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Prevalence of [bla.sub.CTX-M] Gene among Extended-Spectrum [beta]-Lactamases Producing Klebsiella pneumoniae Clinical Isolates in Iran: A Meta-Analysis.

Introduction

Extended-spectrum [beta]-lactamases (ESBLs) are bacterial enzymes that confer resistance to penicillins, broad-spectrum oxyimino-cephalosporins and aztreonam, but suppressed by serine-type [beta]-lactamase inhibitors (e.g. clavulanic acid). ESBLs can be encoded through both chromosome and plasmid genes, and more than ten families have been so far documented to be associated with ESBLs, including CTX-M, SHV, TEM, PER, VEB, BES, GES, TLA, SFO, and OXA. (1-3) CTX-M-type ESBLs are plasmid-encoded enzymes that have been detected in at least 26 bacterial species. CTX-Ms are the most prevalent ESBLs in Enterobacteriaceae particularly in Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. (1,3-5) A member of the Enterobacteriaceae family, K. pneumoniae strains are ubiquitous in nature and exist specifically in natural environments and on mucosal surfaces of mammals. This microorganism is an opportunistic bacterial pathogen that commonly causes different infections in human. (6-8) K. pneumoniae is one of the major ESBLs-producing bacteria. ESBLs-producing K. pneumoniae is more prevalent in Asia and South America, (9) and has recently been listed as one of the six drug-resistant pathogens for which few potentially effective drugs are available. (10) The worldwide spread of CTX-M-producing K. pneumoniae is a major concern in most continents such as Asia. (11-13) Recently, high rate of CTX-M enzymes (as high as 58.5%) among ESBLs-producing K. pneumoniae isolates have been reported in many countries including Brazil, (12) Spain, (14) Korea, (15) etc.

To date, several studies have examined the prevalence of CTX-Ms in ESBLs-producing K. pneumoniae clinical isolates in different geographical regions of Iran. Nevertheless, the average rate of CTX-M enzymes among ESBLs-producing K. pneumoniae isolates has not been clearly identified in Iran. Therefore, in this meta-analysis, we reviewed published studies regarding the prevalence of [bla.sub.CTX-M] gene among ESBLs-producing K. pneumoniae clinical isolates in Iran and presented an overall relative frequency (RF).

Materials and Methods

Search Strategy

To identify all related published studies, we searched PubMed, Scopus, EBSCO, Embase, Google Scholar, Scirus and four Persian scientific search engines including IranMedex, IRANDOC, Magiran, and scientific information database (SID) in both English and Persian. The medical subject headings (MESH) and keywords used for the search were "Enterobacteriaceae" and "Klebsiella pneumoniae or K pneumoniae" and "Extended-spectrum [beta]-lactamases or ESBLs" and "CTX-M" and "Iran". The searched keywords were adapted to the primary language of the database. We also searched the references cited in these articles to find other relevant articles. Selected articles were published between July 2010 and July 2016 and all of them were in English.

Inclusion Criteria

Among obtained articles/abstracts, those with the following features were included in the study: a- Articles that have assessed the prevalence of [bla.sub.CTX-M] gene

b- Clinical isolates that were collected from Iranian hospitals

c- Clinical isolates that were taken from patients (both inpatients and outpatients)

d- Samples that only belonged to the genus Klebsiella, species pneumoniae

e- Phenotypic confirmatory ESBL test (either combination disk test or double disc synergy test) which were used to detect ESBL production

f- Only ESBLs-producing isolates which were confirmed by phenotypic ESBL test.

Exclusion Criteria

Studies with at least one of the following criteria were excluded from our study:

a- Samples that were totally/partially selected from ESBLs collections

b- The origin of samples (region or population) was not clear

c- Unclear report of the results

Statistical Analysis

Statistical analysis was executed by the STATA software, version 11.0 (StataCorp, College Station, TX, USA). The overall RF of CTX-M in Iran was pooled by forest plot using the Meta-Analyst software. Heterogeneity among studies was assessed by Cochrane's Q-test and [I.sup.2] measurement, which was interpreted as the proportion of total variation contributed among study variants. A P[less than or equal to]0.10 and an [I.sup.2] value [greater than or equal to]50% shown significant heterogeneity. A random-effect model was applied in the incidence of significant heterogeneity; if not, a fixed-effect model was executed.

