Carbapenemases and extended-spectrum β-lactamases producing Enterobacteriaceae isolated from Tunisian and Libyan hospitals

Abstract

Introduction: The aim of the study was to investigate the prevalence of extended-spectrum β-lactamase (ESBL) and carbapenemase production among clinical isolates of Enterobacteriaceae recovered from Tunisian and Libyan hospitals. Methodology: Bacterial isolates were recovered from patients in intensive care units and identified by biochemical tests and MALDI-TOF. Antibiotic susceptibility testing was performed by disk diffusion and the E-test method. ESBL and carbapenemase activities were detected using standard microbiological tests. Antibiotic resistance-encoding genes were screened by PCR and sequencing. Clonal relationships between Klebsiella pneumoniae strains were carried out using multi-locus sequence typing (MLST). Results: A total of 87 isolates were characterized, with 51 and 36, respectively, identified as E. coli and K. pneumoniae. Overall the resistance prevalence was high for aminoglycosides (> 60%), fluoroquinolones (> 80%), and extended-spectrum cephalosporins (> 94%), and was low for imipenem (11.4%). Among this collection, 58 strains (66.6%) were ESBL producers and 10 K. pneumoniae strains (11.4%) were carbapenemase producers. The antibiotic resistance-encoding genes detected were blaCTX-M-15 (51.7%), blaTEM-1 (35.6%), several variants of blaSHV (21.8%), and blaOXA-48 (11.4%). The MLST typing of K. pneumoniae isolates revealed the presence of multiple clones and three novel sequence types. Also, close relationships between the OXA-48-producing strains from Tunisia and Libya were demonstrated. Conclusions: This study is the first paper describing the emergence of carbapenemase-and ESBL-producing Enterobacteriaceae, sensitive to colistin, isolated in Tunisia and Libya. Active surveillance and testing for susceptibility to colistin should be implementing because resistance to colistin, mainly in Klebsiella, has been recently reported worldwide.

Prevalence and resistance profile of extended-spectrum -lactamases-producing Enterobacteriaceae in Ouagadougou, Burkina Faso

“…There was an average resistance of 58.5% to cefotaxime and cefepime, while resistance to ceftriaxone and cefoxitine was 61.9 and 26.1% respectively (Table 2). Mathlouthi et al (2016) affirm this finding in their report of isolates from Tunisian and Libyan hospitals with 80% resistance to ceftazidime, cefotaxime, amoxicillin + clavulanic acid, amoxicillin and ciprofloxacin. Our report of 38.5% prevalence of ESBL-E in this study is relatively high; however a similar study by Ouedraogo et al (2016) in Burkina Faso recorded a higher prevalence of 58%.…”

“…Enterobacteriaceae remains the major pathogens causing communityacquired and hospital-acquired infections including infections of the gastrointestinal tracts, urinary tract, sepsis, meningitis and medical device-associated infections (Mathlouthi et al, 2016). Urine, of all 6 clinical sample types analyzed gave the highest number of Enterobecteriaceae of which 50.1% were from Males.…”

Emergence of AmpC β-Lactamase– and Metallo-β-Lactamase–producing Klebsiella pneumoniae in Sebha, Libya

“…The prevalence of ESBL and AmpC enzymes has increased worldwide [50,51,52]. However, the dissemination of ESBL and AmpC enzymes has also been reported in the neighboring country Tunisia [21,38,53,54,55]. In Saudi Arabia, Kader and his group (2005) also isolated ESBL-producing uropathogens from both inpatients and outpatients.…”

“…Further, AmpC enzyme-producing K. pneumoniae isolates were also recovered from the pediatric department in Tripoli, Libya [23]. The prevalence of carbapenemase-producing K. pneumoniae has been recorded worldwide, including the Mediterranean region and North Africa [38,21].…”

“…After 2011, multidrug-resistant K. pneumoniae strains were isolated from Libyan refugees in European hospitals [19,20,21] and also from a Libyan patient transferred to a Tunisian hospital [22].…”