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Hamzaoui Z, Ferjani S, Medini I, Charaa L, Landolsi I, Ben Ali R, Khaled W, Chammam S, Abid S, Kanzari L, Ferjani A, Fakhfakh A, Kebaier D, Bouslah Z, Ben Sassi M, Trabelsi S, Boutiba-Ben Boubaker I. Genomic surveillance of SARS-CoV-2 in North Africa: 4 years of GISAID data sharing. IJID Reg 2024; 11:100356. [PMID: 38655560 PMCID: PMC11035039 DOI: 10.1016/j.ijregi.2024.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/26/2024]
Abstract
Objectives This study aimed to construct geographically, temporally, and epidemiologically representative data sets for SARS-CoV-2 in North Africa, focusing on Variants of Concern (VOCs), Variants of Interest (VOIs), and Variants Under Monitoring (VUMs). Methods SARS-CoV-2 genomic sequences and metadata from the EpiCoV database via the Global Initiative on Sharing All Influenza Data platform were analyzed. Data analysis included cases, deaths, demographics, patient status, sequencing technologies, and variant analysis. Results A comprehensive analysis of 10,783 viral genomic sequences from six North African countries revealed notable insights. SARS-CoV-2 sampling methods lack standardization, with a majority of countries lacking clear strategies. Over 59% of analyzed genomes lack essential clinical and demographic metadata, including patient age, sex, underlying health conditions, and clinical outcomes, which are essential for comprehensive genomic analysis and epidemiological studies, as submitted to the Global Initiative on Sharing All Influenza Data. Morocco reported the highest number of confirmed COVID-19 cases (1,272,490), whereas Tunisia leads in reported deaths (29,341), emphasizing regional variations in the pandemic's impact. The GRA clade emerged as predominant in North African countries. The lineage analysis showcased a diversity of 190 lineages in Egypt, 26 in Libya, 121 in Tunisia, 90 in Algeria, 146 in Morocco, and 10 in Mauritania. The temporal dynamics of SARS-CoV-2 variants revealed distinct waves driven by different variants. Conclusions This study contributes valuable insights into the genomic landscape of SARS-CoV-2 in North Africa, highlighting the importance of genomic surveillance in understanding viral dynamics and informing public health strategies.
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Affiliation(s)
- Zaineb Hamzaoui
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sana Ferjani
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ines Medini
- National Center Chalbibelkahia of Pharmacovigilance of Tunis, Laboratory of Clinical Pharmacology, Tunis, Tunisia
| | - Latifa Charaa
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ichrak Landolsi
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Roua Ben Ali
- National Center Chalbibelkahia of Pharmacovigilance of Tunis, Laboratory of Clinical Pharmacology, Tunis, Tunisia
| | - Wissal Khaled
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Sarra Chammam
- National Center Chalbibelkahia of Pharmacovigilance of Tunis, Laboratory of Clinical Pharmacology, Tunis, Tunisia
| | - Salma Abid
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Lamia Kanzari
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Asma Ferjani
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ahmed Fakhfakh
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Dhouha Kebaier
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Zoubeir Bouslah
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mouna Ben Sassi
- National Center Chalbibelkahia of Pharmacovigilance of Tunis, Laboratory of Clinical Pharmacology, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Tunisia
| | - Sameh Trabelsi
- National Center Chalbibelkahia of Pharmacovigilance of Tunis, Laboratory of Clinical Pharmacology, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Tunisia
| | - Ilhem Boutiba-Ben Boubaker
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
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Ferjani S, Kanzari L, Maamar E, Hamzaoui Z, Rehaiem A, Ferjani A, Boutiba-Ben Boubaker I. Extensively drug-resistant Acinetobacter baumannii co-producing VIM-2 and OXA-23 in intensive care units: Results of a one-day point prevalence in a Tunisian hospital. Infect Dis Now 2022; 52:426-431. [DOI: 10.1016/j.idnow.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022]