Results

According to heterogeneity test, random model methods were performed for meta-analysis tests (P<0.001). The [I.sup.2]>50% indicated the presence of heterogeneity in our pooled analysis.

Out of all papers found by the search of databases, 24 articles matched our inclusion criteria (20 full-text articles and 4 abstracts) selected for our pooled analysis (16-35) (table 1). A detailed flowchart showing the selection process is presented in figure 1. These studies were conducted in 10 provinces and 11 cities of Iran. The prevalence of ESBLs among K pneumoniae clinical isolates varied from 28% in Kerman (21) to 74% in Tehran, (19) with the mean of 49%. The prevalence of [bla.sub.CTX-M] gene among ESBLs-producing K. pneumoniae clinical isolates varied from 7.7% in Tabriz (19) to 100% in Mashhad, Tehran and Zahedan, (23,33,35) with the mean of 56.7%. In Tehran, the capital city of Iran, the prevalence of [bla.sub.CTX-M] gene among ESBLs-producing K. pneumoniae clinical isolates varied from 20.6% to 100%, with the mean of 61.7%. (18,19,27-33) Pooled estimation of K. pneumoniae samples revealed that 55.9% (95% CI=43.0-68.9) of strains are CTX-M positive. Figure 2 demonstrates the forest plot of the relative frequency of [bla.sub.CTX-M] gene among different studies performed in Iran.

Discussion

In recent years, numerous studies by Iranian researchers have been conducted to identify [bla.sub.CTX-M] gene variants among ESBLs-producing K. pneumoniae clinical isolates. Based on these studies, this review presented a meta-analysis to show the prevalence of [bla.sub.CTX-M] gene among ESBLs-producing K. pneumoniae clinical isolates in Iran. Based on our results, the CTX-M-type ESBLs-producing K. pneumoniae is less frequent in western cities compared to central and eastern cities. The mean prevalence of ESBLs among K. pneumoniae clinical isolates in Iran was 49% that, on average, 56.7% of these isolates (ESBLs-producing isolates) possessed [bla.sub.CTX-M] gene. Lee et al., (11) in their study on K. pneumoniae clinical isolates in 9 Asian countries have shown that ESBLs-production rates differed amongst the studied countries. The percentage of ESBLs-producers was low in Hong Kong and Taiwan (7.7% and 8.3%, respectively), but was high in South Korea, India, and Thailand (66.7%, 57.1%, and 55.3%, respectively). Moreover, they showed that 72.8% of ESBLs-producing isolates were possessed [bla.sub.CTX-M] gene which amongst, [bla.sub.CTX-M-15] was the major variant. Similarly, in Iran, the sequencing results in some studies demonstrated that the major variants of [bla.sub.CTX-M] gene among ESBLs-producing K. pneumoniae clinical isolates are [bla.sub.CTX-M-15] (23,26,29,30,32,35-37) followed by [bla.sub.CTX-M-8], (35,36) [bla.sub.CTX-M-3] and [bla.sub.CTX-M-22]. (26) From a regional stand, Iran has a higher mean prevalence of [bla.sub.CTX-M] gene among ESBLs-producing K. pneumoniae clinical isolates compared to reports from neighboring countries including Turkey (30%), (38,39) Saudi Arabia (35.3%), (40,41) Iraq (45.2%), (42,43) and Bahrain (10%) (44) as well as lower mean prevalence compared to Pakistan (96.9%), (45,46) Kuwait (100%), (47) and United Arab Emirates (64.4%). (48) In a continental perspective, Iran has a lower mean prevalence of [bla.sub.CTX-M] gene among ESBLs-producing K. pneumoniae clinical isolates compared to reports from East Asian countries (78.8%). (11,49) At the international level, mean prevalence of [bla.sub.CTX-M] gene among ESBLs-producing K. pneumoniae clinical isolates in Iran is higher than USA (26.4%), (50) Russia (34.9%), (51) and South Africa (7.4%) (39) as well as lower than Brazil (62.1%) (12,52) and Argentina (61.1%) (39) in Latin America and some European countries (84.5%). (9,53-56)

Our study had some limitations, including lack of published data from certain regions of Iran and the unavailability of some in-press articles that were excluded from our study.

