MOLECULAR INVESTIGATION OF THE PREVALENCE OF TEM AND CTX-M GENES IN DOMINANT STRAINS CAUSING URINARY TRACT INFECTION IN PATIENTS UNDER PROPHYLAXIS WITH THE TWO ANTIBIOTICS CEFAZOLIN AND CEFIXIM AFTER THE CESAREAN SECTION

Background and objective: Since the prophylaxis after the cesarean section is mostly done based on doctors’ experiences, this article
has tried to investigate the bacteria causing urinary tract infection after the cesarean section while being under the prophylaxis with
Cefazolin and Cefixim Antibiotics. The incidence of TEM and CTX-M genes in dominant strains resistant to the abovementioned
antibiotics has also been investigated and, finally, an appropriate and accurate way for prophylaxis and preventing such strains has
been suggested so that the treatment economic costs as well as the drug reactions in patients who suffer from urinary tract infection
after the cesarean section would probably decrease.
Materials & Methods: the present study was done on 143 mothers who had been under the cesarean section from March 2013 until
July 2013. A U/A and U/C test was given to each mother 15 days after the cesarean section. In the next phase, following the
identification of positive samples through biochemical tests by applying the Antibiogram test using Kirby-Bauer method, the drug
resistance patterns of the isolates were determined. Then, the dominant strains resistant to Cefazolin and Cefixim were investigated
through Phenotypic Confirmatory Tests by evaluating the increase in diameter of non-growth halo at the presence of cefotaxime,
cefotaxime/ clavulanic acid, ceftazidime and Ceftazidime/ clavulanic acid disks. In the end, the PCR method was used in order to
prove the presence or the absence of TEM and CTX-M genes in dominant strains.
Results: 6 out of 143 people (4.2%) seemed to have urinary tract infections. Amongst all 143 mothers who had the cesarean section, 3
(2.1%) were affected by E. coli, 2 (1.4%) by Klebsiella and 1 (0.7%) by Staph. Based on the Phenotypic Confirmatory Tests, the
E.coli strains that were dominant isolates were all identified as the strains having ESBL. All the three separated E.coli isolates (100%)
had TEM and CTX-M genes.
Conclusion: Regarding the necessity of doing prophylaxis after the cesarean section, some suitable comprehensive tests should be
done on patients before the surgery so that, in the case of the existence of asymptomatic urinary tract infections, proper treatments are
done based on the test results. Since prophylaxis initiates promptly after the surgery and the urine culture result gets false due to taking
antibiotics, designing precise and inexpensive diagnostic kits by which multi-drug resistant strains as well as the genes causing drugresistance
could be identified makes it possible to do some tests within a week after the surgery so that the necessary actions are
immediately taken by the doctors in case the patients have been affected by multi-drug resistant hospital infections during and after
being hospitalized.