{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T18:07:02Z","timestamp":1789063622828,"version":"build-2803163510"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    The rising incidence of\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    (\n                    <jats:italic>E. coli<\/jats:italic>\n                    ) strains harbouring ESBL enzymes in healthcare environment including hospitals poses significant public health concerns. This study sought to assess the occurrence of\n                    <jats:italic>E. coli<\/jats:italic>\n                    strains that carry ESBL enzymes in clinical isolates from patients at hospitals in Tabuk, Saudi Arabia, focusing on the responsible genes and antibiotic susceptibility profiles. The 100 clinical samples positive for these ESBL genes were collected from the different Tabuk hospitals\u2019 in-patients for a 6-month period only, with multiplex PCR used to identify genes that encode ESBLs (\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>TEM<\/jats:sub>\n                    ,\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>SHV<\/jats:sub>\n                    ,\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>CTX-M-group 1<\/jats:sub>\n                    ,\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>CTX-M-group 9<\/jats:sub>\n                    , and\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>CTX-M-group 25<\/jats:sub>\n                    ). These results yielded that 24% of the clinical isolates exhibited positive for ESBL, with the CTX-M-1 gene having the highest prevalence (67% of ESBL-positive samples). This study underscores the high occurrence of the CTX-M-1 gene isolated in ESBL (+)\n                    <jats:italic>E. coli<\/jats:italic>\n                    within the Tabuk region, providing critical insights into local antibiotic resistance patterns. While these findings enhance our understanding of regional dynamics, they also reaffirm existing knowledge regarding global trends in ESBL gene prevalence. Other genes detected included\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>SHV<\/jats:sub>\n                    (46%),\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>TEM<\/jats:sub>\n                    (50%),\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>CTX-M-9<\/jats:sub>\n                    (63%), and\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>CTX-M-25<\/jats:sub>\n                    (50%). Co-occurrence of\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>SHV<\/jats:sub>\n                    and\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>CTX-M-1<\/jats:sub>\n                    genes was observed in 42% of isolates, while\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>TEM<\/jats:sub>\n                    and\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>SHV<\/jats:sub>\n                    co-occurred in 12.5%. These ESBL-positive\n                    <jats:italic>E.coli<\/jats:italic>\n                    were primarily isolated from urine (70.8%), wound (12.5%) and blood (16.5%). While these enzymes confer resistance to many beta-lactam classes, they generally remain sensitive to carbapenems, cephamycin and certain \u03b2-lactamase inhibitors, while cefoxitin showed 95.8% resistance in this study. Although the study was conducted over a limited six-month duration with a relatively small sample size, the isolation of these specific strains is nonetheless significant. These outcomes highlight the necessity for ongoing surveillance studies and robust infection control programs to combat antibiotic resistance in healthcare settings. To address the study\u2019s objectives, it is recommended to develop targeted antibiotic stewardship programs that align with local resistance patterns, enhance surveillance systems to monitor ESBL-producing bacteria, and implement stringent infection control protocols in healthcare settings. Additionally, launching educational initiatives for healthcare professionals and the public, promoting research on resistance mechanisms, and collaborating with public health authorities will ensure that findings inform evidence-based policies. Finally, fostering multidisciplinary approaches will help create comprehensive strategies for effectively managing antibiotic resistance at both local and global levels.