Conclusion

In conclusion, this study showed that the prevalence of CTX-M-type ESBLs-producing K. pneumoniae is diverse in different regions of Iran, and the central and eastern regions have higher RF compared to western regions.

Acknowledgment

The authors appreciate all individuals who willingly participated in the present study. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of Interest: None declared.

References

(1.) Zhao WH, Hu ZQ. Epidemiology and genetics of CTX-M extended-spectrum beta-lactamases in Gram-negative bacteria. Crit Rev Microbiol. 2013;39:79-101. doi: 10.3109/1040841X.2012.691460. PubMed PMID: 22697133; PubMed Central PMCID: PMCPMC4086240.

(2.) Woerther PL, Burdet C, Chachaty E, Andremont A. Trends in human fecal carriage of extended-spectrum beta-lactamases in the community: Toward the globalization of CTX-M. Clin Microbiol Rev. 2013;26:744-58. doi: 10.1128/CMR.00023-13. PubMed PMID: 24092853; PubMed Central PMCID: PMCPMC3811232.

(3.) Trang NH, Nga TV, Campbell JI, Hiep NT, Farrar J, Baker S, et al. The characterization of ESBL genes in Escherichia coli and Klebsiella pneumoniae causing nosocomial infections in Vietnam. J Infect Dev Ctries. 2013;7:922-8. doi: 10.3855/jidc.2938. PubMed PMID: 24334938.

(4.) D'Andrea MM, Arena F, Pallecchi L, Rossolini GM. CTX-M-type beta-lactamases: A successful story of antibiotic resistance. Int J Med Microbiol. 2013;303:305-17. doi: 10.1016/j.ijmm.2013.02.008. PubMed PMID: 23490927.

(5.) Wieler LH, Ewers C, Guenther S, Walther B, Lubke-Becker A. Methicillin-resistant staphylococci (MRS) and extended-spectrum beta-lactamases (ESBL)-producing Enterobacteriaceae in companion animals: Nosocomial infections as one reason for the rising prevalence of these potential zoonotic pathogens in clinical samples. Int J Med Microbiol. 2011;301:635-41. doi: 10.1016/j.ijmm.2011.09.009. PubMed PMID: 22000738.

(6.) Vuotto C, Longo F, Balice MP, Donelli G, Varaldo PE. Antibiotic Resistance Related to Biofilm Formation in Klebsiella pneumoniae. Pathogens. 2014;3:743-58. doi: 10.3390/pathogens3030743. PubMed PMID: 25438022; PubMed Central PMCID: PMCPMC4243439.

(7.) Gupta A, Ampofo K, Rubenstein D, Saiman L. Extended spectrum beta lactamase-producing Klebsiella pneumoniae infections: A review of the literature. J Perinatol. 2003;23:439-43. doi: 10.1038/sj.jp.7210973. PubMed PMID: 13679928.

(8.) Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: Epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev. 1998;11:589-603. PubMed PMID: 9767057; PubMed Central PMCID: PMCPMC88898.

(9.) Onnberg A, Molling P, Zimmermann J, Soderquist B. Molecular and phenotypic characterization of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum beta-lactamases with focus on CTX-M in a low-endemic area in Sweden. APMIS. 2011;119:287-95. doi: 10.1111/j.1600-0463.2011.02730.x. PubMed PMID: 21492229.

(10.) Chong Y, Ito Y, Kamimura T. Genetic evolution and clinical impact in extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. Infect Genet Evol. 2011;11:1499-504. doi: 10.1016/j.meegid.2011.06.001. PubMed PMID: 21689785.

(11.) Lee MY, Ko KS, Kang CI, Chung DR, Peck KR, Song JH. High prevalence of CTX-M-15-producing Klebsiella pneumoniae isolates in Asian countries: Diverse clones and clonal dissemination. Int J Antimicrob Agents. 2011;38:160-3. doi: 10.1016/j.ijantimicag.2011.03.020. PubMed PMID: 21605960.

(12.) Chagas TP, Alves RM, Vallim DC, Seki LM, Campos LC, Asensi MD. Diversity of genotypes in CTX-M-producing Klebsiella pneumoniae isolated in different hospitals in Brazil. Braz J Infect Dis. 2011;15:420-5. PubMed PMID: 22230847.

