
	Thyroid tumor	1 (1%)
	Brain tumor	1 (1%)
	Ewing sarcoma	1 (1%)
	Colorectal carcinoma	5 (5%)
	Adenocarcinoma	5 (5%)

Table 3 Bacterial Isolates Causing Bloodstream Infection in Cancer Patients

Species	Number of Isolates	Sex (Male/Female)	Hematologic Malignancies	Solid Organ Tumors
Pseudomonas aeruginosa	41	14/27	30	11
Escherichia coli	8	3/5	5	3
Klebsiella pneumonia	6	4/2	5	1
Enterobacter species	5	3/2	5	–
Citrobacter freundii	1	1/-	1	–
Serratia marcescens	1	1/-	1	–
Acinetobacter baumannii	12	7/5	11	1
Coagulase-negative staphylococci	16	9/7	12	4
Staphylococcus aureus	5	2/3	3	2
Methicillin-resistant S. aureus	5	1/4	2	3

Table 4 Antibiotic Resistance Patterns of Enterobacteriaceae Isolates

Antibiotics	Escherichia coli (n:8)			Klebsiella pneumoniae (n:6)			Enterobacter species (n:5)
	S*	I*	R*	S	I	R	S	I	R
Aztreonam	1 (12.5%)	2 (25%)	5 (62.5%)	2 (33.3%)	0	4 (66.6%)	5 (100%)	0	0
Cefepime	3 (37.5%)	0	5 (62.5%)	3 (50%)	0	3 (50%)	5 (100%)	0	0
Cefotaxime	0	1 (12.5%)	7 (87.5%)	1 (16.7%)	1 (16.7%)	4 (66.6%)	1 (20%)	1 (20%)	3 (60%)
Ceftazidime	0	1 (12.5%)	7 (87.5%)	0	1 (16.7%)	5 (83.3%)	0	1 (20%)	4 (80%)
Ciprofloxacin	3 (37.5%)	0	5 (62.5%)	4 (66.6%)	1 (16.7%)	1 (16.7%)	3 (60%)	2 (40%)	0
Gentamycin	5 (62.5%)	0	3 (37.5%)	4 (66.6%)	1 (16.7%)	1 (16.7%)	5 (100%)	0	0
Imipenem	5 (62.5%)	2 (25%)	1 (12.5%)	2 (33.3%)	1 (16.7%)	3 (50%)	2 (40%)	3 (60%)	0
Meropenem	0	1 (12.5%)	7 (87.5%)	0	0	6 (100%)	1 (20%)	0	4 (80%)
Piperacillin	1 (12.5%)	1 (12.5%)	6 (75%)	0	1 (16.7%)	5 (83.3%)	1 (20%)	1 (20%)	3 (60%)
Piperacillin-Tazobactam	4 (50%)	2 (25%)	2 (25%)	2 (33.3%)	2 (33.3%)	2 (33.3%)	2 (40%)	1 (20%)	2 (40%)
Tetracycline	2 (25%)	1 (12.5%)	5 (62.5%)	3 (50%)	1 (16.7%)	2 (33.3%)	3 (60%)	1 (20%)	1 (20%)

Notes: *S, susceptible; I, intermediate; R, resistant.

Table 5 The Multidrug Resistance Patterns of Enterobacteriaceae Isolates

Isolates	Resistance Pattern	Number (%)
Escherichia coli(n: 8)	PIP-TET-CAZ-CTX-CFP-MEM-CIP-ATM	4 (50%)
	PIP-PTZ-CAZ-CTX-MEM-GEN	2 (25%)
	TET-CAZ-CTX-CFP	1 (12.5%)
	IMI-MEM-GEN-CIP-ATM	1 (12.5%)
Klebsiella pneumoniae (n: 6)	PIP-PTZ-TET-CAZ-CTX-CFP-IMI-MEM-ATM	2 (33.3%)
	PIP-CAZ-CTX-MEM-ATM	2 (33.3%)
	PIP-CAZ-CFP-MEM	1 (16.7%)
	IMI-MEM-GEN-CIP	1 (16.7%)
Enterobacter species (n:5)	PTZ-CAZ-MEM	2 (40%)
	PIP-TET-CTX	1 (20%)
	PIP-CAZ-CTX-MEM	2 (40%)

Abbreviations: PIP, piperacillin; TET, tetracycline; PTZ, piperacillin-tazobactam; CAZ, ceftazidime; CTX, cefotaxime; CFP, cefepime; IMI, imipenem; MEM, meropenem; GEN, gentamicin; CIP, ciprofloxacin; ATM, azteronam.

Table 6 The Frequency of Extended-Spectrum Beta-Lactamase Genes in Enterobacteriaceae Isolates

Bacterial Isolates	No.	Gender	Age	ESBL (CDDT)	Extended-Spectrum Beta-Lactamase Gene
					blaCTX-M	blaTEM	blaSHV	blaPER
Escherichia coli (n=8)	EC1	M	72	+	+	+	-	-
	EC2	M	50	+	-	+	-	-
	EC3	F	63	+	+	+	-	-
	EC4	M	52	–	–	–	–	-
	EC5	M	8	+	+	–	–	-
	EC6	M	1	+	+	–	–	-
	EC7	M	2	+	+	+	-	-
	EC8	F	76	+	+	-	-	-
Klebsiella pneumoniae (n=6)	KP1	M	44	-	-	-	-	-
	KP2	M	64	-	-	-	-	-
	KP3	M	1	+	+	+	-	-
	KP4	M	54	+	+	-	-	-
	KP5	F	20	-	-	-	-	-
	KP6	F	1.5	-	-	-	-	-
Enterobacter species (n=5)	ES1	M	3	-	-	-	-	-
	ES2	F	56	-	-	-	-	-
	ES3	M	51	-	-	-	-	-
	ES4	M	5	-	-	-	-	-
	ES5	F	62	-	-	-	-	-
Citrobacter freundii (n=1)	CF1	M	35	-	-	-	-	-
Serratia marcescens (n=1)	SM1	F	6	-	-	-	-	-

Abbreviations: EC, Escherichia coli; KP, Klebsiella pneumonia; ES, Enterobacter species; CF, Citrobacter freundii; SM, Serratia marcescens; M, male; F, female.