1
|
Ilham D, Souad L, Asmae LH, Kawtar N, Mohammed T, Nabila S. Prevalence, antibiotic resistance profile, MBLs encoding genes, and biofilm formation among clinical carbapenem-resistant Enterobacterales isolated from patients in Mohammed VI University Hospital Centre, Morocco. Lett Appl Microbiol 2023; 76:ovad107. [PMID: 37699792 DOI: 10.1093/lambio/ovad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/14/2023]
Abstract
Enterobacterales are frequently a major cause of human infections. The emergence of carbapenem resistance as well as the biofilm formation complicate their management. In this regard, this study aimed to investigate the prevalence, antibiogram, carbapenemase genes, and biofilm production among Enterobacterales. For this purpose, 18 172 clinical specimens from hospitalized patients at Mohammed VI University Hospital were collected over two years (2018-2019). The bacteriological investigation was performed to isolate Enterobacterales. Subsequently, BD-Phoenix and MALDI-TOF-MS were used for bacterial identification. The production of ESBLs and carbapenemases was assessed using phenotypic tests and PCR. The biofilm formation was eventually carried out. Out of 195 carbapenem-resistant Enterobacterales strains, 190 were carbapenemase producers, and 74 Enterobacterales produced metallo-beta-lactamases (MBLs). The PCR results revealed that blaNDM was the most common carbapenemase gene, present in 62 cases, followed by the co-existence of blaNDM and blaOXA-48 in 12 cases. Klebsiella pneumoniae was the most frequently identified species among the 74 New Delhi metallo-β-lactamase (NDM) isolates and the XDR resistance phenotype was the most prevalent with 58.10%. Additionally, all 74 NDM-positive Enterobacterales were able to form biofilms, with 82.4% being strong producers. This study highlights the need for rapid detection of carbapenemase and biofilm production in our hospital to manage this health concern.
Collapse
Affiliation(s)
- Dilagui Ilham
- Laboratoire de Lutte Contre les Maladies Infectieuses, Faculty of Medicine and Pharmacy, University Cadi Ayyad, Marrakesh 40000, Morocco
- Laboratory of Microbiology-Virology of Ar-Razi Hospital, Mohammed VI University Hospital Centre, BP 2360, Marrakesh, Morocco
| | - Loqman Souad
- Laboratoire de Lutte Contre les Maladies Infectieuses, Faculty of Medicine and Pharmacy, University Cadi Ayyad, Marrakesh 40000, Morocco
- Laboratory of Microbiology-Virology of Ar-Razi Hospital, Mohammed VI University Hospital Centre, BP 2360, Marrakesh, Morocco
| | - Lamrani Hanchi Asmae
- Laboratoire de Lutte Contre les Maladies Infectieuses, Faculty of Medicine and Pharmacy, University Cadi Ayyad, Marrakesh 40000, Morocco
- Laboratory of Microbiology-Virology of Ar-Razi Hospital, Mohammed VI University Hospital Centre, BP 2360, Marrakesh, Morocco
| | - Nayme Kawtar
- Laboratory of Molecular Bacteriology, Pasteur Institute, Casablanca 20250, Morocco
| | - Timinouni Mohammed
- Laboratory of Molecular Bacteriology, Pasteur Institute, Casablanca 20250, Morocco
| | - Soraa Nabila
- Laboratoire de Lutte Contre les Maladies Infectieuses, Faculty of Medicine and Pharmacy, University Cadi Ayyad, Marrakesh 40000, Morocco
- Laboratory of Microbiology-Virology of Ar-Razi Hospital, Mohammed VI University Hospital Centre, BP 2360, Marrakesh, Morocco
| |
Collapse
|
2
|
Dilagui I, Loqman S, Lamrani Hanchi A, Soraa N. Antibiotic resistance patterns of carbapenemase-producing Enterobacterales in Mohammed VI University Hospital of Marrakech, Morocco. Infect Dis Now 2022; 52:334-340. [PMID: 35700962 DOI: 10.1016/j.idnow.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/16/2022] [Accepted: 06/07/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The emergence and spread of Carbapenem-Resistant Enterobacterales (CRE) has become a growing concern for health services, internationally, nationally, and regionally. In Morocco, the situation is more worrisome as studies on CRE are scarce and/or scattered and/or outdated. As a result, we carried out the present study to determine and update CRE prevalence at Mohammed VI University Hospital of Marrakech, Morocco. PATIENTS AND METHODS A cross-sectional prospective study was carried out from March 2018 to March 2020 on 41161 clinical specimens of 23,469 patients suspected of bacterial infections. Enterobacterales strains were isolated following standard bacteriological procedures. Bacterial strains were identified using BD-Phoenix and MALDI-TOF-MS. Antibiotic susceptibility was determined for 14 antibiotics. Carbapenemase production and phenotypic detection were characterized using modified carbapenem inactivation phenotypic and immunochromatographic methods. RESULTS All in all, 484 Enterobaterales resistant to at least one carbapenem were recovered. The majority was isolated from the neonatal unit (14%), followed by the urology-nephrology (11%), and plastic surgery departments (10%). K. pneumoniae (n=232) was the most isolated, followed by E. cloacae (n=148), E. coli (n=56), and S. marcescens (n=17). Antibiotic susceptibility profile showed high rates of resistance to ciprofloxacin (75.21%), gentamicin (84.50%), and cotrimoxazole (88.42%). Out of 484 CRE positive cultures, 388 (80.16%) were Carbapenemase-positive. Out of the latter, 170 were metallo-beta-lactamase producers (NDM), 162 OXA-48-like, and 56 both. CONCLUSION These findings emphasize the urgent need for control precautions and strict measures to contain and mitigate this issue.