(13.) Randrianirina F, Vedy S, Rakotovao D, Ramarokoto CE, Ratsitohaina H, Carod JF, et al. Role of contaminated aspiration tubes in nosocomial outbreak of Klebsiella pneumoniae producing SHV-2 and CTX-M-15 extended-spectrum beta-lactamases. J Hosp Infect. 2009;72:23-9. doi: 10.1016/j.jhin.2009.02.004. PubMed PMID: 19282056.

(14.) Oteo J, Cuevas O, Lopez-Rodriguez I, Banderas-Florido A, Vindel A, Perez-Vazquez M, et al. Emergence of CTX-M-15-producing Klebsiella pneumoniae of multilocus sequence types 1, 11, 14, 17, 20, 35 and 36 as pathogens and colonizers in newborns and adults. J Antimicrob Chemother. 2009;64:524-8. doi: 10.1093/jac/dkp211. PubMed PMID: 19525516.

(15.) Lee SG, Jeong SH, Lee H, Kim CK, Lee Y, Koh E, et al. Spread of CTX-M-type extended-spectrum beta-lactamases among bloodstream isolates of Escherichia coli and Klebsiella pneumoniae from a Korean hospital. Diagn Microbiol Infect Dis. 2009;63:76-80. doi: 10.1016/j.diagmicrobio.2008.09.002. PubMed PMID: 19073302.

(16.) Khosravi AD, Hoveizavi H, Mehdinejad M. Prevalence of Klebsiella pneumoniae encoding genes for CTX-M-1, TEM-1 and SHV-1 extended-spectrum beta lactamases (ESBL) enzymes in clinical specimens. Jundishapur J Microbiol. 2013;6:e8256. doi: 10.5812/jjm.8256.

(17.) Safari M, Shojapour M, Akbari M, Pourbabaee A, Abtahi H. Dissemination of CTX-M-type beta-lactamase among clinical isolates of Enterobacteriaceae in Markazi province, Iran. Jundishapur J Microbiol. 2013;6:e7182. doi: 10.5812/jjm.7182.

(18.) Ghafourian S, Sekawi Z, Neela V, Khosravi A, Rahbar M, Sadeghifard N. Incidence of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in patients with urinary tract infection. Sao Paulo Med J. 2012;130:37-43. PubMed PMID: 22344358.

(19.) Ghafourian S, Bin Sekawi Z, Sadeghifard N, Mohebi R, Kumari Neela V, Maleki A, et al. The Prevalence of ESBLs Producing Klebsiella pneumoniae Isolates in Some Major Hospitals, Iran. Open Microbiol J. 2011;5:91-5. doi: 10.2174/1874285801105010091. PubMed PMID: 21915229; PubMed Central PMCID: PMCPMC3170933.

(20.) Firoozeh F, Amiri A, Moniri R, Zibaei M. Characterization of Subtypes of Ctx-M Extended-Spectrum B-Lactamase among Klebsiella Spp. Iran J Public Health. 2014;43:83.

(21.) Mansouri S, Kalantar Neyestanaki D, Shokoohi M, Halimi S, Beigverdi R, Rezagholezadeh F, et al. Characterization of AmpC, CTX-M and MBLs types of beta-lactamases in clinical isolates of Klebsiella pneumoniae and Escherichia coli producing Extended Spectrum beta-lactamases in Kerman, Iran. Jundishapur J Microbiol. 2014;7:e8756. doi: 10.5812/jjm.8756. PubMed PMID: 25147671; PubMed Central PMCID: PMCPMC4138687.

(22.) Mansouri S, Kalantar D, Asadollahi P, Taherikalani M, Emaneini M. Characterization of Klebsiella pneumoniae strains producing extended spectrum beta-lactamases and AMPC type beta-lactamases isolated from hospitalized patients in Kerman, Iran. Roum Arch Microbiol Immunol. 2012;71:81-6. PubMed PMID: 23210321.

(23.) Moghaddam MN, Beidokhti MH, Jamehdar SA, Ghahraman M. Genetic properties of [bla.sub.CTX-M] and blaPER beta-lactamase genes in clinical isolates of Enterobacteriaceae by polymerase chain reaction. Iran J Basic Med Sci. 2014;17:378-83. PubMed PMID: 24967067; PubMed Central PMCID: PMCPMC4069837.

