Extended-spectrum β-lactamase gene frequency and antibiotic resistance patterns in Iranian Gram-negative bacteria: a multicenter study (2023)

gene reporter

Volume 21,

December 2020

, 100783

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Extended-spectrum beta-lactamase (ESBL)-producing bacteria are increasing worldwide and causing complications in patients treated with antibiotics, increasing mortality and morbidity.


This study aimed to (a) determine the frequency of ESBL-producing Gram-negative bacteria collected from nine Iranian cities using phenotypic and molecular methods, and (b) extract theirantibiotic sensitivitymodel.

Materials and methods

Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli,Klebsiella pneumoniae, andEnterobacterThe genus was collected from nine cities in Iran within one year. The third-generation cephalosporin-resistant strains were identified by susceptibility testing. According to CLSI guidelines, ESBL-producing bacteria were identified by the double disc method and the most common ESBL genes were identified by PCR detection of phenotypically ESBL-positive strains.

(Video) Mechanisms of Gram Negative Resistance -- Austin Morrison, PharmD


This study included data from a total of 4083 consecutive clinical samples. Of the 1275 isolates resistant to third-generation cephalosporins, 475 were ESBL isolates (12%). TEM was the most common ESBL gene found in phenotype-positive strains.

in conclusion

This study demonstrates the presence of ESBL-producing bacteria in the environment studied. It should be noted here that carbapenems andAminoglycosidesStill the best treatment for ESBL-producing Gram-negative bacteria.


Extended-spectrum beta-lactamase (ESBL)-producing bacteria were first prescribed in 1983. Gram-negative ESBL-producing bacteria can hydrolyze broad-spectrum cephalosporins such as β-lactam antibiotics (cephalosporins, penicillins, and aztreonam) by breaking down the β-lactam ring, thereby limiting available treatment options, Confusing for clinicians (Esteve-Palau et al., 2018). Bacteria possess these enzymes via chromosome or plasmid mediation (Gajamer et al., 2015). Unfortunately, ESBL-producing bacteria are spreading at a steady rate worldwide (Hijazi et al., 2016). Monitoring the behavior and activity of these organisms is important to better visualize resistance patterns, antimicrobial stewardship programs and direct patient care (Gajamer et al., 2015). According to other research, it is important to recognize that within a large country like Iran, there are stark differences across geographic regions. To our knowledge, such a unique multicenter approach has never been conducted in Iran. This study aimed to detect the most common genes responsible for ESBLs in Iran and determine current patterns of antibiotic resistance.

partial fragment

Materials and methods

Bacterial isolates included 4083 strainsPseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli,Klebsiella pneumoniae, and Enterobacter as superbugs were collected from nine provinces of Iran from September 2016 to September 2017. A total of 1274 consecutive non-repeated isolates, resistant to one of the third-generation cephalosporins, were assessed for ESBL-producing enzymes (phenotype and genotype) and patterns of antibiotic resistance.


Five threatening bacteria (Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli,Klebsiella pneumoniae, andEnterobacterspp.) performed phenotypic and molecular assessments to detect ESBL and patterns of antibiotic resistance. The study included data from a total of 4083 consecutive clinical samples. Of these, 1275 isolates were resistant to one of the 3rd generation cephalosporins included in this study. most of them areEscherichia coli(No. 1222) The least isEnterobacterGenus (No. 621). this


ESBL enzymes are produced by some Gram-negative bacteria and can hydrolyze third-generation cephalosporins and aztreonam, which are usually inhibited by clavulanic acid (Ahmed et al., 2014). Several ESBL-producing Gram-negative bacteria are multidrug-resistant to non-β-lactam antibiotics, including chloramphenicol, tetracycline, and amikacin, which are often encoded by the same plasmids required for ESBL production (Hijazi et al. , 2016).

Considering the growth of ESBL-producing organisms

in conclusion

This study demonstrated the presence of ESBL-producing bacteria in the considered environment. To detect the exact ratio of this presence, a unique approach was applied to identify distinct GNBs resistant to third cephalosporins, phenotype and molecularly detect ESBLs. According to the findings, carbapenems and aminoglycosides remain the best treatment.

CRediT Author Contribution Statement

Shanaz Almin:Conceptualization, Data curation, Formal analysis, Project administration, Writing—original draft.Fatma Farah:Conceptualization, data management, formal analysis, writing - manuscript.Abdullah Karimi:Conceptualization, methodology, project management, writing - manuscript.Mehdi Sherdust:Data curation, formal analysis, writing - manuscript, writing - review and editing.Tah Azimi:Conceptualization, Data Curation, Formal Analysis, Writing - Original

Statement of Competing Interests

All authors declare that the submitted manuscript is free from commercial, personal, political and any other potential conflicts of interest.

thank you

Research reported in this publication was supported by the Elite Investigators Grant Committee under award number [940290] fromNational Institute for Medical Research and Development(NIMAD), Tehran, Iran.


