Cross-border transmission of OXA-48-producing Enterobacter cloacae from Morocco to France

Poirel, Laurent; Ros, A.; Carrër, Amélie; Fortineau, Nicolas; Carricajo, Anne; Berthelot, Philippe; Nordmann, Patrice

doi:10.1093/jac/dkr023

Cited by 60 publications

(46 citation statements)

References 5 publications

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“…Recently, a nosocomial dissemination of OXA-48-producing K. pneumoniae isolates has been reported in Moroccan hospitals [21]- [23].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Extended-Spectrum Be-ta-Lactamase-Producing <i>Klebsiella pneumoniae</i> among Patients and in the Environment of Hassan II Hospital, Settat, Morocco

Natoubi¹,

Barguigua²,

Zriouil³

et al. 2016

AiM

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Aim: The aim of the current study is to determine: (1) the prevalence of extended-spectrum β-lactamase-producing K. pneumoniae (ESBL-Kp) isolated from clinical samples and a hospital environment in Hassan II Hospital (Settat, Morocco); (2) the associated risk factors of ESBL-Kp infections; (3) the link between clinical and environmental isolates. Methods: During the study period (April 2010 to March 2011), all patients infected and hospital environment sites contaminated by K. pneumoniae were considered as the potential study population and environmental site. The clinical data were collected to identify risk factors for ESBL carriage of K. pneumoniae infection. Screening of ESBL-and carbapenemase-producing isolates was performed by using a double-disk synergy test and the modified Hodge test, respectively. ESBL-Kp isolates were tested for the presence of genes encoding β-lactamases and were investigated by PCR. The clonal relationship between * Corresponding author. S. Natoubi et al. 153 ESBL-producing isolates was analysed by ERIC-and REP-PCR method. Results:The overall prevalence of ESBL-Kp among clinical and environmental K. pneumoniae isolates was 35.13% (13/37) and 4.04% (4/99), respectively. The main risk factors for carrying ESBL-Kp were renal disease (46.15%), recent surgery (53.84%), previous hospitalisation (76.92%), and the presence of many invasive devices (53.84%). All ESBL isolates were multidrug resistant. The blaCTX-M group1and blaSHV (70.58% for each) were the most prevalent followed by blaTEM (52.94%). Thirteen strains expressed at least two bla genes. One isolate was positive in the modified Hodge test and was a blaOXA-48 producer. ERIC and Rep-PCR methods revealed an epidemic clonal dissemination of these isolates. Conclusion: The emergence of OXA-48 carbapenemase, endemic clonal dissemination and multi-drug resistance of ESBL-Kp isolates in our institution is highly alarming.

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“…Recently, a nosocomial dissemination of OXA-48-producing K. pneumoniae isolates has been reported in Moroccan hospitals [21]- [23].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Extended-Spectrum Be-ta-Lactamase-Producing <i>Klebsiella pneumoniae</i> among Patients and in the Environment of Hassan II Hospital, Settat, Morocco

Natoubi¹,

Barguigua²,

Zriouil³

et al. 2016

AiM

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“…All isolates were tested using imipenem, meropenem, and ertapenem MICs (Etest; bioMérieux, Marcy l'Etoile, France) and by the MHT following the CLSI recommendations (9). The molecular mechanism involved in carbapenem resistance was determined by PCR assays targeting bla NDM-1 , bla VIM , bla IMP , bla KPC , bla , bla OXA40 , and bla OXA23 genes as previously described (10,11,12,13). All carbapenemase-producing clinical strains were sent to the French Reference Centre on Emerging Antibiotic Resistance (Paris, France) for molecular characterization and clone determination.…”

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confidence: 99%

Detection of Carbapenemase-Producing Bacteria by Using an Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry Method

