Taoufik Lahoucine, Amrani Hanchi Asma, Fatiha Bennaoui, Nissrine Slitine, Mrabih Rabou Maouainine Fadl, Nabila Soraa
Laboratory of Bacteriology Virology, Hospital Arrazi, CHU Mohammed VI Marrakech, Marrakesh, Morocco.
Neonatology Service, Mother and Child Hospital, CHU Mohammed VI Marrakech, Marrakech, Morocco.
Clin Med Insights Pediatr. 2019 Mar 14;13:1179556519834524. doi: 10.1177/1179556519834524. eCollection 2019.
This work aims to describe and explore the circumstances of appearance of producing OXA-48 carbapenemase, which has occurred in a neonatal intensive care service at the Mohammed VI University Hospital of Marrakech.
During February 2015, the alert was triggered by the isolation of 6 isolates of with the same antibiotic susceptibility profile in the neonatal intensive care service, suggesting a possible outbreak. Blood cultures represented the main site of isolation of these isolates. The phenotypic study of the isolates made it possible to identify a strain of susceptible to third-generation cephalosporins, ciprofloxacin, and aminoglycosides, and resistant to ertapenem, β-lactamases inhibitors (ticarcillin-clavulanate, piperacillin-tazobactam; amoxicillin-clavulanic acid), and cotrimoxazole. The genotypic study of the epidemic isolate revealed the presence of the gene. The action to be taken was the establishment of corrective measures to stop this epidemic to a multi-resistant germ transmitted by hand transmission. The reinforcement of hygiene measures and the awareness of the staff made it possible to put an end to the epidemic at March 30, 2015, without closing the service. The outcome of 6 infected newborns was fatal due to the fragile terrain and the inappropriate probabilistic antibiotic therapy.
The production of carbapenemase in is an emerging resistance mechanism that must be suspected and identified to offer targeted therapy and to limit its spread. The implementation of a local policy to control multidrug-resistant germs is essential to limit their dissemination in hospitals.
本研究旨在描述和探究在马拉喀什穆罕默德六世大学医院新生儿重症监护病房出现产OXA - 48碳青霉烯酶的情况。
2015年2月，新生儿重症监护病房中6株具有相同抗生素敏感性谱的菌株被分离出来，触发了警报，提示可能存在暴发。血培养是这些菌株的主要分离部位。对这些菌株的表型研究确定了一株对第三代头孢菌素、环丙沙星和氨基糖苷类敏感，但对厄他培南、β - 内酰胺酶抑制剂（替卡西林 - 克拉维酸、哌拉西林 - 他唑巴坦；阿莫西林 - 克拉维酸）和复方新诺明耐药的菌株。对流行菌株的基因研究揭示了blaOXA - 48基因的存在。采取的行动是制定纠正措施，以阻止这种通过接触传播的多重耐药菌的流行。加强卫生措施和提高工作人员的意识使得在2015年3月30日结束了疫情，而无需关闭该病房。由于病情脆弱以及抗生素治疗方案不当，6名受感染新生儿的结局是死亡。
肺炎克雷伯菌中产碳青霉烯酶是一种新出现的耐药机制，必须予以怀疑和识别，以便提供针对性治疗并限制其传播。实施地方控制多重耐药菌的政策对于限制其在医院内的传播至关重要。
