The Open Microbiology Journal

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Occurrence and Characteristics of the Extended-spectrum Beta-lactamase-producing Enterobacterale in a Hospital Setting

Salah H. Elsafi1, *
1 Clinical Laboratory Science, Prince Sultan Military College of Health Science, Dammam, Kingdom of Saudi Arabia



Infectious diseases caused by ESBL-producing Enterobacterale are an emerging problem worldwide, which increase hospital costs, empirical treatment failure, together with rates of morbidity and mortality. The aims of this study were to determine the antibiotic-resistant patterns and the frequency of blaTEM, blaCTX-M and blaSHV genes among Enterobacterale.


A total of 239 non-repeated clinical isolates of the Enterobacterale family, including 202 (84.5%) Escherichia coli and Klebsiella pneumoniae 25 (12.3%) were collected. Identification and susceptibility tests were carried out on 60 (25.9%) ESBL phenotypes using biomérieux VITEK® 2 compact system. Isolates showing ESBL positivity by the phenotypic method were all screened for blaTEM, blaCTX-M and blaSHV genes by PCR.


The prevalence of ESBL-producing Enterobacterale isolates was found to be 25.9%. These ESBL-producing isolates displayed an increasing rate of resistance for aminopenicillins (ampicillin) (96.3%), followed by piperacillin-tazobactam (54.2%), amoxicillin/clavulanic acid (45.8), the cephalosporin groups, ceftriaxone (52.4%), ceftazidime (46.7%), and fluoroquinolone (ciprofloxacin) (42.7%). Both the organisms showed a higher susceptibility to the carbapenems (Imipenem) and aminoglycosides (Amikacin). Out of the 62 ESBL positive isolates, 11 (17.7%) carried the TEM gene, 22 (35.5%) carried the CTX-M gene alone, 8 (12.9%) carried both TEM and CTX-M genes, 1(1.6%) carried both SHV and CTX-M genes, and 20 (32.3%) carried the TEM, SHV, and CTX-M genes. SHV gene alone was not reported in any of the isolates.


The study indicated a moderate occurrence of ESBL-producing Enterobacterale with CTX-M being the most dominant gene. The co-existence of all three genes on many occasions suggested the carriage of multiple plasmids with three resistance genes that might pose a serious epidemiological, clinical and public health threat.

Keywords: Enterobacterale, BlaTEM gene, BlaCTX-M gene, BlaSHV gene, ESBL gene, Aminopenicillins (ampicillin).

Article Information

Identifiers and Pagination:

Year: 2020
Volume: 14
First Page: 190
Last Page: 195
Publisher Id: TOMICROJ-14-190
DOI: 10.2174/1874285802014010190

Article History:

Received Date: 22/03/2020
Revision Received Date: 15/05/2020
Acceptance Date: 16/05/2020
Electronic publication date: 31/07/2020
Collection year: 2020

© 2020 Salah H Elsafi.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Clinical Laboratory Science, Prince Sultan Military College of Health Science, P.O. Box 33048 Dammam 31448 Kingdom of Saudi Arabia; Tel: +966 13 8405448; Fax: 966 13 8405477; E-mails:,

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