Carricajo

Verhoeven

Guezzou

et al. 2014

Antimicrob Agents Chemother

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cThe emergence of carbapenemase-producing bacteria poses a new challenge in the management of antibiotic therapies for patients. This report describes a new method using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) for rapid detection of carbapenemase activity in enterobacteria, Pseudomonas aeruginosa, and Acinetobacter baumannii. In a panel of 78 isolates, including 41 carbapenemase-producing strains, the ULPC-MS/MS assay showed 100% agreement with molecular characterization, whereas six carbapenemase-producing isolates were not detected by the modified Hodge test.T he emergence and dissemination of resistance to carbapenem in Gram-negative pathogens such as Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa represent a challenge for optimizing antibiotic therapies and preventing outbreaks, especially regarding carbapenemase-producing bacteria, by comparison to other resistance mechanisms. Using the Ambler classification of beta-lactamases, the principal carbapenemase enzymes detected in infected patients worldwide belong to class B (metallo-beta-lactamases, including IMP, VIM, and NDM), to class A (beta-lactamases, including Klebsiella pneumoniae carbapenemase [KPC]), and to class D (oxacillinases, including OXA-48 and OXA-23). Moreover, clinical infections due to these carbapenemase-producing strains, which are also resistant to most betalactam antibiotics, are associated with higher morbidity and mortality (1). Bacterial resistance to carbapenem is usually screened using susceptibility and phenotypic assays such as the modified Hodge test (MHT) (2). However, these tests have shown poor sensitivity and specificity in detecting carbapenemase-producing isolates, especially in A. baumannii (3). While PCR-based detection of the carbapenemase gene is considered the gold standard method, in view of the high genetic diversity of genes coding for carbapenemase, numerous PCR assays targeting the most prevalent enzymes must be developed in this approach (2, 4). Recently, mass spectrometry (MS) technologies, such as matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), have been shown to be capable of characterizing carbapenemase-producing bacteria (5,6,7,8).This study reports on a rapid UPLC-MS/MS assay to detect carbapenemase-producing Enterobacteriaceae, P. aeruginosa, and A. baumannii isolates based on the ability of bacterial isolates to hydrolyze ertapenem and meropenem in solution.A total of 78 bacterial strains (27 reference strains and 51 strains isolated from clinical samples) were included in the study: 41 carbapenemase-producing strains (including 23 enterobacterial strains, 3 P. aeruginosa strains, and 15 A. baumannii strains) and 37 strains susceptible to carbapenems or harboring decreased susceptibility to carbapenems due to non-carbapenemase-based mechanisms. Escherichia coli ATCC 25922 and Citrobacter freundii NDM-1-positive strain...

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“…The OXA-48 carbapenemase was first described in Klebsiella pneumoniae epidemic isolates from Turkey and then in several European countries, such as France and Belgium. Recently, it has also been identified in enterobacterial isolates recovered from non-European countries, such as Lebanon, Tunisia, Senegal, Morocco, Israel, and India (2,5,9,10,12,18). In addition to K. pneumoniae, OXA-48 has been identified in Escherichia coli, Enterobacter cloacae, Citrobacter freundii, and Providencia rettgeri (2).…”

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confidence: 99%

Emergence of OXA-48-Type Carbapenemase-Producing Enterobacteriaceae in German Hospitals

Pfeifer

Schlatterer

Engelmann

et al. 2012

Antimicrob Agents Chemother

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h Nine carbapenem-resistant Enterobacteriaceae isolates collected from eight patients in five German hospitals were investigated. Six isolates produced the OXA-48 carbapenemase, and three isolates produced OXA-162, which is a point mutant form of OXA-48. Both carbapenemase genes were located on IncL/M-type conjugative plasmids. Insertion sequence IS1999 (truncated or not by IS1R) was located upstream of the bla OXA-48 and bla OXA-162 genes in all of the isolates. Pulsed-field gel electrophoresis typing indicated the clonal transmission of an OXA-48-producing Klebsiella pneumoniae strain in two hospitals.

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Cross-border transmission of OXA-48-producing Enterobacter cloacae from Morocco to France

Cited by 60 publications

References 5 publications

Incidence of Extended-Spectrum Be-ta-Lactamase-Producing <i>Klebsiella pneumoniae</i> among Patients and in the Environment of Hassan II Hospital, Settat, Morocco

Incidence of Extended-Spectrum Be-ta-Lactamase-Producing <i>Klebsiella pneumoniae</i> among Patients and in the Environment of Hassan II Hospital, Settat, Morocco

Detection of Carbapenemase-Producing Bacteria by Using an Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry Method

Emergence of OXA-48-Type Carbapenemase-Producing Enterobacteriaceae in German Hospitals

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Cross-border transmission of OXA-48-producing Enterobacter cloacae from Morocco to France

Cited by 60 publications

References 5 publications

Incidence of Extended-Spectrum Be-ta-Lactamase-Producing &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; among Patients and in the Environment of Hassan II Hospital, Settat, Morocco

Incidence of Extended-Spectrum Be-ta-Lactamase-Producing &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; among Patients and in the Environment of Hassan II Hospital, Settat, Morocco

Detection of Carbapenemase-Producing Bacteria by Using an Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry Method

Emergence of OXA-48-Type Carbapenemase-Producing Enterobacteriaceae in German Hospitals

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Incidence of Extended-Spectrum Be-ta-Lactamase-Producing <i>Klebsiella pneumoniae</i> among Patients and in the Environment of Hassan II Hospital, Settat, Morocco

Incidence of Extended-Spectrum Be-ta-Lactamase-Producing <i>Klebsiella pneumoniae</i> among Patients and in the Environment of Hassan II Hospital, Settat, Morocco