Collapse
Affiliation(s)
- I Dilagui
- Laboratoire de Lutte Contre les Maladies Infectieuses, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, Marrakech, Morocco; Laboratoire de Microbiologie-Virologie, Hôpital Ar-Razi, Centre Hospitalier Universitaire Mohammed VI, Avenue Ibn Sina Amerchich, BP 2360, Marrakech, Morocco
| | - S Loqman
- Laboratoire de Lutte Contre les Maladies Infectieuses, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, Marrakech, Morocco; Laboratoire de Microbiologie-Virologie, Hôpital Ar-Razi, Centre Hospitalier Universitaire Mohammed VI, Avenue Ibn Sina Amerchich, BP 2360, Marrakech, Morocco.
| | - A Lamrani Hanchi
- Laboratoire de Lutte Contre les Maladies Infectieuses, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, Marrakech, Morocco; Laboratoire de Microbiologie-Virologie, Hôpital Ar-Razi, Centre Hospitalier Universitaire Mohammed VI, Avenue Ibn Sina Amerchich, BP 2360, Marrakech, Morocco
| | - N Soraa
- Laboratoire de Lutte Contre les Maladies Infectieuses, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, Marrakech, Morocco; Laboratoire de Microbiologie-Virologie, Hôpital Ar-Razi, Centre Hospitalier Universitaire Mohammed VI, Avenue Ibn Sina Amerchich, BP 2360, Marrakech, Morocco
| |
Collapse
|
3
|
Nejjari C, El Achhab Y, Benaouda A, Abdelfattah C. Antimicrobial resistance among GLASS pathogens in Morocco: an epidemiological scoping review. BMC Infect Dis 2022; 22:438. [PMID: 35525923 PMCID: PMC9077917 DOI: 10.1186/s12879-022-07412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monitoring of antimicrobial resistance (AMR) is of great importance due to the frequency of strains becoming increasingly resistant to antibiotics. This review, using a public health focused approach, which aims to understand and describe the current status of AMR in Morocco in relation to WHO priority pathogens and treatment guidelines. METHODS PubMed, ScienceDirect and Google Scholar Databases and grey literature are searched published articles on antimicrobial drug resistance data for GLASS priority pathogens isolated from Morocco between January 2011 and December 2021. Articles are screened using strict inclusion/exclusion criteria. AMR data is extracted with medians and IQR of resistance rates. RESULTS Forty-nine articles are included in the final analysis. The most reported bacterium is Escherichia coli with median resistance rates of 90.9%, 64.0%, and 56.0%, for amoxicillin, amoxicillin-clavulanic acid, and co-trimoxazole, respectively. Colistin had the lowest median resistance with 0.1%. A median resistance of 63.0% is calculated for amoxicillin-clavulanic acid in Klebsiella pneumonia. Imipenem resistance with a median of 74.5% is reported for Acinetobacter baumannii. AMR data for Streptococcus pneumonie does not exceed 50.0% as a median. CONCLUSIONS Whilst resistance rates are high for most of GLASS pathogens, there are deficient data to draw vigorous conclusions about the current status AMR in Morocco. The recently join to the GLASS system surveillance will begin to address this data gap.
Collapse
Affiliation(s)
- Chakib Nejjari
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Youness El Achhab
- Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy of Fez, University Sidi Mohamed Ben Abdellah, Km 2.2 Rte Sidi Harazem, B.P 1893, Fez, Morocco. .,CRMEF Fez-Meknes, Rue Kuwait, B.P 49, Fez, Morocco.
| | - Amina Benaouda
- Department of Microbiology, Cheikh Zayed International University Hospital, Rabat, Morocco
| | - Chakib Abdelfattah
- Department of Infectious Diseases, Faculty of Medicine, University Hassan II, Casablanca, Morocco
| |
Collapse
|
4
|
Ragheb SM, Govinden U, Osei Sekyere J. Genetic support of carbapenemases: a One Health systematic review and meta-analysis of current trends in Africa. Ann N Y Acad Sci 2021; 1509:50-73. [PMID: 34753206 DOI: 10.1111/nyas.14703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/06/2021] [Accepted: 09/26/2021] [Indexed: 11/28/2022]
Abstract
Antimicrobial resistance (AMR) is a public health threat globally. Carbapenems are β-lactam antibiotics used as last-resort agents for treating antibiotic-resistant infections. Mobile genetic elements (MGEs) play an important role in the dissemination and expression of antimicrobial resistance genes (ARGs), including the mobilization of ARGs within and between species. The presence of MGEs around carbapenem-hydrolyzing enzymes, called carbapenemases, in bacterial isolates in Africa is concerning. The association between MGEs and carbapenemases is described herein. Specific plasmid replicons, integrons, transposons, and insertion sequences were found flanking specific and different carbapenemases across the same and different clones and species isolated from humans, animals, and the environment. Notably, similar genetic contexts have been reported in non-African countries, supporting the importance of MGEs in driving the intra- and interclonal and species transmission of carbapenemases in Africa and globally. Technical and budgetary limitations remain challenges for epidemiological analysis of carbapenemases in Africa, as studies undertaken with whole-genome sequencing remained relatively few. Characterization of MGEs in antibiotic-resistant infections can deepen our understanding of carbapenemase epidemiology and facilitate the control of AMR in Africa. Investment in genomic epidemiology will facilitate faster clinical interventions and containment of outbreaks.