(24.) Ghasemi Y, Archin T, Kargar M, Mohkam M. A simple multiplex PCR for assessing prevalence of extended-spectrum beta-lactamases producing Klebsiella pneumoniae in Intensive Care Units of a referral hospital in Shiraz, Iran. Asian Pac J Trop Med. 2013;6:703-8. doi: 10.1016/S1995-7645(13)60122-4. PubMed PMID: 23827147.

(25.) Ghafourian S, Sadeghifard N, Sekawi Z, Neela VK, Shamsudin MN, Pakzad I, et al. Phenotypic and genotypic assay for detection of extended spectrum B-lactamases production by Klebsiella pnemoniae isolates in Emam Reza Hospital in Tabriz, Iran. J Pure Appl Microbiol. 2011;5:1-10.

(26.) Pormohammad A, Hasani A, Shams F, Nahaie MR, Hasani A, Mohammadzade A, et al. Prevalence of Ctx-3 (Ctx-M 3, 15, 22) Family Gene in Various E. coli and Klebsiella Pneumoniae Clinical Specimes in Tabriz. Iran J Public Health. 2014;43:91.

(27.) Nematzadeh S, Shahcheraghi F, Feizabadi MM, Nikbin VS, Nasehi L. Molecular characterization of CTX-Mbeta-lactamases among Klebsiella pneumoniae isolated from patients at Tehran hospitals. Indian J Med Microbiol. 2011;29:254-7. doi: 10.4103/0255-0857.83908. PubMed PMID: 21860105.

(28.) Nasehi L, Shahcheraghi F, Nikbin VS, Nematzadeh S. PER, CTX-M, TEM and SHV Beta-lactamases in clinical isolates of Klebsiella pneumoniae isolated from Tehran, Iran. Iran J Basic Med Sci. 2010;13:111-8.

(29.) Peerayeh SN, Rostami E, Siadat SD, Derakhshan S. High rate of aminoglycoside resistance in CTX-M-15 producing Klebsiella pneumoniae isolates in Tehran, Iran. Lab Med. 2014;45:231-7. doi: 10.1309/LMDQQW246NYAHHAD. PubMed PMID: 25051075.

(30.) Hashemi A, Fallah F, Erfanimanesh S, Hamedani P, Alimehr S, Goudarzi H. Detection of beta -Lactamases and Outer Membrane Porins among Klebsiella pneumoniae Strains Isolated in Iran. Scientifica (Cairo). 2014;2014:726179. doi: 10.1155/2014/726179. PubMed PMID: 25548718; PubMed Central PMCID: PMCPMC4274865.

(31.) Taherpour A, Hashemi A. Detection of OqxAB efflux pumps, OmpK35 and OmpK36 porins in extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae isolates from Iran. Hippokratia. 2013;17:355-8. PubMed PMID: 25031516; PubMed Central PMCID: PMCPMC4097418.

(32.) Karimisup A, Rahbar M, Fallahsup F, Navidiniasup M, Malekansup MA. Detection of integron elements and gene groups encoding ESBLs and their prevalence in Escherichia coli and Klebsiella isolated from urine samples by PCR method. Afr J Microbiol Res. 2012;6:1806-9.

(33.) Derakhshan S, Peerayeh SN, Fallah F, Bakhshi B, Rahbar M, Ashrafi A. Detection of class 1, 2, and 3 integrons among Klebsiella pneumoniae isolated from children in Tehran hospitals. Archives of Pediatric Infectious Diseases. 2014;2:164-8.

(34.) Saeidi S, Alavi-Naini R, Shayan S. Antimicrobial susceptibility and distribution of tem and ctx-m genes among esbl-producing Klebsiella pneumoniae and Pseudomonas aeruginosa causing urinary tract infections. Zahedan Journal of Research in Medical Sciences. 2014;16:1-5.

(35.) Shahraki-Zahedani S, Moghadampour M, Bokaeian M, Ansari-Moghaddam A. Prevalence of CTX-M-8 and CTX-M-15 type extended-spectrum beta-lactamases between Klebsiella pneumoniae spp. isolated from Zahedan, Southeast Iran. J Chemother. 2016;28:343-5. doi: 10.1179/1973947815Y.0000000008. PubMed PMID: 25801185.

