Risk factors associated with community-acquired CTX-M producing Klebsiellapneumoniae typing by Rep-PCR in Sanandaj, Iran

Noeman Ardalan¹, Shahab Jamaran², Farzam Memari³, Kambiz Davari², Bahareh Rostami² and Rashid Ramazanzadeh¹  

¹Department of Biology, Urmia Branch, Islamic Azad University, Urmia, Iran.

²Department of Biology, College of science, Sanandaj branch, Islamic Azad University, Sanandaj, Iran.

³Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.

⁴Cellular and Molecular Research Center and Microbiology Department, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj- Iran.

Corresponding Author E-mail: atrop_t51@yahoo.com 

DOI : http://dx.doi.org/10.13005/bbra/2271

ABSTRACT: The CTX-M producing organism is emerging as a resistance source to oxyimino-cephalosporin like ceftriaxone and ceftazidime. However, the laboratory detection of this gene has not yet been well defined in Sanandaj, Iran. The purpose beyond this study is identifying the prevalence of CTX-M and its risk factors in the community-acquired Klebsiella pneumoniae infections in Sanandaj.In this case-control study, 100 community-acquired Klebsiella pneumoniae strains were used. CTX-M gene was detected using PCR. The probable clonal relation among strains was determined via Rep-PCR. Risk factors associated with CTX-M positive were examined through the univariate logistic regression, Student’s t-test, and Mann-Whitney U test.The polymerase chain reaction test, used to identify CTX-M gene, showed that 37 (37%) Samples, out of 100 were positive. Based on Rep-PCR, 31 genotypes were identified among 37 Samples of CTX-M positive isolates. According to the statistical analysis, the following were the most important independent risk factors in this study: Gestation (p value= 0.036), previous exposure to antibiotic within 3 months (p value= 0.016), having relatives who work in a hospital (p value= 0.001, and distance of under 2 Km from home address to hospital (p value< 0.001). Regarding the increased value of ESBLs-producing strain, it is strongly recommended to use appropriate curative protocols based on the antibiogram. The results of Rep-PCR experiment refute the hypothesis of the clonal spread of one epidemic strain Klebsiella; meaning that not all CTX-M-producing species originate from the same strain and that the gene has extended among various strains. Hence, hospitals and their worker have to have better hygiene, hospital wastes have to be disposed properly, and antibiotics use may help prevent the spread of ESBL resistance only in case of being prescribed by a doctor.

KEYWORDS: CTX-M; Community-acquired; Klebsiellapneumonia; Risk factors; Rep-PCR

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