Collapse
Affiliation(s)
- Suzan Mohammed Ragheb
- Department of Microbiology and Immunology, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Cairo, Egypt
| | - Usha Govinden
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - John Osei Sekyere
- Department of Microbiology & Immunology, Indiana University School of Medicine-Northwest, Gary, Indiana.,Department of Dermatology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
5
|
Mzimela BW, Nkwanyana NM, Singh R. Clinical outcome of neonates with Carbapenem-resistant Enterobacteriaceae infections at the King Edward VIII Hospital's neonatal unit, Durban, South Africa. S Afr J Infect Dis 2021; 36:223. [PMID: 34485496 PMCID: PMC8377997 DOI: 10.4102/sajid.v36i1.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Carbapenem-resistant infections in neonates are increasing worldwide. These organisms are associated with poor outcomes because of the severity of the disease, lack of treatment options and impaired immune systems of premature neonates. These infections are associated with significantly higher morbidity, mortality and prolonged hospitalisations, especially in developing countries. Methods A retrospective study was conducted to evaluate the prevalence and clinical outcomes of neonates with Carbapenem-resistant Enterobacteriaceae (CRE) infection over 24 months, from January 2015 to December 2016. All charts for neonates with positive cultures were reviewed, including characteristics of neonates that acquired the infection, possible risk factors and outcomes. Results A total of 32 cases were included with a prevalence of 5/1000 admissions. The mortality rate was 0.6/1000, with case facility rate at 12.5%. Most neonates developed CRE infections within the first 7 days of admission. There was an equal distribution between early neonatal deaths (ENND) and late neonatal deaths (LNND). Neonates (34.4%) had prior exposure to Carbapenem, with a higher mortality rate of (75%). There was zero mortality in the HIV-exposed group. Conclusion Neonates developed CRE much earlier than previously reported. Invasive procedures on admission carry an associated higher risk for developing CRE, more than the length of stay as previously stipulated. Prevalence of CRE seems to be high in middle-income countries with higher mortality. Thus, strict infection prevention and control (IPC) measures during admission and during the first weeks of life can decrease the incidence and outcome of CRE-related mortality and morbidity.
Collapse
Affiliation(s)
- Bongani W Mzimela
- Department of Paediatrics and Child Health, College of Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ntombifikile M Nkwanyana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Radhika Singh
- Department of Paediatrics and Child Health, College of Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
6
|
Loqman S, Soraa N, Diene SM, Rolain JM. Dissemination of Carbapenemases (OXA-48, NDM and VIM) Producing Enterobacteriaceae Isolated from the Mohamed VI University Hospital in Marrakech, Morocco. Antibiotics (Basel) 2021; 10:antibiotics10050492. [PMID: 33925772 PMCID: PMC8145435 DOI: 10.3390/antibiotics10050492] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/26/2022] Open
Abstract
The emergence and spread of carbapenem-resistant Enterobacteriaceae (CRE) represent a major clinical problem and raise serious health concerns. The present study aimed to investigate and ascertain the occurrence of CRE among hospitalized patients of Mohamed VI University Hospital, Marrakech, Morocco. Biological samples were collected over a one-year period (2018). The bacterial isolates were identified by MALDI-TOF-MS. Antibiotic susceptibility testing was performed using disc diffusion and Etest. The modified Hodge test and combined disc diffusion test were used for phenotypic detection. CRE hydrolyzing enzyme encoding genes: blaOXA-48, blaKPC, blaIMP, blaVIM, and blaNDM were characterized by PCR and DNA sequencing. In total, 131 non-duplicate CRE clinical strains resistant to Ertapenem were isolated out of 1603 initial Enterobacteriaceae. Klebsiella pneumoniae was the most common species (59%), followed by Enterobacter cloacae (24%), E. coli (10%), Citrobacter freundii (3%), Klebsiellaoxycota (2%), Serratia marcescens (1%), and Citrobacter braakii (1%). Of these, 56.49%, 21.37%, 15.27%, 3.38%, and 3.05% were collected from blood, urine, pus, catheters and respiratory samples, respectively. Approximately 85.5% (112/131) of the isolates were carbapenemase producers (40 blaOXA-48, 27 blaNDM, 38 blaOXA-48 + blaNDM and 7 blaVIM). All metallo-β-lactamases isolates were NDM-1 and VIM-1 producers. This is the first documentation of blaOXA-48 genes from C. freundii and C. braakii in Morocco.
Collapse
Affiliation(s)
- Souad Loqman
- Laboratoire de Lutte Contre les Maladies Infectieuses, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, Marrakech 40000, Morocco;
- Laboratoire de Microbiologie, CHU Mohammed VI, Av Ibn Sina Amerchich, BP 2360, Marrakech 40000, Morocco
- Correspondence: ; Tel.: +212-6-6105-0497
| | - Nabila Soraa
- Laboratoire de Lutte Contre les Maladies Infectieuses, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, Marrakech 40000, Morocco;
- Laboratoire de Microbiologie, CHU Mohammed VI, Av Ibn Sina Amerchich, BP 2360, Marrakech 40000, Morocco
| | - Seydina M. Diene
- Aix Marseille Université, IRD, APHM, MEPHI, IHU-Mediterranée Infection, 13385 Marseille, France; (S.M.D.); (J.-M.R.)
| | - Jean-Marc Rolain
- Aix Marseille Université, IRD, APHM, MEPHI, IHU-Mediterranée Infection, 13385 Marseille, France; (S.M.D.); (J.-M.R.)
