Résistance plasmidique aux quinolones

Prevalence and Characterization of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in Major Hospitals in Gabon

In Gabon, few data exist on extended-spectrum beta-lactamases-producing Enterobacteriaceae (ESBL-PE). This study investigated ESBL-PE prevalence and the associated resistance genes in clinical samples (n = 5,956) and anal swabs (n = 78) analyzed in eight hospitals and a medical analysis laboratory in Gabon from January 2016 to March 2018. Matrix-Assisted Laser Desorption Ionization-Time Of Flight (MALDI-TOF) mass spectrometry analysis identified 790 Enterobacteriaceae isolates (n = 712 clinical samples and n = 78 fecal samples). ESBL-PE prevalence (Müller-Hinton agar disk diffusion method and double-disk synergy test) was 11.8% (84/712) in clinical samples (15.5% from inpatients and 7.1% from outpatients; p < 0.05) and 16.7% (13/78) in carriage isolates. Most ESBL-PE were isolated from urine samples (46/84). In clinical and carriage ESBL-PE isolates, Escherichia coli was predominant (42.8% and 61.5%; phylogroups A, B1, B2, and D), followed by Klebsiella pneumoniae (41.7% and 23.1%). Multiplex PCR and bi-directional sequencing showed that CTX-M group 1 (blaCTX-M-15) was predominant in clinical and carriage ESBL-PE (94% and 92.3%) among which 85.7% and 92.3% also harbored one to three β-lactamase-encoding genes (blaTEM-1, blaOXA-1, or blaSHV-1). Resistance genes were detected in all hospitals in Gabon. ESBL-PE prevalence in Gabon has not reached alarming levels yet, but corrective and monitoring measures are needed to curb their emergence.

[Recent evolution of the epidemiological profile of extended-spectrum β-lactamase producing uropathogenic enterobacteria in Marrakech, Morocco]

INTRODUCTION

Urinary tract infection by extended-spectrum β-lactamase producing enterobacteriaceae (ESBL-E) is a growing infection risk and may even lead in many cases to therapeutic impasses because of their multidrug resistance.

AIM OF THE STUDY

Follow, over a 5-year period, the evolution of the epidemiological profile of uropathogenic ESBL-E and describe their current level of antibiotic resistance.

MATERIALS AND METHODS

A retrospective work was made over a period of 5 years (from 1st January 2008 to 31st December 2012). It focused on all the ESBL-E strains isolated from all the urinary samples at the microbiology laboratory of Avicenne hospital, Marrakech (Morocco).

RESULTS

We noticed in 5 years, an important increase in the prevalence of ESBL-E. The higher prevalence of ESBL-E (51%) was recorded in the urology department. The study of the antibiotic resistance of the ESBL-E had shown antibiotic co-resistances to the ciprofloxacin (82%), to sulfamethoxazole-trimethropim (85%), to gentamicin (74%), to amikacine (51%). Our results also showed, for the first time in our region, an emergence in the resistance of enterobacteria producing ESBL to imipenem (10%).

CONCLUSION

The significant increase in the prevalence of ESBL-E has become a concern at the hospitals and in community medicine as well. The study of the resistance of ESBL-E strains antibiotics showed high rates of co-resistance to antibiotics, including the usual urology molecules.

LEVEL OF PROOF

5.

[Epidemiological study of Klebsiella spp. uropathogenic strains producing extended-spectrum β-lactamase in a Tunisian university hospital, 2009]

OBJECTIVE

An update on the prevalence of antibiotic resistance in extended-spectrum β-lactamase among urinary strains of Klebsiella spp. isolated from in-come and out-come patients at University Hospital, Mahdia (Tunisia).

PATIENTS AND METHODS

A retrospective survey was made over a period of twelve months (year 2009). It focused on 3564 patients with urinary tract infection confirmed by the Laboratory of Microbiology in the University Hospital, Mahdia.

RESULTS

Klebsiella spp. was involved in 5.5% (198/3564) of all cases of urinary tract infections identified. Klebsiella pneumoniae accounted for 94.9% of all Klebsiella (5.1% for Klebsiella oxytoca). The frequency of Klebsiella spp. resistance to fluoroquinolones was 19.2% and to third generation cephalosporins was 22.7%. Forty strains of Klebsiella spp. producing extended-spectrum β-lactamase witch corresponds to 20.2% of all the Klebsiella. The extended-spectrum β-lactamase strains with resistance to fluoroquinolones were 67.5% (27/40) or 13.6% of all klebsiella (27/198). No strain was resistant to imipenem. The 27 strains multiresistant (ESBL+FQ resistance) are likely to be carriers of plasmids encoding the ESBL and resistance to fluoroquinolones.

CONCLUSION

the resistance of Enterobacteriaceae, including Klebsiella spp, to fluoroquinolones has become a concern both in hospital in community medicine. The advent of this resistance mechanism involves a more rational use of fluoroquinolones, especially as first-line treatment of urinary tract infections.