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Hamzaoui Z, Ocampo-Sosa A, Maamar E, Fernandez Martinez M, Ferjani S, Hammami S, Harbaoui S, Genel N, Arlet G, Saidani M, Slim A, Boutiba-Ben Boubaker I, Martinez-Martinez L. An Outbreak of NDM-1-ProducingKlebsiella pneumoniae, Associated with OmpK35 and OmpK36 Porin Loss in Tunisia. Microb Drug Resist 2018; 24:1137-1147. [DOI: 10.1089/mdr.2017.0165] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Zaineb Hamzaoui
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia
| | - Alain Ocampo-Sosa
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Elaa Maamar
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
| | | | - Sana Ferjani
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia
| | - Samia Hammami
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia
| | - Sarra Harbaoui
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
| | - Nathalie Genel
- Department of Bacteriology, Medical School, University Pierre et Marie Curie, Paris, France
| | - Guillaume Arlet
- Department of Bacteriology, Medical School, University Pierre et Marie Curie, Paris, France
| | - Mabrouka Saidani
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Amine Slim
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ilhem Boutiba-Ben Boubaker
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Luis Martinez-Martinez
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Department of Molecular Biology, School of Medicine, University of Cantabria, Santander, Spain
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Maamar E, Alonso CA, Ferjani S, Jendoubi A, Hamzaoui Z, Jebri A, Saidani M, Ghedira S, Torres C, Boubaker IBB. NDM-1- and OXA-23-producing Acinetobacter baumannii isolated from intensive care unit patients in Tunisia. Int J Antimicrob Agents 2018; 52:910-915. [PMID: 29665444 DOI: 10.1016/j.ijantimicag.2018.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/23/2018] [Accepted: 04/07/2018] [Indexed: 10/17/2022]
Abstract
Gastrointestinal colonisation by carbapenem-resistant Acinetobacter baumannii (CRAB) is a critical step before nosocomial infection. This study evaluated CRAB intestinal carriage in patients admitted to a Tunisian ICU and determined the antimicrobial resistance mechanisms involved. From December 2014 to February 2015, all 63 patients admitted to the ICU were screened for rectal CRAB colonisation upon admission and once weekly thereafter. ICU patients who acquired a CRAB nosocomial infection were also included. β-Lactamases and associated resistance genes were screened by PCR sequencing, and molecular typing was performed by PFGE and MLST. The CRAB faecal carriage rate at admission was 4.8% (3/63). The CRAB acquisition rate during ICU stay was analysed in 39 of the remaining 60 patients and the rate of acquired CRAB faecal carriage was 15.4% (6/39); 4 patients also showed an ICU-acquired CRAB infection (one patient was a faecal carrier and suffered infection). Overall, 13 CRAB isolates were collected from 12 patients, of which 11 isolates showed resistance to all antibiotics tested except colistin. blaOXA-23 and blaNDM-1 were detected in 11 and 2 isolates, respectively. All OXA-23-producing strains carried armA, tetB, sul1 and catB, and some of them carried aph(3')-VIa, blaTEM-1, aph(3')-Ia and ant(2'')-Ia. The blaNDM-1-positive isolates harboured aph(3')-VIa and catB. Three PFGE patterns and two STs were identified [ST195 (n = 11), ST1089 (n = 2, NDM-1-positive)]. Whether imported or acquired during ICU stay, CRAB colonisation is a major risk factor for the occurrence of serious nosocomial infection. Systematic screening of faecal carriage is mandatory to prevent their spread.
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Affiliation(s)
- Elaa Maamar
- University of Tunis El Manar, Faculty of Medicine of Tunis-LR99ES09 Research Laboratory 'Antimicrobial resistance', 15 Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia.