(36.) Feizabadi MM, Delfani S, Raji N, Majnooni A, Aligholi M, Shahcheraghi F, et al. Distribution of bla(TEM), bla(SHV), bla(CTX-M) genes among clinical isolates of Klebsiella pneumoniae at Labbafinejad Hospital, Tehran, Iran. Microb Drug Resist. 2010;16:49-53. doi: 10.1089/mdr.2009.0096. PubMed PMID: 19961397.

(37.) Feizabadi MM, Mahamadi-Yeganeh S, Mirsalehian A, Mirafshar SM, Mahboobi M, Nili F, et al. Genetic characterization of ESBL producing strains of Klebsiella pneumoniae from Tehran hospitals. J Infect Dev Ctries. 2010;4:609-15. PubMed PMID: 21045352.

(38.) Eser OK, Ergin A, Hascelik G. Occurrence and characterisation of CTX-M enzymes in Enterobacteriaceae isolated from intensive care units of a Turkish university hospital. Indian J Med Microbiol. 2013;31:415-6. doi: 10.4103/0255-0857.118881. PubMed PMID: 24064656.

(39.) Paterson DL, Hujer KM, Hujer AM, Yeiser B, Bonomo MD, Rice LB, et al. Extended-spectrum beta-lactamases in Klebsiella pneumoniae bloodstream isolates from seven countries: Dominance and widespread prevalence of SHV- and CTX-M-type beta-lactamases. Antimicrob Agents Chemother. 2003;47:3554-60. PubMed PMID: 14576117; PubMed Central PMCID: PMCPMC253771.

(40.) Al-Agamy MH, Shibl AM, Tawfik AF. Prevalence and molecular characterization of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in Riyadh, Saudi Arabia. Ann Saudi Med. 2009;29:253-7. PubMed PMID: 19587523; PubMed Central PMCID: PMCPMC2841451.

(41.) Tawfik AF, Alswailem AM, Shibl AM, Al-Agamy MH. Prevalence and genetic characteristics of TEM, SHV, and CTX-M in clinical Klebsiella pneumoniae isolates from Saudi Arabia. Microb Drug Resist. 2011;17:383-8. doi: 10.1089/mdr.2011.0011. PubMed PMID: 21612509.

(42.) Mohammed AS. Molecular Detection of CTX-M Genes in Klebsiella pneumoniae Isolated from Different Clinical Samples in Baghdad City. Medical Journal of Babylon. 2015;12:152-60.

(43.) Shabaa RAH. Detection of CTX-M-1 gene Among Klebsiella pneumonia Isolates in An Najaf Province. Iraqi Journal of Biotechnology. 2014;13:128-33.

(44.) Bindayna KM, Murtadha M. High prevalence of [bla.sub.CTX-M] in Enterobacteriaceae isolates from the Kingdom of Bahrain. Asian Pac J Trop Med. 2011;4:937-40. doi: 10.1016/S1995-7645(11)60222-8. PubMed PMID: 22118027.

(45.) Khan E, Schneiders T, Zafar A, Aziz E, Parekh A, Hasan R. Emergence of CTX-M Group 1-ESBL producing Klebsiella pneumonia from a tertiary care centre in Karachi, Pakistan. J Infect Dev Ctries. 2010;4:472-6. PubMed PMID: 20818098.

(46.) Habeeb MA, Haque A, Nematzadeh S, Iversen A, Giske CG. High prevalence of 16S rRNA methylase RmtB among CTX-M extended-spectrum beta-lactamase-producing Klebsiella pneumoniae from Islamabad, Pakistan. Int J Antimicrob Agents. 2013;41:524-6. doi: 10.1016/j.ijantimicag.2013.02.017. PubMed PMID: 23622882.

(47.) Al Sweih N, Salama MF, Jamal W, Al Hashem G, Rotimi VO. An outbreak of CTX-M-15-producing Klebsiella pneumoniae isolates in an intensive care unit of a teaching hospital in Kuwait. Indian J Med Microbiol. 2011;29:130-5. doi: 10.4103/0255-0857.81791. PubMed PMID: 21654106.

