Species composition and molecular-genetic characteristics of antibiotic-resistant strains of gram negative bacteria isolated from patients of a hospital’s urology department

B. U. Shalekenov, А.Л. Бисекенова, Б.А. Рамазанова, D.A. Adambekov Adambekov, С.Б. Шалекенов

2018

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DOI 10.18565/urology.2018.1.77-83
Data confidence 70 medium
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Abstract

AIM: To analyze the composition and molecular mechanisms of antibiotic resistance of Gram-negative bacteria - pathogens of urinary tract infections (UTIs) in adult patients living in the city of Almaty. MATERIALS AND METHODS: The study examined the etiological composition and antibiotic susceptibility of clinically significant isolates of bacteria and fungi ( more or equal 103) isolated from the urine of the patients of the Department of Urology of the Almaty city Central Clinical Hospital No. 12. The production of extended-spectrum beta-lactamases (ESBL) in antibiotic-resistant strains was determined using a phenotypic method with the double disk test. Detection of class A genes for cultures with confirmed ESBL phenotypes (TEM-1, CTX-M1, SHV, OXA) and carbapenemases of class B metallo--lactamases (VIM-2) genes was performed by PCR. RESULTS: Among the isolates obtained from patients, the species of Enterobacteriaceae family in the etiological composition of the UTI pathogens comprised 44.8% including E. coli (31%), K. pneumoniae (4.6%). The most effective drugs against all types of Enterobacteria were carbapenems (96.3-100%). E.coli showed highest sensitivity to nitrofurantoin (96.3%), amikacin (92.6%) and cefoxitin (81.5%). The high rate of resistance to III-IV generation cephalosporins among of E. coli (44.4%) and K. pneumoniae (50%) species was due to the production of ESBL types CTX-M1 and OXA. The proportion of non-fermenting Gram-negative bacteria in the etiological composition of UTI pathogens was 3.5%. Among them, there was a strain producing the metal -lactamase (VIM-2), characterized by absolute resistance to antibiotics of all classes, including carbapenems. CONCLUSION: The findings on sensitivity profiles and molecular genetic mechanisms of resistance of Gram-negative uropathogens are unique for the Almaty region provides the rationale for developing a local strategy for rational antibiotic therapy. Timely microbiological diagnosis and strict adherence to infection control in a specific hospital are the only way to contain the spread of ESBL and metal -lactamase.