الفهرس 
Epidemiology and molecular characterization of extended-spectrum ?-lactamase-producing enterobacteriaceae isolated from patients with urinary tract infection
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Abstract
Background: Extended-spectrum Ý-lactamases (ESBLs) are a group of plasmid-mediated and rapidly evolving enzymes that are posing a major therapeutic challenge in the treatment of hospital- and community-acquired urinary tract infections (UTIs). CTX-Ms have become the most prevalent ESBLs worldwide. Objectives: The aim of the present work was to detect the prevalence and molecular characterization of uropathogenic ESBL-producing Enterobacteriaceae as well as determining their antimicrobial susceptibility. Methods: This descriptive cross-sectional study was conducted from January 2016 to May 2017. It included 100 ESBL-producing Enterobacteriaceae isolates from patients with UTIs. The phenotypic screening of the ESBL isolates was done using double and combined disc method. Antimicrobial susceptibility testing was performed by disc diffusion method. Bla CTX-M, SHV and TEM ESBL genes were amplified by PCR and then 25 isolates with CTX-M positive genotype were sequenced for detection of different CTX-M genotypes. Results: The frequency of UTI caused by ESBL- producing Enterobacteriaceae was 40% of which 66% were E.coli and 34% were Klebsiella spp. Carbapenems and fosfomycin were the most effective antibiotics. The ESBL production pattern observed included single production of CTX-M 88%, TEM 2% and combined producion of CTX-M and SHV 10%. Using sequencer CTX-M-15 was the most abundant genotype accounting for 88% followed by CTX-M-3 which was detected in 8% and CTX-M-123 detected in 4% of ESBL isolates. Conclusion: This study confirms a high rate of ESBL production in UTI among Egyptian patients. Carbapenems still hold promise in treatment of ESBL-UTI. High prevalence of bla CTX-M type ESBL was detected with dominance of CTX-M-15 producing ESBL isolates