| |
Collapse
|
7
|
Ballot DE, Bandini R, Nana T, Bosman N, Thomas T, Davies VA, Cooper PA, Mer M, Lipman J. A review of -multidrug-resistant Enterobacteriaceae in a neonatal unit in Johannesburg, South Africa. BMC Pediatr 2019; 19:320. [PMID: 31493789 PMCID: PMC6731552 DOI: 10.1186/s12887-019-1709-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/03/2019] [Indexed: 11/21/2022] Open
Abstract
Background Multi-drug resistant organisms are an increasingly important cause of neonatal sepsis. Aim This study aimed to review neonatal sepsis caused by multi-drug resistant Enterobacteriaceae (MDRE) in neonates in Johannesburg, South Africa. Methods This was a cross sectional retrospective review of MDRE in neonates admitted to a tertiary neonatal unit between 1 January 2013 and 31 December 2015. Results There were 465 infections in 291 neonates. 68.6% were very low birth weight (< 1500 g). The median age of infection was 14.0 days. Risk factors for MDRE included prematurity (p = 0.01), lower birth weight (p = 0.04), maternal HIV infection (p = 0.02) and oxygen on day 28 (p < 0.001). The most common isolate was Klebsiella pneumoniae (66.2%). Total MDRE isolates increased from 0.39 per 1000 neonatal admissions in 2013 to 1.4 per 1000 neonatal admissions in 2015 (p < 0.001). There was an increase in carbapenem-resistant Enterobacteriaceae (CRE) from 2.6% in 2013 to 8.9% in 2015 (p = 0.06). Most of the CRE were New Delhi metallo—β lactamase- (NDM) producers. The all-cause mortality rate was 33.3%. Birth weight (p = 0.003), necrotising enterocolitis (p < 0.001) and mechanical ventilation (p = 0.007) were significantly associated with mortality. Serratia marcescens was isolated in 55.2% of neonates that died. Conclusions There was a significant increase in MDRE in neonatal sepsis during the study period, with the emergence of CRE. This confirms the urgent need to intensify antimicrobial stewardship efforts and address infection control and prevention in neonatal units in LMICs. Overuse of broad- spectrum antibiotics should be prevented.
Collapse
Affiliation(s)
- Daynia E Ballot
- Neonatal Unit, Department of Paediatrics and Child Health, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa. .,Infection control, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, 2196, South Africa.
| | - Rosella Bandini
- Critical Care Infection Collaboration, Witwatersrand, South Africa
| | - Trusha Nana
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the National Health Laboratory Services and University of Witwatersrand, Witwatersrand, South Africa
| | - Noma Bosman
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the National Health Laboratory Services and University of Witwatersrand, Witwatersrand, South Africa
| | - Teena Thomas
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the National Health Laboratory Services and University of Witwatersrand, Witwatersrand, South Africa
| | - Victor A Davies
- Neonatal Unit, Department of Paediatrics and Child Health, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Peter A Cooper
- Neonatal Unit, Department of Paediatrics and Child Health, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Mervyn Mer
- Infection control, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, 2196, South Africa.,Department of Critical Care, University of the Witwatersrand, Witwatersrand, South Africa
| | - Jeffrey Lipman
- Infection control, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, 2196, South Africa.,The University of Queensland, Brisbane, Australia
| |
Collapse
|
8
|
Barguigua A, Rguibi Idrissi H, Nayme K, Timinouni M. Virulence and Antibiotic Resistance Patterns in E. coli, Morocco. ECOHEALTH 2019; 16:570-575. [PMID: 30895488 DOI: 10.1007/s10393-019-01404-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 12/22/2018] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
Of 28 non-duplicate isolates of Escherichia coli recovered from yellow-legged Larus michahellis in Morocco, 92.86% were resistant to more than three antibiotics and 71.4% were multidrug resistant. Phylogenetic group A was most predominant (57.14%), followed by B1 (18%), B2 (14.28%) and F (10.71%). One isolate was resistant to ertapenem and contained the blaOXA-48 gene. The plasmid-mediated quinolone resistance determinants were detected in nine isolates (aac(6')-Ib-cr, qnrS1, qnrB1). Thirteen isolates carried one of the Shiga toxin E. coli-associated genes: stx1 (n = 6), stx2 (n = 5) and eae (n = 2) genes. Our data support the idea that gull feces may create potential public health risk.
Collapse
Affiliation(s)
- Abouddihaj Barguigua
- Laboratory of Biotechnology and Sustainable Development of Natural Resources, Polydisciplinary Faculty, Sultan Moulay Slimane University, Bd Ibn Khaldoun, 23000, Beni Mellal, Morocco.
| | - Hamid Rguibi Idrissi
- Laboratory of Biodiversity, Ecology and Genome, Centre of Research "Plant and Microbial Biotechnology, Biodiversity and Environment, Faculty of Sciences, University Mohammed V, Rabat, Morocco
| | - Kaoutar Nayme
- Molecular Bacteriology Laboratory, Pasteur Institute of Morocco, 1, Place Louis Pasteur, 20360, Casablanca, Morocco
| | - Mohammed Timinouni
- Molecular Bacteriology Laboratory, Pasteur Institute of Morocco, 1, Place Louis Pasteur, 20360, Casablanca, Morocco
| |
Collapse
|
9
|
Bourafa N, Chaalal W, Bakour S, Lalaoui R, Boutefnouchet N, Diene SM, Rolain JM. Molecular characterization of carbapenem-resistant Gram-negative bacilli clinical isolates in Algeria. Infect Drug Resist 2018; 11:735-742. [PMID: 29844691 PMCID: PMC5961646 DOI: 10.2147/idr.s150005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives The aims of this study were to investigate the occurrence of carbapenem-resistant Gram-negative bacilli (GNB) isolated from inpatients and outpatients in Algeria between July and September 2015, and to screen their resistance mechanisms and genetic relatedness. Materials and methods A total of 68 non-redundant isolates were identified using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) antibiotic susceptibility testing was performed using disk diffusion and Etest methods. Carbapenemase activity was carried out using modified Carba NP test, EDTA assay, and the modified Hodge test. Molecular characterization of carbapenemases and extended-spectrum β-lactamase (ESBL) genes were detected by standard PCR and sequencing. Genotyping of carbapenem-resistant isolates was performed by multilocus sequence typing (MLST) analysis. Results Of the 68 GNB isolates, 13 (19%) showed reduced susceptibility to carbapenems, including, four Klebsiella pneumoniae, one Escherichia coli, six Acinetobacter baumannii, and two Pseudomonas aeruginosa. blaOXA-48 gene was detected in the five Enterobacteriaceae isolates, and blaOXA-23 was identified in all A. baumannii isolates. OprD mutations were revealed in the two P. aeruginosa isolates. A total of 11 out of the 13 carbapenem-resistant GNB were detected in inpatients, and the two remaining strains were isolated from outpatients. Molecular typing showed the presence of four sequence types (STs) among the OXA-48-producing K. pneumoniae isolates: ST101, ST147, ST163, and ST2017. ST533 was identified for the OXA-48 producing E. coli isolate. All of the A. baumannii and P. aeruginosa were assigned to the international clonal lineages ST2 and ST654, respectively. Conclusion This study reports the first detection of the epidemic multidrug-resistant lineage, K. pneumoniae ST147 coproduced blaOXA-48 and ESBL genes in Algeria and represents the first description of OXA-48-producing E. coli ST533 and K. pneumoniae ST163 and ST2017. In addition, this study describes for the first time the emergence of OXA-48-producing E. coli and K. pneumoniae in the community in Algeria, leading to major problems for managing microbial infections.
