摩洛哥马拉喀什穆罕默德六世大学医院产碳青霉烯酶肠杆菌科的抗生素耐药模式。

Antibiotic resistance patterns of carbapenemase-producing Enterobacterales in Mohammed VI University Hospital of Marrakech, Morocco.

机构信息

Laboratoire de Lutte Contre les Maladies Infectieuses, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, Marrakech, Morocco; Laboratoire de Microbiologie-Virologie, Hôpital Ar-Razi, Centre Hospitalier Universitaire Mohammed VI, Avenue Ibn Sina Amerchich, BP 2360, Marrakech, Morocco.

出版信息

Infect Dis Now. 2022 Sep;52(6):334-340. doi: 10.1016/j.idnow.2022.06.001. Epub 2022 Jun 11.

DOI:10.1016/j.idnow.2022.06.001

PMID:35700962

Abstract

OBJECTIVES

The emergence and spread of Carbapenem-Resistant Enterobacterales (CRE) has become a growing concern for health services, internationally, nationally, and regionally. In Morocco, the situation is more worrisome as studies on CRE are scarce and/or scattered and/or outdated. As a result, we carried out the present study to determine and update CRE prevalence at Mohammed VI University Hospital of Marrakech, Morocco.

PATIENTS AND METHODS

A cross-sectional prospective study was carried out from March 2018 to March 2020 on 41161 clinical specimens of 23,469 patients suspected of bacterial infections. Enterobacterales strains were isolated following standard bacteriological procedures. Bacterial strains were identified using BD-Phoenix and MALDI-TOF-MS. Antibiotic susceptibility was determined for 14 antibiotics. Carbapenemase production and phenotypic detection were characterized using modified carbapenem inactivation phenotypic and immunochromatographic methods.

RESULTS

All in all, 484 Enterobaterales resistant to at least one carbapenem were recovered. The majority was isolated from the neonatal unit (14%), followed by the urology-nephrology (11%), and plastic surgery departments (10%). K. pneumoniae (n=232) was the most isolated, followed by E. cloacae (n=148), E. coli (n=56), and S. marcescens (n=17). Antibiotic susceptibility profile showed high rates of resistance to ciprofloxacin (75.21%), gentamicin (84.50%), and cotrimoxazole (88.42%). Out of 484 CRE positive cultures, 388 (80.16%) were Carbapenemase-positive. Out of the latter, 170 were metallo-beta-lactamase producers (NDM), 162 OXA-48-like, and 56 both.

CONCLUSION

These findings emphasize the urgent need for control precautions and strict measures to contain and mitigate this issue.

摘要

目的

碳青霉烯类耐药肠杆菌科（CRE）的出现和传播已成为国际、国家和地区卫生服务部门日益关注的问题。在摩洛哥，情况更为令人担忧，因为关于 CRE 的研究很少，或者分散，或者过时。因此，我们进行了本研究，以确定并更新摩洛哥马拉喀什穆罕默德六世大学医院的 CRE 患病率。

患者和方法

2018 年 3 月至 2020 年 3 月，对 23469 名疑似细菌感染的患者的 41161 份临床标本进行了横断面前瞻性研究。肠杆菌科菌株按照标准细菌学程序分离。使用 BD-Phoenix 和 MALDI-TOF-MS 鉴定细菌菌株。对 14 种抗生素进行了抗生素敏感性测定。使用改良碳青霉烯灭活表型和免疫层析法对产碳青霉烯酶和表型检测进行了特征描述。

结果

共回收至少一种碳青霉烯类耐药的 484 株肠杆菌科。大多数是从新生儿病房（14%）分离出来的，其次是泌尿科-肾病科（11%）和整形科（10%）。分离出的最主要的菌株是肺炎克雷伯菌（n=232），其次是阴沟肠杆菌（n=148）、大肠埃希菌（n=56）和粘质沙雷氏菌（n=17）。抗生素敏感性谱显示出对环丙沙星（75.21%）、庆大霉素（84.50%）和复方新诺明（88.42%）的高耐药率。在 484 株 CRE 阳性培养物中，388 株（80.16%）为碳青霉烯酶阳性。在后者中，有 170 株为金属β-内酰胺酶产生者（NDM），162 株为 OXA-48 样，56 株为两者兼有。