Document Type : Original Research


1 Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Student Research Committee (SRC), Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Women’s Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran


Background & Objectives:Extended-spectrum-B-lactamase (ESBL)-producing strains of Klebsiella Pneumoniaare an important cause of many serious infections in hospitalized and nonhospitalized patients and delayed treatment of these infections in crease chance of death in patients. This study was performed to determine the prevalence of ESBL-producing K. Pneumonia and to evaluate the frequency of TEM and SHV genes among the clinical samples. Methods:One hundred and thirty isolates of K. Pneumoniawere collected at Imam Reza Hospital in Mashhad (Iran) from May 2011 to July 2012. ESBL production was determined by the double disk diffusion (DDs) test. PCR method was used to detect TEM and SHV genes. Results:Of 130 patients withK. pneumoniainfection 28 were out-patients and 102 hospitalized patients. The most specimens was urine samples (n=25 in out-patients, n=39 in hospitalized patients, totally 49.2%) followed by wound samples (n=3 in out-patients, n=21 in hospitalized patients, totally 21.5%), blood samples (n=19 in hospitalized, 14.6%). The prevalence of ESBL producingK. pnemoniaewas estimated 43% (n=56) including three of ESBLs positive isolates from out-patients and 53 from hospitalized patients. Of 56 ESBLs positive isolates, 44(87.54%) TEM, 39(69.64%) SHV and in 27 cases (48.21%) both TEM and SHV were detected. Conclusion:A high prevalence of ESBL-producing K. Pneumoniaamong the hospital isolates obtained of urinary followed by blood and wound samples were documented. The majority of them carried both TEM and SHV genes. Results of this study alarm for the physicians because treatment and control nosocomial infections for them were difficult.


  1. Chuang YP, Fang CT, Lai SY, Chang SC, Wang JT. Genetic determinants of capsular serotype K1 of Klebsiella pneumoniae causing primary pyogenic liver abscess. J Inf Dis 2006 Mar 1;193(5):645-54.
  2. Tumbarello M, Spanu T, Sanguinetti M, Citton R, Montuori E, Leone F, et al. Bloodstream infections caused by extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae: risk factors, molecular epidemiology, and clinical outcome. Antimicrob Agents Chemother 2006 Feb;50(2):498-504.
  3. Woodford N, Tierno PM, Jr., Young K, Tysall L, Palepou MF, Ward E, et al. Outbreak of Klebsiella pneumoniae producing a new carbapenem-hydrolyzing class A beta-lactamase, KPC-3, in a New York Medical Center. Antimicrob Agents Chemother 2004 Dec;48(12):4793-9.
  4. Jarlier V, Nicolas MH, Fournier G, Philippon A. Extended broad-spectrum beta-lactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis 1988 Jul-Aug;10(4):867-78.
  5. Tasli 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 Jun;58(3):162-7.
  6. Sharma J, Sharma M, Ray P. Detection of TEM & SHV genes in Escherichia coli & Klebsiella pneumoniae isolates in a tertiary care hospital from India. Indian J Med Res 2010 Sep;132:332-6.
  7. Tedesco Maiullari RM, Guevara A. [Enterobacteria producers of extended-spectrum beta-lactamase in a hospital from Venezuela]. Infez Med 2012 Jun;20(2):93-9.
  8. Enterobacteriaceae. In: Connie R. Mahon DCL, George, Manuselis., editors. Textbook of Diagnostic Microbiology. Fourth ed: W.B. Saunders Company; 2011. p. 427-62.
  9. d'Azevedo PA, Goncalves AL, Musskopf MI, Ramos CG, Dias CA. Laboratory tests in the detection of extended spectrum beta-lactamase production: National Committee for Clinical Laboratory Standards (NCCLS) screening test, the E-test, the double disk confirmatory test, and cefoxitin susceptibility testing. Braz J Infect Dis 2004 Oct;8(5):372-7.
  10. Zaniani FR, Meshkat Z, Naderi Nasab M, Khaje-Karamadini M, Ghazvini K, Rezaee A, et al. The Prevalence of TEM and SHV Genes among Extended-Spectrum Beta-Lactamases Producing Escherichia Coli and Klebsiella pneumoniae. Iran J Basic Med Sci 2012 Jan;15(1):654-60.
  11. Ramdani-Bouguessa N, Manageiro V, Jones-Dias D, Ferreira E, Tazir M, Canica M. Role of SHV beta-lactamase variants in resistance of clinical Klebsiella pneumoniae strains to beta-lactams in an Algerian hospital. J Med Microbiol 2011 Jul;60(Pt 7):983-7.
  12. Knothe H, Shah P, Krcmery V, Antal M, Mitsuhashi S. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 1983 Nov-Dec;11(6):315-7.
  13. Valverde A, Coque TM, Garcia-San Miguel L, Baquero F, Canton R. Complex molecular epidemiology of extended-spectrum beta-lactamases in Klebsiella pneumoniae: a long-term perspective from a single institution in Madrid. J Antimicrob Chemother 2008 Jan;61(1):64-72.
  14. 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(1):37-43.
  15. 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 Jul-Aug;29(4):253-7.
  16. Goyal A, Prasad KN, Prasad A, Gupta S, Ghoshal U, Ayyagari A. Extended spectrum beta-lactamases in Escherichia coli & Klebsiella pneumoniae & associated risk factors. Indian J Med Res 2009 Jun;129(6):695-700.
  17. Kaftandzieva A, Trajkovska-Dokic E, Panovski N. Prevalence and molecular characterization of Extended Spectrum Beta-Lactamases (ESBLs) producing Escherichia Coli and Klebsiella Pneumoniae. Prilozi 2011 Dec;32(2):129-41.
  18. Lee KM, Yoo JI, Yoo YS, Yoo JS, Chung GT, Ahn TI, et al. Investigation of Klebsiella pneumoniae isolates producing SHV-12 and SHV-11 beta-lactamases in Korean hospitals. J Microbiol Biotechnol 2009 Sep;19(9):1065-9.