Collapse
Affiliation(s)
- Nadjette Bourafa
- Aix Marseille Universite, MEPHI, IHU-Mediterranee Infection, Marseille, France.,Laboratoire de Microbiologie et Biochimie Appliquée, Département de Biochimie, Faculté des Sciences, Université Badji Mokhtar Annaba, Algeria.,Département de Biologie, Faculté des Sciences de la Nature et de la Vie, Université Mohamed Cherif Messaadia-Souk-ahras, Algeria
| | - Wafaa Chaalal
- Aix Marseille Universite, MEPHI, IHU-Mediterranee Infection, Marseille, France.,Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université d'Oran, Es Senia, Oran, Algeria
| | - Sofiane Bakour
- Aix Marseille Universite, MEPHI, IHU-Mediterranee Infection, Marseille, France
| | - Rym Lalaoui
- Aix Marseille Universite, MEPHI, IHU-Mediterranee Infection, Marseille, France
| | - Nafissa Boutefnouchet
- Laboratoire de Microbiologie et Biochimie Appliquée, Département de Biochimie, Faculté des Sciences, Université Badji Mokhtar Annaba, Algeria
| | - Seydina M Diene
- Aix Marseille Universite, MEPHI, IHU-Mediterranee Infection, Marseille, France
| | - Jean-Marc Rolain
- Aix Marseille Universite, MEPHI, IHU-Mediterranee Infection, Marseille, France
| |
Collapse
|
10
|
Mairi A, Pantel A, Sotto A, Lavigne JP, Touati A. OXA-48-like carbapenemases producing Enterobacteriaceae in different niches. Eur J Clin Microbiol Infect Dis 2017; 37:587-604. [PMID: 28990132 DOI: 10.1007/s10096-017-3112-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 12/26/2022]
Abstract
The emergence of carbapenem-resistant enterobacterial species poses a serious threat to public health worldwide. OXA-48-type carbapenem-hydrolyzing class D β-lactamases are widely distributed among Enterobacteriaceae, with significant geographical differences. To date, 11 OXA-48-like variants have been identified, with classical OXA-48 being the most widespread. These enzymes show high-level hydrolytic activity against penicillins and low-level hydrolysis towards carbapenems. Since the first description of the OXA-48 carbapenemase in Turkey, bacterial strains producing the enzyme have been extensively reported in nosocomial and community outbreaks in many parts of the word, particularly in the Mediterranean area and European countries. The rapid spread of Enterobacteriaceae producing OXA-48-like enzymes in different ecosystems has become a serious issue recently. The number of reservoirs for such organisms is increasing, not only in hospitals, but also in the community, among animals (e.g., livestock, companion animals, and wildlife) and in the environment. This review aims to summarize the main characteristics of the OXA-48-type carbapenemases, covering genetic and enzymatic traits, their epidemiology, clonality and associated genes, correlation with extended-spectrum β-lactamases (ESBLs) or plasmidic AmpC (pAmpC) in different bacterial species worldwide.
Collapse
Affiliation(s)
- Assia Mairi
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, 06000, Bejaia, Algeria.,Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France
| | - Alix Pantel
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France.,Department of Microbiology, University Hospital of Nîmes, Nîmes, France
| | - Albert Sotto
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France
| | - Jean-Philippe Lavigne
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France. .,Department of Microbiology, University Hospital of Nîmes, Nîmes, France.
| | - Aziz Touati
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, 06000, Bejaia, Algeria
| |
Collapse
|
11
|
Skalova A, Chudejova K, Rotova V, Medvecky M, Studentova V, Chudackova E, Lavicka P, Bergerova T, Jakubu V, Zemlickova H, Papagiannitsis CC, Hrabak J. Molecular Characterization of OXA-48-Like-Producing Enterobacteriaceae in the Czech Republic and Evidence for Horizontal Transfer of pOXA-48-Like Plasmids. Antimicrob Agents Chemother 2017; 61:e01889-16. [PMID: 27855076 PMCID: PMC5278705 DOI: 10.1128/aac.01889-16] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/14/2016] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to characterize the first cases and outbreaks of OXA-48-like-producing Enterobacteriaceae recovered from hospital settings in the Czech Republic. From 2013 to 2015, 22 Klebsiella pneumoniae isolates, 3 Escherichia coli isolates, and 1 Enterobacter cloacae isolate producing OXA-48-like carbapenemases were isolated from 20 patients. Four of the patients were colonized or infected by two or three different OXA-48-like producers. The K. pneumoniae isolates were classified into nine sequence types (STs), with ST101 being predominant (n = 8). The E. coli isolates were of different STs, while the E. cloacae isolate belonged to ST109. Twenty-four isolates carried blaOXA-48, while two isolates carried blaOXA-181 or blaOXA-232 Almost all isolates (n = 22) carried blaOXA-48-positive plasmids of a similar size (∼60 kb), except the two isolates producing OXA-181 or OXA-232. In an ST45 K. pneumoniae isolate and an ST38 E. coli isolate, S1 nuclease profiling plus hybridization indicated a chromosomal location of blaOXA-48 Sequencing showed that the majority of blaOXA-48-carrying plasmids exhibited high degrees of identity with the pOXA-48-like plasmid pE71T. Additionally, two novel pE71T derivatives, pOXA-48_30715 and pOXA-48_30891, were observed. The blaOXA-181-carrying plasmid was identical to the IncX3 plasmid pOXA181_EC14828, while the blaOXA-232-carrying plasmid was a ColE2-type plasmid, being a novel derivative of pOXA-232. Finally, sequencing data showed that the ST45 K. pneumoniae and ST38 E. coli isolates harbored the IS1R-based composite transposon Tn6237 containing blaOXA-48 integrated into their chromosomes. These findings underlined that the horizontal transfer of pOXA-48-like plasmids has played a major role in the dissemination of blaOXA-48 in the Czech Republic. In combination with the difficulties with their detection, OXA-48 producers constitute an important public threat.
