The Prevalence of TEM and SHV Genes among Extended-Spectrum Beta-Lactamases Producing Escherichia Coli and Klebsiella Pneumoniae

Document Type : Original Article


1 Microbiology and Virology Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran

2 Women's Health Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Biostatistics in Health Sciences, Mashhad University of Medical Sciences, Mashhad, Iran


Production of extended-spectrum beta-lactamases (ESBLs) by enteric bacteria continues to be a major problem in hospitals and community. ESBLs producing bacteria cause many serious infections including urinary tract infections, peritonitis, cholangitis and intra-abdominal abscess. The aim of this study was to determine the prevalence of ESBLs producing Escherichia coli and Klebsiella pneumoniae                   bacteria isolated from clinical samples of patients attending Imam Reza and Ghaem University Hospitals, Mashhad, Northeast of Iran.
Materials and Methods
During 2009 and 2010, 82 strains of E. coli and 78 strains of K. pneumoniae were isolated from out-patients and hospitalized patients and they were examined by Oxoid combination disk test and PCR methods.
We found that 43.9% of E. coli and 56.1% of K. pneumoniae produced ESBLs. The frequency of SHV and TEM among the ESBLs producing isolates were 14.4% and 20.6%, respectively. Ratios of ESBLs positive isolates from out-patients to hospitalized patients were 24/33.
This study shows that the prevalence of ESBLs producing E. coli and K. pneumoniae is high in both study groups (out-patients and hospitalized patients). Therefore it seems that continuous surveillance is essential to monitor the ESBLs producing microorganisms in hospitals and community. 