| | - Carla Andrea Alonso
- Universidad de La Rioja, Area de Bioquímica y Biología Molecular, Logroño, Spain
| | - Sana Ferjani
- University of Tunis El Manar, Faculty of Medicine of Tunis-LR99ES09 Research Laboratory 'Antimicrobial resistance', 15 Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Ali Jendoubi
- Charles Nicolle Hospital, Intensive Care Unit, 1006 Tunis, Tunisia
| | - Zaineb Hamzaoui
- University of Tunis El Manar, Faculty of Medicine of Tunis-LR99ES09 Research Laboratory 'Antimicrobial resistance', 15 Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Alia Jebri
- Charles Nicolle Hospital, Intensive Care Unit, 1006 Tunis, Tunisia
| | - Mabrouka Saidani
- University of Tunis El Manar, Faculty of Medicine of Tunis-LR99ES09 Research Laboratory 'Antimicrobial resistance', 15 Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, 1006 Tunis, Tunisia
| | - Salma Ghedira
- Charles Nicolle Hospital, Intensive Care Unit, 1006 Tunis, Tunisia
| | - Carmen Torres
- Universidad de La Rioja, Area de Bioquímica y Biología Molecular, Logroño, Spain
| | - Ilhem Boutiba-Ben Boubaker
- University of Tunis El Manar, Faculty of Medicine of Tunis-LR99ES09 Research Laboratory 'Antimicrobial resistance', 15 Rue Djebel Akhdhar, La Rabta, 1007 Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, 1006 Tunis, Tunisia
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Hamzaoui Z, Ocampo-Sosa A, Fernandez Martinez M, Landolsi S, Ferjani S, Maamar E, Saidani M, Slim A, Martinez-Martinez L, Boutiba-Ben Boubaker I. Role of association of OmpK35 and OmpK36 alteration and bla ESBL and/or bla AmpC genes in conferring carbapenem resistance among non-carbapenemase-producing Klebsiella pneumoniae. Int J Antimicrob Agents 2018; 52:898-905. [PMID: 29621592 DOI: 10.1016/j.ijantimicag.2018.03.020] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/01/2018] [Accepted: 03/28/2018] [Indexed: 12/16/2022]
Abstract
In Klebsiella pneumoniae, loss of the two major outer membrane porins (OMPs) OmpK35 and OmpK36 confers resistance to carbapenems in strains producing extended-spectrum β-lactamases (ESBLs) or plasmid-mediated AmpC-type β-lactamases. This study investigated mechanisms responsible for carbapenem resistance in non-carbapenemase-producing K. pneumoniae (NCPK). All carbapenem-resistant Enterobacteriaceae (CRE) at Charles Nicolle Hospital (Tunis, Tunisia) were collected over a 6-year period (2010-2015). Among the 334 CRE strains collected, 44 (13.2%) were NCPK. MIC ranges for ertapenem, imipenem and meropenem were 1 to >32 mg/L, 0.125-8 mg/L and 0.125-32 mg/L, respectively. All strains showed a multidrug-resistant (MDR) phenotype and were negative for carbapenemase activity. None of the carbapenemase genes searched for were found. ESBL production was confirmed in all isolates except one [CTX-M-15 (n = 39) and SHV-5 (n = 4)]. Three isolates produce DHA-1 (associated with CTX-M-15 in two strains). Molecular fingerprints grouped the 44 NCPK isolates into seven clusters. In seven representative strains of these clusters, SDS-PAGE results showed that four isolates lacked the OmpK35 porin, one isolate lacked OmpK36 and two isolates lacked both OmpK35 and OmpK36. Sequencing of the corresponding porin genes showed amino acid insertions and deletions leading to early termination of translation, point mutations in the promoter region, or insertion sequences disrupting the gene coding sequence. Loss or deficiency of OMPs, coupled with ESBL and/or AmpC production, plays an important role in conferring carbapenem resistance in K. pneumoniae. Dissemination of these MDR bacteria in our hospital may create serious therapeutic problems in the future.
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Affiliation(s)
- Zaineb Hamzaoui
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia; University of Carthage, Faculty of Sciences of Bizerte, Tunis, Tunisia.