Collapse
Affiliation(s)
- Anna Skalova
- Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Katerina Chudejova
- Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Veronika Rotova
- Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | | | - Vendula Studentova
- Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Eva Chudackova
- Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Pavel Lavicka
- Department of Neurosurgery, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Tamara Bergerova
- Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Vladislav Jakubu
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic
- National Reference Laboratory for Antibiotics, National Institute of Public Health, Prague, Czech Republic
| | - Helena Zemlickova
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic
- National Reference Laboratory for Antibiotics, National Institute of Public Health, Prague, Czech Republic
- Department of Clinical Microbiology, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Costas C Papagiannitsis
- Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Jaroslav Hrabak
- Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| |
Collapse
|
12
|
Mathlouthi N, Al-Bayssari C, Bakour S, Rolain JM, Chouchani C. RETRACTED ARTICLE: Prevalence and emergence of carbapenemases-producing Gram-negative bacteria in Mediterranean basin. Crit Rev Microbiol 2016; 43:43-61. [DOI: 10.3109/1040841x.2016.1160867] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Najla Mathlouthi
- Université Tunis El-Manar, Faculté des Sciences de Tunis, Laboratoire des Microorganismes et Biomolécules Actives, Campus Universitaire, El-Manar II, Tunisia
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
- Université de Carthage, Institut Supérieur des Sciences et Technologies de l’Environnement de Borj-Cedria, Technopôle de Borj-Cedria, BP-1003, Hammam-Lif, Tunisia
| | - Charbel Al-Bayssari
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Sofiane Bakour
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Jean Marc Rolain
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Chedly Chouchani
- Université Tunis El-Manar, Faculté des Sciences de Tunis, Laboratoire des Microorganismes et Biomolécules Actives, Campus Universitaire, El-Manar II, Tunisia
- Université de Carthage, Institut Supérieur des Sciences et Technologies de l’Environnement de Borj-Cedria, Technopôle de Borj-Cedria, BP-1003, Hammam-Lif, Tunisia
| |
Collapse
|
13
|
Epidemiology of Carbapenem Resistant Klebsiella pneumoniae Infections in Mediterranean Countries. Mediterr J Hematol Infect Dis 2016; 8:e2016032. [PMID: 27441063 PMCID: PMC4943068 DOI: 10.4084/mjhid.2016.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/25/2016] [Indexed: 01/27/2023] Open
Abstract
Infections by Carbapenem-Resistant Enterobacteriaceae (CRE), in particular, carbapenem-resistant Klebsiella pneumoniae (CRKp), are a significant public health challenge worldwide. Resistance to carbapenems in enterobacteriaceae is linked to different mechanisms, including the production of the various types of enzymes like KPC, VIM, IMP, NDM, and OXA-48. Despite several attempts to control the spread of these infections at the local and national level, the epidemiological situation for CRKp had worsened in the last years in the Mediterranean area. The rate and types of CRKp isolates greatly differ in the various Mediterranean countries. KPC-producing K. pneumoniae is diffused particularly in the European countries bordering the Mediterranean Sea and is endemic in Greece and Italy. On the contrary, OXA-48-producing K. pneumoniae is endemic in Turkey and Malta and diffused at inter-regional level particularly in some North African and Middle East countries. The spread of these multiresistant pathogens in the world and the Mediterranean countries has been related to various epidemiological factors including the international transfer of patients coming from endemic areas.
Collapse
|
14
|
Meradji S, Barguigua A, Bentakouk MC, Nayme K, Zerouali K, Mazouz D, Chettibi H, Timinouni M. Epidemiology and virulence of VIM-4 metallo-beta-lactamase-producing Pseudomonas aeruginosa isolated from burn patients in eastern Algeria. Burns 2016; 42:906-18. [PMID: 27156788 DOI: 10.1016/j.burns.2016.02.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 10/21/2022]
Abstract
In this study, we investigated the prevalence of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in burn patients from eastern Algeria, CRPA virulence factors and the molecular epidemiology of CRPA. The overall prevalence of CRPA was 48.38%. Seven (46.66%) isolates were metallo-β-lactamases (MBL) producers and contained the MBL genes blaVIM-4 (n=6) and blaVIM-2 (n=1). Risk factors for CRPA infection were urinary catheter use and intubation (p=0.008). A high percentage of virulence factors (86.6% of these isolates were able to produce protease; 73.3% of isolates has DNase; and 66.6% were haemolysin positive) was observed in CRPA isolates. Among the seven MBL-producing isolates, four had the same clonal profile. The class 1 integrons, which contained the aadA7 gene cassette, were detected in six isolates. The 16SrRNA methylase gene, rmtB, was detected in one strain. All CRPA isolates were biofilm formers. A study on the kinetics of biofilm production revealed that biofilm production increased when the concentration of imipenem or ciprofloxacin and the incubation time increased. This is the first study to report the presence of VIM-4-producing P. aeruginosa from North Africa and also of the high prevalence of CRPA isolates. Based on our study of burn unit patients, the high percentage of P. aeruginosa with virulence factors and multi-drug resistance is alarming.