1. Kotra L, Samama J, Mobashery S. Beta-lactamases and resistance to beta-lactam antibiotics.  Bacterial resistance to antimicrobials. NewYork: Marcel Decker; 2002. p.123-160.
2. Bradford PA. Extended spectrum beta-lactamases in the 21st century:characterization, epidemiology and the detection of this important resistance threat. Clin Microbiol Rev 2001; 14:933-951.
3. Kim YK, Pai H, Lee HJ, Park SE, Choi EH, Kim J, et al. Bloodstream infections by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob Agents Chemother  2002; 46:1481-1491.
4. Livermore DM. Beta-lactamases in laboratory and clinical resistance.Clin Microbiol Rev 1995; 8:557-584.
5. Behrooozi A, Rahbar M, Vand Yousefi J. Frequency of extended spectrum beta-lactamase (ESBLs) producing Escherichia coli and Klebseilla pneumoniae isolated from urine in an Iranian 1000-bed tertiary care hospital. Afr J Microbiol Res  2010; 4:881-884.
6. Ramazanzadeh R, Farhadifar F, Mansouri M. Etiology and antibiotic resistance pattern of community-acquired extended-spectrum beta-lactamas-producing gram negative isolates in Sanandaj. Res J Med Sci 2010; 4:243-247.
7. Kalematizadeh E. Determination of extended-spectrum beta-lactamases bacteria in Escherichia coli and Klebsiella pneumoniae. Mashhad: Mashhad University of Medical Sciences; 2008.
8. Herna´ndez JR, Martı´nez-Martı´nez L, Canto´n R, Coque TM, Pascual A. Nationwide study of escherichia coli and Klebsiella pneumoniae producing extended-spectrum -lactamases in Spain. Antimicrob Agents Chemother  2005;49:2122-2125.
9. Mansouri M,Ramazanzadeh R. Spread of extended-spectrum beta-lactamase producing Esherichia coli clinical isolates in Sanandaj hospitals. J Biol Sci  2009; 9:362-366.
10. Gniadkowski M. Evolution and epidemiology of extended-spectrum beta-lactamases (ESBLs) and ESBL-producing microorganisms. Clin Microbiol Infect  2001; 7:597-608.
11. Schiappa DA, Hayden MK, Matushek MG, Hashemi FN, Sullivan J, Smith KY, et al. Ceftazidime-resistant Klebsiella pneumoniae and Escherichia coli bloodstream infection: a case-control and molecular epidemiologic investigation. J Infect Dis 1996; 174:529-536.
12. Alcantar-Curiel D,Tinoco JC, Gayosso C, Carlos A, Daza C, Perez-Prado MC, et al. Nosocomial bacteremia and urinary tract infections caused by extended-spectrum beta -lactamase-producing Klebsiella pneumoniae with plasmids carrying both SHV-5 and TLA-1 genes.Clin Infect Dis  2004; 38:1067-1074.
13. Sambrook J, Russell DW. Molecular cloning.3rd ed.New York (NY):Cold Spring Harbor; 2001.
14. M'Zali FH, Gascoyne-Binzi DM, Heritage J, Hawkey PM. Detection of mutations conferring extended-spectrum activity on SHV beta-lactamases using polymerase chain reaction single strand conformational polymorphism (PCR-SSCP). J Antimicrob Chemother 1996; 37:797-802.
15. Shahcheragh iF,Nasiri S,Noveiri H.The Survey of Genes Encoding Beta-Lactamases, in Escherichia coli resistant to beta-lactam and non-beta-lactam antibiotics. Iran J Basic Med Sci 2010; 13:230-237.
16. Goossens H. MYSTIC (Meropenem Yearly Susceptibility Test Information Collection) results from Europe: comparison of antibiotic susceptibilities between countries and centre types. J Antimicrob Chemother  2000; 46:39-52.
17. Varaiya A, Dogra J, Kulkarni M, Bhalekar P. Extended spectrum beta lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae n diabetic foot infection. Indian J Med Microbiol 2008; 26:281-282.
18. Yu WL,Chuang YC,Walther-Rasmussen J. Extendedspectrum β-lactamases in Taiwan: epidemiology, detection, treatment and infection control. J Microbiol Immunol Infect  2006; 39:264-277.
19. Chaikittisuk N, Munsrichoom A. Extended-spectrum β-Lactamase-producing escherichia coli and Klebsiella pneumoniae in children at Queen Sirikit National Institute of Child Health. J Infect Dis Antimicrob Agents  2007; 24:107-115.
20. Pai H. The characteristics of extended-spectrum β- lactamases in Korean isolates of Enterobactericeae. Yonsei Med J  1998; 39:514-519.
21. Jabeen K, Zafar A, Hasan R. Frequency and sensitivity pattern of extended-spectrum β-lactamase producing isolates in a tertiary care hospital laboratory of  Pakistan. J Pak Med Assoc 2005; 55:436-439.
22. Ullah F, Malik SA, Ahmed J. Antibiotic susceptibility pattern and ESBLS prevallence in nosocomial Escherichia coli from urinary tract infections in Pakistan. Afr J Biotechnol 2009; 8:3921-3926.
23. Fazly Bazzaz BS, Naderinasab M, Mohamadpoor AH, Farshadzadeh Z, Ahmadi S, Yousefi F. The prevalence of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae among clinical isolates from a general hospital in Iran. Acta Microbiol Immunol Hung 2009; 56:89-99.
24. Aminzadeh Z, Sadat KM, Sha'bani M. Bacteriuria by extendedspectrum Beta-lactamase-producing E. coli and Klebsiella pneumoniae: isolates in a governmental hospital in South of Tehran, Iran. Iran J Kidney Dis  2008; 2:197-200.
25. Feizabadi MM, Etemadi G, Yadegarinia D, Rahmati M, Shabanpoor S, Bokaei S. Antibiotic-resistance patterns and frequency of extended-spectrum beta-lactamase-producing isolates of Klebsiella pneumoniae in Tehran. Med Sci Monit  2006; 12:BR362-365.
26. Mehrgan H, Rahbar M. Prevalence of extended-spectrum betalactamase- producing Escherichia coli in a tertiary care hospital in Tehran, Iran. Int J Antimicrob Agents  2008; 31:1471-1451.
27. Bell JM, Chitsaz M, Turnidge JD, Barton M, Walters LJ, Jones RN. Prevalence and significance of a negative extended-spectrum-lactamase (ESBL) confirmation test result after a positive ESBL screening test result for isolates of Escherichia coli and Klebsiella pneumoniae: Results from the SENTRY Asia-Pacific surveillance program. J Clin Microbiol  2007; 45:1478-1482.
28. Masjedian Jazi F, Valehi F, Talebi A, Rastegar Lari A. Molecular characterization of resistance to Extended - Spectrum antibiotics in Escherichia coli and Klebsiella pneumoniae. Iran J Med Microbiol 2007; 2:27-34 (In Persian).
29. Shahcheragh F, Nasiri S, Noveiri H. Detection of extended-spectrum β-lactamases (ESBLs) in Escherichia coli. Iran J Clin Infect Dis  2009; 4:63-70.
30. Taşli H, Bahar IH. Molecular characterization of TEM- and SHV-derived extended-spectrum beta-lactamases in hospital-based Enterobacteriaceae in Turkey. Jpn J Infect Dis  2005; 58:162-167.
31. Ramazanzadeh R. Prevalence and characterization of extended-spectrum beta-lactamase production in clinical isolates of Klebsiella spp. Afr J Microbiol Res  2010; 4:1359-1362.