Dos Santos Sandra, Diene Seydina M, Benouda Amina, Zerouali Khalid, Ghaith Doaa M, El-Mahdy Rasha H, El Tayeb Sawsan H M, Boutiba Ilhem, Hammami Adnene, Chrabieh Remie, Daoud Ziad, Mereghetti Laurent, Francois Patrice, Van Der Mee-Marquet Nathalie
Centre d'Appui pour la Prévention des Infections Associées aux Soins Centre Val de Loire, Centre Hospitalier Universitaire, Tours, France.
Faculté de Pharmacie, Aix-Marseille Université, Marseille, France.
Front Microbiol. 2024 Apr 12;15:1370553. doi: 10.3389/fmicb.2024.1370553. eCollection 2024.
The colonization of patients by carbapenemase-producing (CPE) has been associated with heightened mortality, especially in vulnerable individuals within intensive care units (ICUs). Our study aimed to comprehensively assess CPE prevalence among ICU patients across the Mediterranean region pre-COVID-19, conducting a multicenter prevalence study in the first quarter of 2019.
We collected clinical data and rectal or fecal samples from 256 ICU patients for CPE testing. Additionally, we performed whole-genome sequencing on 40 representative CPE strains to document their molecular characteristics.
Among the 256 patients, CPE was detected in 73 samples (28.5%), with prevalence varying from 3.3 to 69.0% across participating centers. We observed 13 colistin-resistant CPE strains, affecting three ICUs. Genetic analysis revealed highly diverse and strains, predominantly from international high-risk clones. Notably, and were the most prevalent carbapenemase genes. Molecular typing uncovered potential patient clusters in six centers. Significantly, longer hospital stays were associated with increased CPE carriage ( < 0.001). Nine centers across Morocco, Tunisia, Egypt, and Lebanon voluntarily participated.
Our study provides CPE prevalence in Mediterranean ICUs and reaffirms established CPE presence in this setting but also provides updates on the molecular diversity of CPE strains. These findings highlight the imperative of reinforcing infection control measures in the participating ICUs to curtail escalated mortality rates, and of strictly applying isolation measures around patients originating from the Mediterranean region when transferred to other healthcare institutions.
产碳青霉烯酶（CPE）的患者定植与死亡率升高有关，尤其是在重症监护病房（ICU）中的脆弱个体中。我们的研究旨在全面评估2019年第一季度地中海地区ICU患者中CPE的流行情况，开展一项多中心患病率研究。
我们收集了256例ICU患者的临床数据以及直肠或粪便样本进行CPE检测。此外，我们对40株具有代表性的CPE菌株进行了全基因组测序，以记录其分子特征。
在256例患者中，73份样本（28.5%）检测到CPE，各参与中心的患病率从3.3%至69.0%不等。我们观察到13株耐黏菌素CPE菌株，影响了三个ICU。基因分析显示菌株高度多样，主要来自国际高危克隆。值得注意的是， 和 是最常见的碳青霉烯酶基因。分子分型在六个中心发现了潜在的患者聚集情况。显著的是，住院时间延长与CPE携带增加相关（ ＜0.001）。摩洛哥、突尼斯、埃及和黎巴嫩的九个中心自愿参与。
我们的研究提供了地中海地区ICU中CPE的患病率，再次证实了该环境中已存在的CPE，但也提供了CPE菌株分子多样性的最新情况。这些发现强调了加强参与研究的ICU中的感染控制措施以降低死亡率上升的必要性，以及在将来自地中海地区的患者转至其他医疗机构时严格实施隔离措施的必要性。