Collapse
Affiliation(s)
- Samah Meradji
- Biochemistry and Applied Microbiology Laboratory, Badji Mokhtar Faculty of Sciences, Department of Biology, Annaba University, Box 12 Sidi Amar, 23000 Annaba, Algeria
| | - Abouddihaj Barguigua
- Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, 1 Place Louis Pasteur, 20360 Casablanca, Morocco; Microbiology Laboratory, Faculty of Medicine and Pharmacy, 1 Street Hospital, 20360 Casablanca, Morocco
| | | | - Kaotar Nayme
- Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, 1 Place Louis Pasteur, 20360 Casablanca, Morocco; Microbiology Laboratory, Faculty of Medicine and Pharmacy, 1 Street Hospital, 20360 Casablanca, Morocco
| | - Khalid Zerouali
- Microbiology Laboratory, Faculty of Medicine and Pharmacy, 1 Street Hospital, 20360 Casablanca, Morocco
| | - Dekhil Mazouz
- Microbiology Laboratory, University Hospital Dorban, 23000 Annaba, Algeria
| | - Houria Chettibi
- Biochemistry and Applied Microbiology Laboratory, Badji Mokhtar Faculty of Sciences, Department of Biology, Annaba University, Box 12 Sidi Amar, 23000 Annaba, Algeria
| | - Mohammed Timinouni
- Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, 1 Place Louis Pasteur, 20360 Casablanca, Morocco.
| |
Collapse
|
15
|
Sekyere JO, Govinden U, Essack S. The Molecular Epidemiology and Genetic Environment of Carbapenemases Detected in Africa. Microb Drug Resist 2015; 22:59-68. [PMID: 26161476 DOI: 10.1089/mdr.2015.0053] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Research articles describing carbapenemases and their genetic environments in Gram-negative bacteria were reviewed to determine the molecular epidemiology of carbapenemases in Africa. The emergence of resistance to the carbapenems, the last resort antibiotic for difficult to treat bacterial infections, affords clinicians few therapeutic options, with a resulting increase in morbidities, mortalities, and healthcare costs. However, the molecular epidemiology of carbapenemases throughout Africa is less described. Research articles and conference proceedings describing the genetic environment and molecular epidemiology of carbapenemases in Africa were retrieved from Google Scholar, Scifinder, Pubmed, Web of Science, and Science Direct databases. Predominant carbapenemase genes so far described in Africa include the blaOXA-48 type, blaIMP, blaVIM, and blaNDM in Acinetobacter baumannii, Klebsiella pneumoniae, Enterobacter cloacae, Citrobacter spp., and Escherichia coli carried on various plasmid types and sizes, transposons, and integrons. Class D and class B carbapenemases, mainly prevalent in A. baumannii, K. pneumoniae, E. cloacae, Citrobacter spp., and E. coli were the commonest carbapenemases. Carbapenemases are mainly reported in North and South Africa as under-resourced laboratories, lack of awareness and funding preclude the detection and reporting of carbapenemase-mediated resistance. Consequently, the true molecular epidemiology of carbapenemases and their genetic environment in Africa is still unknown.
Collapse
Affiliation(s)
- John Osei Sekyere
- Antimicrobial Resistance Unit, School of Health Sciences, University of KwaZulu-Natal , Durban, South Africa
| | - Usha Govinden
- Antimicrobial Resistance Unit, School of Health Sciences, University of KwaZulu-Natal , Durban, South Africa
| | - Sabiha Essack
- Antimicrobial Resistance Unit, School of Health Sciences, University of KwaZulu-Natal , Durban, South Africa
| |
Collapse
|
16
|
Meradji S, Barguigua A, Zerouali K, Mazouz D, Chettibi H, Elmdaghri N, Timinouni M. Epidemiology of carbapenem non-susceptible Pseudomonas aeruginosa isolates in Eastern Algeria. Antimicrob Resist Infect Control 2015; 4:27. [PMID: 26075066 PMCID: PMC4465145 DOI: 10.1186/s13756-015-0067-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/04/2015] [Indexed: 01/19/2023] Open
Abstract
Background Carbapenem resistance among Pseudomonas aeruginosa has become a serious life-threatening problem due to the limited therapeutic options. In this study, we investigated the prevalence and the molecular epidemiology of carbapenem resistant Pseudomonas aeruginosa (CRPA) isolated from three hospitals in Annaba city, Algeria. Methods During the study period (January, 2012 to December, 2013), all patients infected by P. aeruginosa were considered as the potential study population. Antibiotic susceptibility testing was performed as recommended by the CLSI. Screening of carbapenemase producer isolates was performed by using imipenem-EDTA double-disk synergy test and modified Hodge test. CRPA isolates were tested for the presence of genes encoding β-lactamases, plasmid mediated quinolone resistance, aminoglycoside resistance and class 1 integrons were investigated by PCR and sequencing. The clonal relatedness among CRPA isolates was analyzed by pulsed-field gel electrophoresis method. The clinical data were collected to identify risk factors for CRPA carriage of P. aeruginosa infection. Results The overall prevalence of CRPA was 18.75 %. The risk factors for carrying CRPA were the length of hospital stay (p = 0.04), co-infections with Staphylococcus aureus (p = 0.01), and the use of urinary catheter (p = 0.03). The in-hospital mortality rate among case patients was 13.33 % compared with 1.53 % for control patients (p = 0.09). All CRPA isolates were multidrug resistance and the most effective antibiotic against CRPA isolates was amikacin and colistin. PFGE revealed an epidemic clonal dissemination of CRPA isolates. None of CRPA isolated were found to be carbapenemase-producers. The blaPSE-1 and aac(3)-II gene was detected in two and five strains respectively. The class1 integrons were detected in 2 isolates with the presence of aadA7 gene cassette in these integrons. Conclusion The endemic clonal dissemination and multi-drug resistance of CRPA isolates in our institution is highly alarming. Strict measure will be required to control the further spread of these pathogens in hospital setting.
