Published date: Mar 31 2021

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 16 (2021), Issue No. 1

Pages: 5-16

DOI: 10.18502/sjms.v16i1.8933

Hisham N AltaybBiochemistry Department, Faculty of Sciences, King Abdulaziz University, Jeddah, 21452, Saudi Arabia

Mohamed A M Siddig Botany department, Faculty of Science, University of Khartoum, Sudan

Nagwa M El AminDepartment of Microbiology, Faculty of Medicine, Qassim University, KSA

Maowia M. MukhtarBioscience Research Institute, Ibn Sina University, P.O. Box 11463, Khartoum, Sudan

Background: This study aimed to characterize bla_CTX-M, bla_TEM, and bla_SHV genes among extended-spectrum beta-lactamases (ESBLs)-producing Enterobacteriaceae species in different regions of Sudan.

Methods: In this cross-sectional study, different clinical samples (n = 985) were collected randomly from symptomatic patients from four geographical regions of Sudan and cultured on chromogenic media. Following bacterial identification, phenotypic screening of ESBLs was done according to CLSI guidelines using cefotaxime (30 μg), ceftazidime (30 μg), and cefepime (30 μg) discs with and without clavulanic acid. The DNA was extracted by guanidine hydrochloride protocol, and then conventional PCR was used to detect bla_CTX-M, bla_TEM, and bla_SHV genes. The presence of genes’ subtypes was characterized by DNA Sanger sequencing for selected samples. 

Results: Enterobacteriaceae represented 31% (305/985) of all isolates, 42 (128/305) of which were ESBLs producer, confirmed by phenotypic confirmatory test (75% [96/128] of them were positive for bla_CTX-M genes, 61% [78/128] for bla_TEM genes, and 38% [48/128] for bla_SHV genes). Fourteen isolates (11%) were negative for all genes. Forty-eight percent (63/75) of Escherichia coli isolates were positive for bla_CTX-M, while in Klebsiella pneumoniae, the dominant gene was bla_TEM (82%) and had a low amount of bla_SHV (59%). There was a significant association (P-value = 0.001 for all except for chloramphenicol, P = 0.014, and amikacin, P = 0.017) between resistance to third-generation cephalosporins and ciprofloxacin, nalidixic acid, meropenem, chloramphenicol, and amikacin.  Forty-two percent (40/96) of CTX-M-positive isolates were in Gizera State, 33% (32.96) in Sinnar, 24% (23/96) in Khartoum, and 1% (1/96) in White Nile. 

Conclusion: We conclude that bla_CTX-M genes are the most dominant genes in ESBLs-producing isolates and are more prevalent in big cities than in rural areas.

Keywords: phenotypic, bla_CTX-M, bla_TEM, and bla_SHV ESBLs genes, Enterobacteriaceae, Sudan

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