(48.) Alfaresi MS, Elkoush AA, Alshehhi HM, Abdulsalam AI. Molecular characterization and epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates in the United Arab Emirates. Med Princ Pract. 2011;20:177-80. doi: 10.1159/000319912. PubMed PMID: 21252576.

(49.) An S, Chen J, Wang Z, Wang X, Yan X, Li J, et al. Predominant characteristics of CTX-M-producing Klebsiella pneumoniae isolates from patients with lower respiratory tract infection in multiple medical centers in China. FEMS Microbiol Lett. 2012;332:137-45. doi: 10.1111/j.1574-6968.2012.02586.x. PubMed PMID: 22537112.

(50.) Wang G, Huang T, Surendraiah PK, Wang K, Komal R, Zhuge J, et al. CTX-M beta-lactamase-producing Klebsiella pneumoniae in suburban New York City, New York, USA. Emerg Infect Dis. 2013;19:1803-10. doi: 10.3201/eid1911.121470. PubMed PMID: 24188126; PubMed Central PMCID: PMCPMC3837662.

(51.) Edelstein M, Pimkin M, Palagin I, Edelstein I, Stratchounski L. Prevalence and molecular epidemiology of CTX-M extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Russian hospitals. Antimicrob Agents Chemother. 2003;47:3724-32. PubMed PMID: 14638473; PubMed Central PMCID: PMCPMC296190.

(52.) Tollentino FM, Polotto M, Nogueira ML, Lincopan N, Neves P, Mamizuka EM, et al. High prevalence of bla(CTX-M) extended spectrum beta-lactamase genes in Klebsiella pneumoniae isolates from a tertiary care hospital: First report of bla(SHV-12), bla(SHV-31), bla(SHV-38), and bla(CTX-M-15) in Brazil. Microb Drug Resist. 2011;17:7-16. doi: 10.1089/mdr.2010.0055. PubMed PMID: 20795871.

(53.) Lester CH, Olsen SS, Jakobsen L, Arpi M, Fuursted K, Hansen DS, et al. Emergence of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae in Danish hospitals; this is in part explained by spread of two CTX-M-15 clones with multilocus sequence types 15 and 16 in Zealand. Int J Antimicrob Agents. 2011;38:180-2. doi: 10.1016/j.ijantimicag.2011.03.018. PubMed PMID: 21612893.

(54.) Mshana SE, Fritzenwanker M, Falgenhauer L, Domann E, Hain T, Chakraborty T, et al. Molecular epidemiology and characterization of an outbreak causing Klebsiella pneumoniae clone carrying chromosomally located bla(CTX-M-15) at a German University-Hospital. BMC Microbiol. 2015;15:122. doi: 10.1186/s12866-015-0460-2. PubMed PMID: 26077154; PubMed Central PMCID: PMCPMC4469578.

(55.) Vranic-Ladavac M, Bosnjak Z, Beader N, Barisic N, Kalenic S, Bedenic B. Clonal spread of CTX-M-15-producing Klebsiella pneumoniae in a Croatian hospital. J Med Microbiol. 2010;59:1069-78. doi: 10.1099/jmm.0.019778-0. PubMed PMID: 20576749.

(56.) Ibrahimagic A, Bedenic B, Kamberovic F, Uzunovic S. High prevalence of CTX-M-15 and first report of CTX-M-3, CTX-M-22, CTX-M-28 and plasmid-mediated AmpC beta-lactamase producing Enterobacteriaceae causing urinary tract infections in Bosnia and Herzegovina in hospital and community settings. J Infect Chemother. 2015;21:363-9. doi: 10.1016/j.jiac.2015.01.003. PubMed PMID: 25638292.

Ebrahim Eskandari-Nasab (1,) (2), MSc;

Mehdi Moghadampour (3), MSc;

Arezoo Tahmasebi (4), MSc

(1) Genetic of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran;

(2) Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran;

(3) Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran;

(4) Department of Statistical and Actuarial Sciences, University of Western Ontario (UWO), London, ON, Canada

Correspondence:

Mehdi Moghadampour, MSc; Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, P. O. Box: 81746-73461, Isfahan, Iran

Tel: +98 913 9351772

Fax: +98 31 36688597

Email: mehdimoghadampoor@yahoo.com

Received: 01 November 2016

Revised: 20 December 2016

Accepted: 01 January 2017

What's Known

* Several studies have examined the prevalence of CTX-Ms in ESBLs-producing K. pneumoniae clinical isolates in different geographical regions of Iran.