| | - Alain Ocampo-Sosa
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander 39008, Spain
| | - Marta Fernandez Martinez
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander 39008, Spain
| | - Sarrah Landolsi
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia
| | - Sana Ferjani
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia; University of Carthage, Faculty of Sciences of Bizerte, Tunis, Tunisia
| | - Elaa Maamar
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia
| | - Mabrouka Saidani
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, 1006 Tunis, Tunisia
| | - Amine Slim
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, 1006 Tunis, Tunisia
| | - Luis Martinez-Martinez
- Clinical Unit of Microbiology, University Hospital Reina Sofía, Córdoba, Spain; Department of Microbiology, University of Córdoba, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Ilhem Boutiba-Ben Boubaker
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, 1006 Tunis, Tunisia
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Maamar E, Alonso CA, Hamzaoui Z, Dakhli N, Abbassi MS, Ferjani S, Saidani M, Boutiba-Ben Boubaker I, Torres C. Emergence of plasmid-mediated colistin-resistance in CMY-2-producing Escherichia coli of lineage ST2197 in a Tunisian poultry farm. Int J Food Microbiol 2018; 269:60-63. [PMID: 29421359 DOI: 10.1016/j.ijfoodmicro.2018.01.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/15/2018] [Accepted: 01/19/2018] [Indexed: 01/14/2023]
Abstract
Our study aimed to investigate colistin resistance and the mechanisms involved in a collection of 35 extended-spectrum beta-lactamase (ESBL) and 13 CMY-2-producing E. coli strains which were previously recovered from chicken gut microbiota in Tunisia, as well as to determine the genetic location of mcr genes. Forty-eight ESBL and CMY-2-producing E. coli strains were obtained from 137 fecal samples of healthy chickens during 2013. These strains were tested for colistin resistance by the broth microdilution method, and screened for mcr-1 and mcr-2 genes by PCR. Two of these strains were colistin-resistant (MIC = 8 mg/L). Both harbored the mcr-1 gene, were CMY-2 producers, and were additionally resistant to tetracycline, ciprofloxacin, chloramphenicol, gentamicin, tobramycin and trimethoprim-sulfamethoxazole. They shared phylogroup A, the same pulsed-field gel electrophoresis (PFGE)-pattern, and were typed as ST2197. In both strains, ISApl1 and pap2 were detected upstream and downstream of mcr-1 gene, respectively. The analysis of the two mcr-1-positive strains and their transconjugants by PCR-based replicon typing and S1-PFGE, demonstrated that mcr-1 gene is linked to an IncP plasmid (~242 kb), and blaCMY-2 to an IncI1 plasmid (97 kb). The occurrence of E. coli harboring mcr-1 gene among intestinal microbiota in poultry and its location on a conjugative plasmid could represent a risk for public health. The evolution of this type of resistant microorganisms should be evaluated in the future.
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Affiliation(s)
- Elaa Maamar
- University of Tunis El Manar, Faculty of Medicine of Tunis- LR99ES09 Research Laboratory «Antimicrobial resistance», 1007 Tunis, Tunisia.
| | - Carla Andrea Alonso
- Universidad de La Rioja, Area de Bioquímica y Biología Molecular, Logroño, Spain
| | - Zaineb Hamzaoui
- University of Tunis El Manar, Faculty of Medicine of Tunis- LR99ES09 Research Laboratory «Antimicrobial resistance», 1007 Tunis, Tunisia
| | - Nouha Dakhli
- University of Tunis El Manar, Faculty of Medicine of Tunis- LR99ES09 Research Laboratory «Antimicrobial resistance», 1007 Tunis, Tunisia
| | - Mohamed Salah Abbassi
- University of Tunis El Manar, Faculty of Medicine of Tunis- LR99ES09 Research Laboratory «Antimicrobial resistance», 1007 Tunis, Tunisia; University of Tunis El Manar, Institute of Veterinary Research of Tunisia-Laboratory of bacteriological research, Tunis, Tunisia
| | - Sana Ferjani
- University of Tunis El Manar, Faculty of Medicine of Tunis- LR99ES09 Research Laboratory «Antimicrobial resistance», 1007 Tunis, Tunisia
| | - Mabrouka Saidani
- University of Tunis El Manar, Faculty of Medicine of Tunis- LR99ES09 Research Laboratory «Antimicrobial resistance», 1007 Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, 1006 Tunis, Tunisia
| | - Ilhem Boutiba-Ben Boubaker
- University of Tunis El Manar, Faculty of Medicine of Tunis- LR99ES09 Research Laboratory «Antimicrobial resistance», 1007 Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, 1006 Tunis, Tunisia
| | - Carmen Torres
- Universidad de La Rioja, Area de Bioquímica y Biología Molecular, Logroño, Spain