Collapse
Affiliation(s)
- Samah Meradji
- Department of Biology, Biochemstry and Applied Microbiology Laboratory, Badji Mokhtar Faculty of sciences, Annaba University, Box 12, Sidi Amar, 23000 Annaba, Algeria
| | - Abouddihaj Barguigua
- Molecular Bacteriology Laboratory, Pasteur Institute of Morocco, 1, Place Louis Pasteur, 20360 Casablanca,, Morocco ; Microbiology Laboratory, Faculty of Medicine and Pharmacy, 1 Street Hospital, 20360 Casablanca, Morocco
| | - Khalid Zerouali
- Microbiology Laboratory, Faculty of Medicine and Pharmacy, 1 Street Hospital, 20360 Casablanca, Morocco
| | - Dekhil Mazouz
- Microbiology Laboratory, University Hospital Ibn Rochd, 23000 Annaba, Algeria
| | - Houria Chettibi
- Department of Biology, Biochemstry and Applied Microbiology Laboratory, Badji Mokhtar Faculty of sciences, Annaba University, Box 12, Sidi Amar, 23000 Annaba, Algeria
| | - Naima Elmdaghri
- Molecular Bacteriology Laboratory, Pasteur Institute of Morocco, 1, Place Louis Pasteur, 20360 Casablanca,, Morocco
| | - Mohammed Timinouni
- Molecular Bacteriology Laboratory, Pasteur Institute of Morocco, 1, Place Louis Pasteur, 20360 Casablanca,, Morocco
| |
Collapse
|
17
|
Barguigua A, Zerouali K, Katfy K, El Otmani F, Timinouni M, Elmdaghri N. Occurrence of OXA-48 and NDM-1 carbapenemase-producing Klebsiella pneumoniae in a Moroccan university hospital in Casablanca, Morocco. INFECTION GENETICS AND EVOLUTION 2015; 31:142-8. [DOI: 10.1016/j.meegid.2015.01.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 12/24/2022]
|
18
|
Manenzhe RI, Zar HJ, Nicol MP, Kaba M. The spread of carbapenemase-producing bacteria in Africa: a systematic review. J Antimicrob Chemother 2014; 70:23-40. [PMID: 25261423 DOI: 10.1093/jac/dku356] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Carbapenems are the last line of defence against ever more prevalent MDR Gram-negative bacteria, but their efficacy is threatened worldwide by bacteria that produce carbapenemase enzymes. The epidemiology of bacteria producing carbapenemases has been described in considerable detail in Europe, North America and Asia; however, little is known about their spread and clinical relevance in Africa. METHODS We systematically searched in PubMed, EBSCOhost, Web of Science, Scopus, Elsevier Masson Consulte and African Journals Online, international conference proceedings, published theses and dissertations for studies reporting on carbapenemase-producing bacteria in Africa. We included articles published in English or French up to 28 February 2014. We calculated the prevalence of carbapenemase producers only including studies where the total number of isolates tested was at least 30. RESULTS Eighty-three studies were included and analysed. Most studies were conducted in North Africa (74%, 61/83), followed by Southern Africa (12%, 10/83), especially South Africa (90%, 9/10), West Africa (8%, 7/83) and East Africa (6%, 6/83). Carbapenemase-producing bacteria were isolated from humans, the hospital environment and community environmental water samples, but not from animals. The prevalence of carbapenemase-producing isolates in hospital settings ranged from 2.3% to 67.7% in North Africa and from 9% to 60% in sub-Saharan Africa. CONCLUSIONS Carbapenemase-producing bacteria have been described in many African countries; however, their prevalence is poorly defined and has not been systematically studied. Antibiotic stewardship and surveillance systems, including molecular detection and genotyping of resistant isolates, should be implemented to monitor and reduce the spread of carbapenemase-producing bacteria.
Collapse
Affiliation(s)
- Rendani I Manenzhe
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Mark P Nicol
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Institute for Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Mamadou Kaba
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Institute for Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
19
|
Epidemiology of carbapenemase-producing Enterobacteriaceae and Acinetobacter baumannii in Mediterranean countries. BIOMED RESEARCH INTERNATIONAL 2014; 2014:305784. [PMID: 24955354 PMCID: PMC4052623 DOI: 10.1155/2014/305784] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 04/22/2014] [Indexed: 01/17/2023]
Abstract
The emergence and global spread of carbapenemase-producing Enterobacteriaceae and Acinetobacter baumannii are of great concern to health services worldwide. These β-lactamases hydrolyse almost all β-lactams, are plasmid-encoded, and are easily transferable among bacterial species. They are mostly of the KPC, VIM, IMP, NDM, and OXA-48 types. Their current extensive spread worldwide in Enterobacteriaceae is an important source of concern. Infections caused by these bacteria have limited treatment options and have been associated with high mortality rates. Carbapenemase producers are mainly identified among Klebsiella pneumoniae, Escherichia coli, and A. baumannii and still mostly in hospital settings and rarely in the community. The Mediterranean region is of interest due to a great diversity and population mixing. The prevalence of carbapenemases is particularly high, with this area constituting one of the most important reservoirs. The types of carbapenemase vary among countries, partially depending on the population exchange relationship between the regions and the possible reservoirs of each carbapenemase. This review described the epidemiology of carbapenemases produced by enterobacteria and A. baumannii in this part of the world highlighting the worrisome situation and the need to screen and detect these enzymes to prevent and control their dissemination.
Collapse
|