*Beta-Lactamase-Producing Genes and Integrons in* Escherichia coli *from Diarrheal Children… DOI: http://dx.doi.org/10.5772/intechopen.103169*

of Ouagadougou, and most of the people living in the slums with poor sanitation conditions attend it for healthcare sought. Moreover, the provision of confessional care has less difficult accessibility for the peripheral neighborhoods and the population with low socioeconomic level. Otherwise, people in Burkina Faso do not consult a healthcare agent in the case of diseases such as gastrointestinal infections and use self-medication instead [37]. Our results showed 19.4% of SHV-type ESBLproducing *E. coli* which is a little similar to 21% detected in Pakistan [42]. By cons, this prevalence is higher than 0% [9] and 5.9% [17], previously reported in Burkina Faso but lower than 45% reported in Iran [27]. The *bla*CTX-M gene (**Figure 4**) has been detected in three *E. coli* isolates, while its prevalence was 25% in our earlier report [9] and 40.1% by a study conducted in *Enterobacteriaceae* from Burkinabe patients [17]. Moreover, few studies from other parts of world have shown different prevalence of *bla*CTX-M gene among isolates, including 98.8% (China), 84.7% (Chile), 13.6% (Tanzania), 76% (Pakistan), 97.8% (Chad), and 81.6% (Egypt) [25, 42–46]. Indeed, CTX-M β-lactamases are recognized as the most widespread extended-spectrum β-lactamases (ESBLs) among clinical isolates of *Enterobacteriaceae* [47]. Besides, an earlier report from Nigeria has shown the predominance of CTX-M15 in wild birds and cattle in Nigeria [48] suggesting that this gene could be transferred to humans by animals. Finally, our study revealed 6.5% of TEM-type ESBL-producing *E. coli*, while no *bla*TEM gene has been detected in our previous study [9]. However, this value is lower than 26.2 and 28% reported in Burkina Faso and Pakistan, respectively [17, 42]. The resistance to amoxicillin/amoxicillin-clavulanic acid observed in the two *E. coli* strains (6.5%) may be mainly mediated by the production of these plasmid-encoded TEM enzymes.

Among the three class of integron, class 1 integron (58.1%) was majority characterized from the resistant strains in accordance with 56% reported in Bangladesh [41]. This result confirms those of previous studies showing that class 1 integron was predominantly represented in *Enterobacteriaceae* [49, 50]. However, a previous report in Burkina Faso has shown a lower prevalence (44.4%) of *Int1* [51]. On the other hand, studies reported a high prevalence of *Int1* (80%) in *E. coli* isolated from dairy products consumed in Burkina Faso [52] and in human, animal, and food in Spain [53]. This could increase the risk of emergence and spread of MDR *E. coli*, since humans are always in contact with these

#### **Figure 4.**

*blaCTX-M gene on agarose gel electrophoresis (1.5%). Lane M: molecular size marker (100 bp), A: blaCTX-M positive control (544 pb), lanes: B, D, and E are positive for blaCTX-M gene (544 pb), lane T: negative control.*

different ecosystems, especially when there is a lack of food hygiene and sanitation. Moreover, class 1 integrons can facilitate the spread of antibiotic-resistant genes meaning that it could have public health consequences [54].

The class 3 integron was detected in only EIEC. No class 2 integron (*Int2*) was characterized from the resistant strains. By cons, 22.2% of *Int2* was detected in our previous study [51]. Moreover, a study also found the presence of *Int2* gene in Senegalese *Shigella* spp. isolates [49].

Two strains of EIEC harbored both class 1 and 3 integrons. However, a previous study showed that *E. coli* harbored class 1 and 2 integrons simultaneously [50]. Otherwise, in the present study, one EIEC strain was resistant to aztreonam and imipenem and possesses ESBL-carbapenemase phenotype. This strain was resistant to all subfamilies (penicillins, cephalosporins, monobactam, and carbapenems) of β-lactams antibiotic tested and also showed simultaneous presence of *bla*SHV*, bla*OXA, *bla*CTX-M, and *Int1*. Indeed, strains that had this aztreonam-resistant phenotype possessed both the resistance gene [27]. Resistance to this antibiotic could be explained by genetic mutations [43]. It has been described that the coexistence of these two classes of integrons [42] and/ or several genes suggests that they have integrated the same gene and give these strains a high level of resistance. However, *bla*TEM, *bla*SHV, *bla*OXA, *bla*CTX-M as well as integrons (*Int1, Int2*, *and Int3*) are involved in the antibiotic resistance of DEC, but the presence of resistant strains producing ESBL and lacking ESBL gene (*bla*TEM, *bla*SHV, *bla*OXA, and *bla*CTX-M) and integron suggests that there are other mechanisms for the dissemination of antibiotic resistance in DEC strains.