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Maamar E, Ferjani S, Jendoubi A, Hammami S, Hamzaoui Z, Mayonnove-Coulange L, Saidani M, Kammoun A, Rehaiem A, Ghedira S, Houissa M, Boutiba-Ben Boubaker I, Slim A, Dubois V. High Prevalence of Gut Microbiota Colonization with Broad-Spectrum Cephalosporin Resistant Enterobacteriaceae in a Tunisian Intensive Care Unit. Front Microbiol 2016; 7:1859. [PMID: 27965626 PMCID: PMC5126703 DOI: 10.3389/fmicb.2016.01859] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/04/2016] [Indexed: 11/15/2022] Open
Abstract
Healthcare-associated infections due to cefotaxime-resistant (CTX-R) Enterobacteriaceae have become a major public health threat, especially in intensive care units (ICUs). Often acquired nosocomially, CTX-R Enterobacteriaceae can be introduced initially by patients at admission. This study aimed to determine the prevalence and genetic characteristics of CTX-R Enterobacteriaceae-intestinal carriage in ICU patients, to evaluate the rate of acquisition of these organisms during hospitalization, and to explore some of the associated risk factors for both carriage and acquisition. Between December 2014 and February 2015, the 63 patients admitted in the ICU of Charles Nicolle hospital were screened for rectal CTX-R Enterobacteriaceae colonization at admission and once weekly thereafter to identify acquisition. CTX-R Enterobacteriaceae fecal carriage rate was 20.63% (13/63) at admission. Among the 50 non-carriers, 35 were resampled during their hospitalization and the acquisition rate was 42.85% (15/35). Overall, 35 CTX-R Enterobacteriaceae isolates were collected from 28 patients (25 Klebsiella pneumoniae, seven Escherichia coli, and three Enterobacter cloacae strains). Seven patients were simultaneously colonized with two CTX-R Enterobacteriaceae isolates. CTX-M-15 was detected in most of the CTX-R Enterobacteriaceae isolates (30/35, 88.23%). Three strains co-produced CMY-4 and 22 strains were carbapenem-resistant and co-produced a carbapenemase [OXA-48 (n = 13) or NDM-1 (n = 6)]. Molecular typing of K. pneumoniae strains, revealed eight Pulsed field gel electrophoresis (PFGE) patterns and four sequence types (ST) [ST101, ST147, ST429, and ST336]. However, E. coli isolates were genetically unrelated and belonged to A (n = 2), B1 (n = 2) and B2 (n = 3) phylogenetic groups and to ST131 (two strains), ST572 (two strains), ST615 (one strain) and ST617 (one strain). Five colonized patients were infected by CTX-R Enterobacteriaceae (four with the same strain identified from their rectal swab and one with a different strain). Whether imported or acquired during the stay in the ICU, colonization by CTX-R Enterobacteriaceae is a major risk factor for the occurrence of serious nosocomial infections. Their systematic screening in fecal carriage is mandatory to prevent the spread of these multidrug resistant bacteria.
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Affiliation(s)
- Elaa Maamar
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Faculty of Sciences of Tunis, University of Tunis El ManarTunis, Tunisia
| | - Sana Ferjani
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar Tunis, Tunisia
| | - Ali Jendoubi
- Intensive Care Unit, Charles Nicolle Hospital Tunis, Tunisia
| | - Samia Hammami
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Faculty of Sciences of Gafsa, University of GafsaGafsa, Tunisia
| | - Zaineb Hamzaoui
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar Tunis, Tunisia
| | | | - Mabrouka Saidani
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia
| | - Aouatef Kammoun
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia
| | - Amel Rehaiem
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia
| | - Salma Ghedira
- Intensive Care Unit, Charles Nicolle Hospital Tunis, Tunisia
| | - Mohamed Houissa
- Intensive Care Unit, Charles Nicolle Hospital Tunis, Tunisia
| | - Ilhem Boutiba-Ben Boubaker
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia
| | - Amine Slim
- Faculty of Medicine of Tunis - LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El ManarTunis, Tunisia; Laboratory of Microbiology, Charles Nicolle HospitalTunis, Tunisia
| | - Veronique Dubois
- University Bordeaux, Microbiologie Fondamentale et Pathogénicité, UMR5234 Bordeaux, France
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Maamar E, Hammami S, Ferjani S, Hamzaoui Z, Jlizi A, Saidani M, Slim A, Boubaker IBB. Molecular characterization of extended spectrum β-lactamases, ampccephalosporinases and carbapenemases in klebsiellapneumoniae causing bacteremia at charles nicolle Hospital of Tunisia. Acta Med Int 2016. [DOI: 10.5530/ami.2016.2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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