Uwingabiye Jean, Lemnouer Abdelhay, Roca Ignasi, Alouane Tarek, Frikh Mohammed, Belefquih Bouchra, Bssaibis Fatna, Maleb Adil, Benlahlou Yassine, Kassouati Jalal, Doghmi Nawfal, Bait Abdelouahed, Haimeur Charki, Louzi Lhoussain, Ibrahimi Azeddine, Vila Jordi, Elouennass Mostafa
Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
Department of Clinical Microbiology and ISGlobal- Barcelona Ctr. Int. Health Res. CRESIB, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
Antimicrob Resist Infect Control. 2017 Sep 26;6:99. doi: 10.1186/s13756-017-0262-4. eCollection 2017.
Carbapenem-resistant has recently been defined by the World Health Organization as a critical pathogen. The aim of this study was to compare clonal diversity and carbapenemase-encoding genes of isolates collected from colonized or infected patients and hospital environment in two intensive care units (ICUs) in Morocco.
The patient and environmental sampling was carried out in the medical and surgical ICUs of Mohammed V Military teaching hospital from March to August 2015. All isolates recovered from clinical and environmental samples, were identified using routine microbiological techniques and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. Antimicrobial susceptibility testing was performed using disc diffusion method. The carbapenemase-encoding genes were screened for by PCR. Clonal relatedness was analyzed by digestion of the DNA with low frequency restriction enzymes and pulsed field gel electrophoresis (PFGE) and the multi locus sequence typing (MLST) was performed on two selected isolates from two major pulsotypes.
A total of 83 multidrug-resistant isolates were collected: 47 clinical isolates and 36 environmental isolates. All isolates were positive for the and genes. The coexistence of and were detected in 27 (32.5%) and 2 (2.4%) of isolates, respectively. The environmental samples and the fecally-colonized patients were significantly identified ( < 0.05) as the most common sites of isolation of NDM-1-harboring isolates. PFGE grouped all isolates into 9 distinct clusters with two major groups (0007 and 0008) containing up to 59% of the isolates. The pulsotype 0008 corresponds to sequence type (ST) 195 while pulsotype 0007 corresponds to ST 1089.The genetic similarity between the clinical and environmental isolates was observed in 80/83 = 96.4% of all isolates, belonging to 7 pulsotypes.
This study shows that the clonal spread of environmental isolates is related to that of clinical isolates recovered from colonized or infected patients, being both associated with a high prevalence of the and genes. These findings emphasize the need for prioritizing the bio-cleaning of the hospital environment to control and prevent the dissemination of clonal lineages.
耐碳青霉烯类肠杆菌科细菌最近被世界卫生组织定义为一种关键病原体。本研究的目的是比较从摩洛哥两个重症监护病房（ICU）的定植或感染患者以及医院环境中分离出的肠杆菌科细菌的克隆多样性和碳青霉烯酶编码基因。
2015年3月至8月在穆罕默德五世军事教学医院的内科和外科ICU进行患者和环境采样。从临床和环境样本中分离出的所有肠杆菌科细菌，使用常规微生物学技术和基质辅助激光解吸/电离飞行时间质谱进行鉴定。采用纸片扩散法进行药敏试验。通过PCR筛选碳青霉烯酶编码基因。用低频限制性内切酶消化DNA并通过脉冲场凝胶电泳（PFGE）分析克隆相关性，并对来自两个主要脉冲型的两个选定分离株进行多位点序列分型（MLST）。
共收集到83株多重耐药肠杆菌科细菌分离株：47株临床分离株和36株环境分离株。所有分离株的blaCTX-M和blaNDM基因均为阳性。分别在32.5%（27/83）和2.4%（2/83）的肠杆菌科细菌分离株中检测到blaCTX-M和blaNDM的共存。环境样本和粪便定植患者被显著确定（P<0.05）为携带NDM-1分离株最常见的分离部位。PFGE将所有分离株分为9个不同的簇，两个主要组（0007和0008）包含多达59%的分离株。脉冲型0008对应序列型（ST）195，而脉冲型0007对应ST 1089。在所有分离株的80/83 = 96.4%中观察到临床和环境分离株之间的遗传相似性，属于7个脉冲型。
本研究表明，环境肠杆菌科细菌分离株的克隆传播与从定植或感染患者中分离出的临床分离株相关，两者均与blaCTX-M和blaNDM基因的高流行率相关。这些发现强调了优先对医院环境进行生物清洁以控制和预防肠杆菌科细菌克隆谱系传播的必要性。