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What does it mean when you are ESBL positive? ›

In healthy people, this often means urinary tract infections. ESBL germs have also been identified in people returning to the United States after traveling abroad, especially to places where these germs are more commonly found.

What happens if ESBL is left untreated? ›

You can spread ESBL infection to others. But because you aren't sick, you don't need treatment. But if ESBL bacteria enter the body and causes an infection, this can make you very sick or even be fatal if not treated properly.

Can I pass ESBL to my family? ›

ESBL bacteria can be spread from person to person on contaminated hands of both patients and healthcare workers. The risk of transmission is increased if the person has diarrhoea or has a urinary catheter in place as these bacteria are often carried harmlessly in the bowel.

Do patients with ESBL need to be isolated? ›

Because ESBL is discovered on clinical specimen (e.g., urine cultures), you will still know when an infection occurs due to an ESBL-producing bacteria. Patients that we know are carrying ESBL-producing bacteria will no longer require isolation or Contact Precautions.

How serious is ESBL in urine? ›

Bacteria That Produce ESBLs

coli strains and types are harmless, but some of them can cause infections leading to stomach pains and diarrhea. Klebsiella pneumoniae may make its way to other parts of your body, causing various infections like pneumonia and urinary tract infections — or UTIs.

Can a healthy person get ESBL? ›

Healthy people often are not colonized or infected with ESBL bacteria. But certain things can make colonization or infection more likely. These are called risk factors.

Can you be cleared of ESBL? ›

Can ESBL be cleared? Some children can be cleared of ESBL. This depends on the use of antibiotics, whether they have any drains / tubes or devices, and whether they have any ongoing health conditions. The infection control nurses will be able to advise you.

Is ESBL infection life threatening? ›

ESBL infections usually occur in the urinary tract, lungs, skin, blood, or abdomen. ESBL infections are serious and can be life-threatening.

What is the mortality rate for ESBL infections? ›

The mortality rate for ESBL infections ranges between 3.7 and 22.1% [2, 4, 5] which may be explained by a delay in initiating active antibiotic therapy [1, 3].

Is ESBL permanent? ›

Most ESBL infections can be treated successfully once your doctor has found a medication that can stop the resistant bacteria. After your infection is treated, your doctor will likely give you good hygiene practices. These can help ensure you don't develop any other infections that can also resist antibiotics.

What triggers an ESBL? ›

Most ESBL infections are spread by direct contact with an infected person's bodily fluids (blood, drainage from a wound, urine, bowel movements, or phlegm). They can also be spread by contact with equipment or surfaces that have been contaminated with the germ.

What antibiotics should be avoided with ESBL? ›

These enzymes can often be excreted. Extended-spectrum β-lactamases (ESBLs) mediate resistance to all penicillins, third generation cephalosporins (e.g. ceftazidime, cefotaxime, and ceftriaxone) and aztreonam, but not to cephamycins (cefoxitin and cefotetan) and carbapenems (Bonnet, 2004).

How long do antibiotics take to treat ESBL? ›

In a retrospective study that evaluated treatment with ertapenem administered through outpatient parenteral antibiotic therapy (OPAT) in patients with urinary tract infections caused by ESBL-EB, the mean duration of antimicrobial treatment was 11.2 days [15].

Is ESBL the same as MRSA? ›

MRSA is resistant to all beta-lactam antibiotics and many commonly used antibiotic groups including, aminoglycosides, macrolides, fluoroquinolones, chloramphenicol and tetracyclines [8-10]. ESBL-producing Enterobacteriaceae are resistant to third generation cephalosporins and monobactams [11].

Where is ESBL found in the body? ›

An infection with ESBL germs can be in any part of the body, including blood, organs, skin, and sites where surgery was done. There are many ways ESBL germs can be spread. The most common ways are by touching a person or thing that has the bacteria on it. The infection is more likely to spread in a hospital.

Does ESBL cause sepsis? ›

The clinical diagnosis/condition of the study subjects as the reason for blood culture was mostly suspected sepsis. Among those infected by the ESBL producing bacteria 63.9% were diagnosed as sepsis, 13.9% each were diagnosed as SIRS and other infections, and 8.3% suffered from fever.

Is ESBL a bloodstream infection? ›

Bloodstream infections caused by extended-spectrum-β-lactamase (ESBL)-producing Klebsiella pneumoniae isolates are a major concern for clinicians, since they markedly increase the rates of treatment failure and death.

