Nitric Oxide and Hypochlorite Assessment and Screening of some β-Lactamase Encoding Genes among Gram Negative Bacteria in Patients with Acute Leukemia
Authors: Suhel Mustafa Mustafa , Mujahid Abdullah Rana 
Published: December 2023

Objective: The serologic levels of both nitric oxide (NO) and hypochlorite (ClO-) were assessed in this study for Iraqi acute leukemic patients infected with Gram negative bacteria (GNB). Alongside, the phylogenetic analysis for both blaSHV and blaTEM genes of GNB was performed. Methods: The clinical samples were recovered from acute leukemic patients at hematology center in Baghdad from January 2021 to December 2021. The identification of bacterial isolates and susceptibility test were performed using Vitek 2 Compact System. Serum levels of NO and ClO- were assayed by Enzyme Linked Immunosorbent assay and colorimetric method, respectively. Gene screening was done utilizing polymerase chain reaction. DNA sequencing, GenBank accession numbers submission, and phylogenetic analysis were also conducted. Results: From 260 patients with acute leukemia, 485 clinical samples were collected from different sites. Of this total, 70 (15%) isolates of GNB were obtained, distributing as Klebsiella pneumoniae 23 (33%), Escherichia coli 21 (30%), Pseudomonas aeruginosa 18 (26%), and Acinetobacter baumannii 8 (11%). These isolates were mainly collected from urine 39 (55.71%), followed by blood 23 (32.85%), and the least from swabs 8 (11.42%). The infections of GNB were higher among acute myeloblastic leukemia (AML) patients 40 (57.14%) than these with acute lymphoblastic leukemia (ALL) 30 (42.85%). The levels of NO were higher among groups of patients than control groups. Additionally, ClO-levels were observed to be slightly increased in patients above these of controls. Most isolates of K. pneumoniae and E. coli showed high resistance rates for penicillins (ampicillin and ticarcillin), cephalosporins (ceftazidime, cefotaxime, ceftriaxone, and cefepime), followed by gentamicin and ciprofloxacin. Cefoxitin, aztreonam, imipenem and meropenem were nearly more effective against GNB isolates. On the other hand, about half isolates P. aeruginosa and all A. baumannii were resistant to the tested antibiotics. Extended Spectrum β- Lactamases (ESBLs) were released in 49 (70%) of the tested isolates of GNB. The multidrug resistant (MDR) pattern was noticed among 58 (82.85%) of GNB. Interestingly, ESBLs producing MDR isolates were determined in 34 (58.62%) of the studied GNB. Genotypic screening revealed that blaSHV and blaTEM genes were characterized in 20 (28.57%) and 32 (45.71%) of GNB isolates, respectively, while all GNB were negative for blaCTX-M. DNA sequencing of blaSHV amplicons revealed the occurrence of one point mutation (111T>A) in six isolates of K. pneumoniae with a missense effect (p.31Q>L) on the encoded protein. Forty-five GenBank accession numbers were recorded in NCBI to represent the studied variants of ESBLs. Phylogenetic analysis of both blaSHV and blaTEM displayed the possible epidemiologic routes of the tested GNB by detecting the origin host, source of collection, and geographic spread as compared with the reference sequences. Conclusion: high serum levels of both NO and ClO- indicated the potential role of these microbicidal agents to predict the serious infections of GNB in acute leukemia population. Phylogenetic analysis represented an important tool, possibly aiding in early control and prevention of pathogenic GNB.