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0350207","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T17:23:22Z","timestamp":1789061002000},"page":"e0350207","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Distribution of blaCTX-M, blaTEM and blaSHV encoding-genes among extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli isolates at the different hospitals in Tabuk, Kingdom of Saudi Arabia"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8621-8614","authenticated-orcid":true,"given":"Ruqaiah Ismael","family":"Bedaiwi","sequence":"first","affiliation":[{"name":"University of Tabuk","place":["Tabuk, Saudi Arabia"],"department":["Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1788-4889","authenticated-orcid":true,"given":"Marah Naif","family":"Alatawi","sequence":"additional","affiliation":[{"name":"University of Tabuk","place":["Tabuk, Saudi Arabia"],"department":["Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3685-0917","authenticated-orcid":true,"given":"Bernard","family":"Silvala","sequence":"additional","affiliation":[{"name":"University of Tabuk","place":["Tabuk, Saudi Arabia"],"department":["Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"pone.0350207.ref001","author":"M Mueller","year":"2023"},{"issue":"11","key":"pone.0350207.ref002","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2023.e22109","article-title":"Multidrug-resistant Escherichia coli isolated from patients and surrounding hospital environments in Bangladesh: A molecular approach for the determination of pathogenicity and resistance","volume":"9","author":"M Moniruzzaman","year":"2023","journal-title":"Heliyon"},{"issue":"9","key":"pone.0350207.ref003","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.3390\/healthcare10091778","article-title":"The Prevalence of Multidrug-Resistant Escherichia coli Producing ESBL among Male and Female Patients with Urinary Tract Infections in Riyadh Region, Saudi Arabia","volume":"10","author":"A Abalkhail","year":"2022","journal-title":"Healthcare (Basel)"},{"key":"pone.0350207.ref004","doi-asserted-by":"crossref","first-page":"104722","DOI":"10.1016\/j.micpath.2020.104722","article-title":"Characterization and resistant determinants linked to mobile elements of ESBL-producing and mcr-1-positive Escherichia coli recovered from the chicken origin","volume":"150","author":"M Shafiq","year":"2021","journal-title":"Microb Pathog"},{"issue":"3","key":"pone.0350207.ref005","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S1473-3099(08)70041-0","article-title":"Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern","volume":"8","author":"JDD Pitout","year":"2008","journal-title":"The Lancet Infectious Diseases"},{"key":"pone.0350207.ref006","doi-asserted-by":"crossref","first-page":"213","DOI":"10.11604\/pamj.2020.37.213.24988","article-title":"Prevalence of extended-spectrum \u03b2-lactamase (ESBL) and molecular detection of blaTEM, blaSHV and blaCTX-M genotypes among Enterobacteriaceae isolates from patients in Khartoum, Sudan","volume":"37","author":"MH Dirar","year":"2020","journal-title":"Pan Afr Med J"},{"issue":"10325","key":"pone.0350207.ref007","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"CJ Murray","year":"2022","journal-title":"The Lancet"},{"issue":"6","key":"pone.0350207.ref008","doi-asserted-by":"crossref","DOI":"10.3892\/etm.2021.10885","article-title":"Emergence of blaTEM, blaCTX-M, blaSHV, and blaOXA genes in multidrug-resistant Enterobacteriaceae and Acinetobacter baumannii in Saudi Arabia","volume":"22","author":"MT Ibrahim","year":"2021","journal-title":"Experimental and Therapeutic Medicine"},{"key":"pone.0350207.ref009","unstructured":"World Health Organization: WHO. Antimicrobial Resistance. WHO. 2023. Accessed 2023 November 21."},{"issue":"12","key":"pone.0350207.ref010","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.00213-21","article-title":"Overview of changes to the clinical and laboratory standards institute performance standards for antimicrobial susceptibility testing, M100, 31st edition","volume":"59","author":"R Humphries","year":"2021","journal-title":"J Clin Microbiol"},{"key":"pone.0350207.ref011","unstructured":"Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: 31st Edition. Clinical and Laboratory Standards Institute. 2021."