How to live with ESBL? ›

Take care of yourself — eat right, exercise, do not smoke and avoid stress. Keep skin infections covered to avoid spreading ESBL-producing bacteria to others. ESBL-producing bacteria live in the gastrointestinal (GI) tract.

What is extended spectrum beta lactamase ESBL resistance? ›

Extended-spectrum beta-lactamases (ESBLs) are enzymes that confer resistance to most beta-lactam antibiotics, including penicillins, cephalosporins, and the monobactam aztreonam. Infections with ESBL-producing organisms have been associated with poor outcomes.

How long can ESBL last? ›

coli, 18 had had several consecutive negative cultures after shedding ESBL–E. coli for a median of 7.5 months (range, 0–39 months), 16 had died while still carrying ESBL–E. coli (median duration of carriage, 9 months; range, 0–38 months), and 3 had been lost to follow-up.

Who is at risk of ESBL infection? ›

Patients in the community with indwelling urinary catheters, history of recurrent UTIs, or recent antimicrobial use are at higher risk for de novo ESBL Enterobacteriaceae UTIs.

Is ESBL always E. coli? ›

Although ESBLs can be made by different bacteria, they are most often made by E. coli (more correctly called Escherichia coli).

What bacteria produces extended spectrum beta lactamases? ›

Extended-spectrum beta-lactamases (ESBL) are enzymes produced by gram-negative bacteria such as Klebsiella pneumoniae and Escherichia coli (24) as well as by species from other genera, such as Enterobacter sp., Salmonella sp., Proteus sp., Serratia marcescens, Shigella dysenteriae, Pseudomonas aeruginosa, and ...

What is the best antibiotic for ESBL UTI? ›

Carbapenems are generally considered the drug of choice for the treatment of ESBL-EC infections. With a half-life of 4 hours, ertapenem may be a good option due to the fact that it is administered only once daily, unlike the other carbapenems.

Can ESBL be airborne? ›

Fields amended with ESBL-positive organic fertilizers might be affected by wind erosion, leading to bioaerosol formation (Jones and Harrison, 2004) and a possible airborne spread of these resistant bacteria.

What is the first line treatment for ESBL? ›

The first line of treatment for people who have been confirmed as having the infection is usually a class of drugs called carbapenems.

What kills ESBL on surfaces? ›

cleanser that reads “disinfectant” on the label. Disinfectants need enough time to kill ESBL; therefore, wet surfaces with your disinfectant and allow to air dry. and before eating. This practice should be followed by everyone in your house.

Can you treat ESBL with oral antibiotics? ›

Pivmecillinam, fosfomycin and nitrofurantoin are available in oral form. Their activity against ESBL producing Enterobacteriacae and oral availability make it appropriate for use in the treatment of uncomplicated UTIs.

How long does it take to treat a UTI with ESBL? ›

The conventional therapy for UTI is administration of antibiotics for 3 to 10 days. However, empirical treatment of these infections is sometimes problematic as a result of the emergence of ESBL producing organisms among common pathogens including E. coli and K. pneumoniae.

When should you suspect ESBL? ›

Screening for ESBL producers

If isolates show resistance or diminished susceptibility to any of these five agents, it indicates suspicion for ESBL production, and phenotypic confirmatory tests should be used to ascertain the diagnosis.

Is MRSA the same as sepsis? ›

If left untreated, MRSA infections can become severe and cause sepsis—the body's extreme response to an infection.

What precautions should be taken for ESBL infection? ›

How do we prevent the spread of ESBLs? soap and water or by using an alcohol-based hand rub (ABHR). I Use contact isolation precautions for patients with ESBL infections. A sign will be placed outside the room to alert everyone about the precautions needed.

Is staph and MRSA the same thing? ›

Staph bacteria are usually harmless, but they can cause serious infections that can lead to sepsis or death. Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of staph infection that is difficult to treat because of resistance to some antibiotics.

What is the survival rate of ESBL? ›

Infections caused by ESBL producing pathogens are associated with higher mortality than corresponding infections due to non-ESBL pathogens [3]. The mortality rate for ESBL infections ranges between 3.7 and 22.1% [2, 4, 5] which may be explained by a delay in initiating active antibiotic therapy [1, 3].

What causes ESBL infection in urine? ›

Most ESBL infections are spread by direct contact with an infected person's bodily fluids (blood, drainage from a wound, urine, bowel movements, or phlegm). They can also be spread by contact with equipment or surfaces that have been contaminated with the germ.

How long does an ESBL infection last? ›

coli, 18 had had several consecutive negative cultures after shedding ESBL–E. coli for a median of 7.5 months (range, 0–39 months), 16 had died while still carrying ESBL–E. coli (median duration of carriage, 9 months; range, 0–38 months), and 3 had been lost to follow-up.


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