* The average rate of CTX-M enzymes among ESBLs-producing K. pneumoniae isolates has not been clearly identifed in Iran.

What's New

* We reviewed published studies regarding the prevalence of [bla.sub.CTX-M] gene among ESBLs-producing K. pneumoniae clinical isolates in Iran and presented an overall relative frequency (RF).

* The overall RF of [bla.sub.CTX-M] gene among ESBLs-producing K. pneumoniae clinical isolates in Iran is 56.7%.
Table 1: Characteristics of studies included in meta-analysis

City     Hospitals name         Sample  Number
                                size    of isolates
                                        carrying the
                                        [bla.sub.CTX-M] gene

Ahvaz    Golestan, Razi         26       7
Arak     Educational hospitals  41      36
         of Medical University
Ilam     Emam Khomaini,         43      10
         Mostafa Khomaini,
         Ghaem
Ilam     Emam Khomaini,         17       5
         Mostafa Khomaini,
         Ghaem
Kashan   Hospitals in Kashan    35      28
Kerman   Afzali Poor, Kashani,  33      16
         Bahonar
Kerman   Hospitals in Kerman    31       6
Mashhad  Qaem, 17-Shahrivar      9       9
Shiraz   Namazi                 36      25
Tabriz   Emam Reza              45       7
Tabriz   Sina                   45      26
Tabriz   Emam Reza              21       4
Tabriz   Emam Reza              13       1
Tehran   10 hospitals           102     73
Tehran   3 general and          77      45
         2 private hospitals
Tehran   Hospitals in Tehran    72      45
Tehran   Milad                  68      14
Tehran   Taleghani, Mofid       48      30
Tehran   Taleghani, Mofid       48      28
Tehran   Mofid                  19      18
Tehran   Milad                  37      10
Tehran   Loghman-E Hakim,       17      17
         Imam Khomeini,
         Milad
Zabol    Amir Al-Momenin        20      13
Zahedan  Ali ibn Abi Talib,     51      51
         Khatamal Anbiya,
         Buali
City     Relative            Study                    Year
         frequency           team (reference no.)     published
         of [bla.sub.CTX-M]
         gene (%)

Ahvaz     26.9               Khosravi et al. (16)     2013
Arak      87.8               Safari et al. (17)       2013
Ilam      23.3               Ghafourian et al. (18)   2012
Ilam      29.4               Ghafourian et al. (19)   2011
Kashan    80                 Firoozeh et al. (20)     2014
Kerman    48.5               Mansouri et al. (21)     2014
Kerman    20                 Mansouri et al. (22)     2012 (abstract)
Mashhad  100                 Moghaddam et al. (23)    2014
Shiraz    69.4               Ghasemi et al. (24)      2013
Tabriz    15.5               Ghafourian et al. (25)   2011
Tabriz    57.8               Pormohammad et al. (26)  2014 (abstract)
Tabriz    19                 Ghafourian et al. (18)   2012
Tabriz     7.7               Ghafourian et al. (19)   2011
Tehran    71.6               Nematzadeh et al. (27)   2011
Tehran    58.4               Nasehi et al. (28)       2010

Tehran    62.5               Peerayeh et al. (29)     2014 (abstract)
Tehran    20.6               Ghafourian et al. (18)   2012
Tehran    62.5               Hashemi et al. (30)      2014
Tehran    58.3               Taherpour et al. (31)    2013
Tehran    94.7               Karimi et al. (32)       2012
Tehran    27                 Ghafourian et al. (19)   2011
Tehran   100                 Derakhshan et al. (33)   2014
Zabol     65                 Saeidi et al. (34)       2014
Zahedan  100                 Shahraki-Zahedani        2016
                             et al. (35)
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Author:Eskandari-Nasab, Ebrahim; Moghadampour, Mehdi; Tahmasebi, Arezoo
Publication:Iranian Journal of Medical Sciences
Article Type:Report
Geographic Code:7IRAN
Date:Jul 1, 2018
Words:4282
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