},{"issue":"12","key":"pone.0350207.ref012","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(18)30414-6","article-title":"Epidemiology of common resistant bacterial pathogens in the countries of the Arab League","volume":"18","author":"RA Moghnieh","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"11","key":"pone.0350207.ref013","doi-asserted-by":"crossref","first-page":"3554","DOI":"10.1128\/AAC.47.11.3554-3560.2003","article-title":"Extended-spectrum beta-lactamases in Klebsiella pneumoniae bloodstream isolates from seven countries: dominance and widespread prevalence of SHV- and CTX-M-type beta-lactamases","volume":"47","author":"DL Paterson","year":"2003","journal-title":"Antimicrob Agents Chemother"},{"issue":"4","key":"pone.0350207.ref014","doi-asserted-by":"crossref","DOI":"10.5812\/jjm.8(4)2015.15620","article-title":"Occurrence of SHV, TEM and CTX-M \u03b2-lactamase genes among enteropathogenic Escherichia 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Escherichia coli isolates in Riyadh, Saudi Arabia","volume":"11","author":"A Alqasim","year":"2018","journal-title":"J Infect Public Health"},{"issue":"4","key":"pone.0350207.ref018","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1128\/CMR.18.4.657-686.2005","article-title":"Extended-spectrum beta-lactamases: a clinical update","volume":"18","author":"DL Paterson","year":"2005","journal-title":"Clin Microbiol Rev"},{"issue":"4","key":"pone.0350207.ref019","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.diagmicrobio.2006.06.015","article-title":"Outcome of cephalosporin treatment of bacteremia due to CTX-M-type extended-spectrum beta-lactamase-producing Escherichia coli","volume":"56","author":"C Bin","year":"2006","journal-title":"Diagn Microbiol Infect Dis"},{"issue":"6","key":"pone.0350207.ref020","first-page":"1345","article-title":"The prevalence of extended-spectrum beta-lactamase-producing Escherichia coli in patients with urinary tract infections in Eastern Saudi Arabia","volume":"24","author":"F Mashwal","year":"2017","journal-title":"Saudi J Biol Sci"},{"issue":"11","key":"pone.0350207.ref021","first-page":"3582","article-title":"High prevalence of extended-spectrum beta-lactamase-producing bacteria in South Africa: a study using multiplex-pcr assay","volume":"47","author":"MM Ehlers","year":"2009","journal-title":"J Clin Microbiol"},{"issue":"1","key":"pone.0350207.ref022","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1186\/s12879-018-3436-7","article-title":"Prevalence and antibiotic susceptibility pattern of CTX-M type extended-spectrum \u03b2-lactamases among clinical isolates of gram-negative bacilli in Jimma, Ethiopia","volume":"18","author":"A Zeynudin","year":"2018","journal-title":"BMC Infect Dis"},{"issue":"8","key":"pone.0350207.ref023","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1080\/00365540701367801","article-title":"Successful treatment of ctx-m ESBL producing Escherichia coli relapsing pyelonephritis with long term pivmecillinam","volume":"39","author":"LE Nicolle","year":"2007","journal-title":"Scand J Infect Dis"},{"issue":"1","key":"pone.0350207.ref024","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.joad.2015.07.007","article-title":"Relation between blaTEM, blaSHV and blaCTX-M genes and acute urinary tract infections","volume":"5","author":"SS Seyedjavadi","year":"2016","journal-title":"Journal of Acute Disease"},{"key":"pone.0350207.ref025","first-page":"15","article-title":"Alternative treatment strategies for infections caused by blaTEM-carrying bacteria","volume":"9","author":"SS Seyedjavadi","year":"2016","journal-title":"Infect Drug Resist"},{"issue":"1","key":"pone.0350207.ref026","first-page":"24","article-title":"The evolution of Escherichia coli and the emergence of antibiotic resistance","volume":"21","author":"JR Johnson","year":"2008","journal-title":"Clinical Microbiology 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infections","volume":"15","author":"JR Smith","year":"2020","journal-title":"Infectious Disease Journal"},{"issue":"3","key":"pone.0350207.ref031","first-page":"112","article-title":"The relationship between E. coli serogroups and antibiotic resistance","volume":"58","author":"RA Thompson","year":"2019","journal-title":"Journal of Clinical Microbiology"},{"issue":"2","key":"pone.0350207.ref032","first-page":"145","article-title":"Multidrug-resistant E. coli serogroups in healthcare settings","volume":"12","author":"SY Lee","year":"2021","journal-title":"Healthcare Epidemiology"},{"issue":"5","key":"pone.0350207.ref033","first-page":"299","article-title":"Surveillance of E. coli strains: a public health perspective","volume":"30","author":"KR Patel","year":"2022","journal-title":"Journal of Epidemiology"},{"issue":"9","key":"pone.0350207.ref034","doi-asserted-by":"crossref","first-page":"935","DOI":"10.15537\/smj.2016.9.16139","article-title":"Antimicrobial resistance in Saudi 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