PhD Program in Clinical Laboratory Science, Department of Medical and Health Sciences, Faculty of Graduate Studies, An-Najah National University, Nablus, 44839, State of Palestine.
Department of Microbiology, Palestinian Medical Complex, Ministry of Health, Ramallah, State of Palestine.
BMC Infect Dis. 2024 Aug 12;24(1):812. doi: 10.1186/s12879-024-09726-x.
Infections resulting from multidrug-resistant Enterobacterales (MDR-E) pose a growing global threat, presenting challenges in treatment and contributing significantly to morbidity and mortality rates. The main objective of this study was to characterize phenotypically and genetically extended-spectrum β-lactamase- and carbapenemase- producing Enterobacterales (ESBLE and CPE respectively) isolated from clinical samples in the West Bank, Palestine.
A cross sectional study was conducted in October 2023 on clinical bacterial isolates collected from five governmental hospitals in the West Bank, Palestine. The isolates obtained from the microbiology laboratories of the participating hospitals, underwent identification and antibiotic susceptibility testing (AST) using the VITEK 2 Compact system. ESBL production was determined by the Vitek2 Compact system. A modified carbapenem inactivation method (mCIM) was employed to identify carbapenemase-producing Enterobacterales (CPE). Resistance genes were detected by real-time PCR.
Out of the total 1380 collected isolates, we randomly selected 600 isolates for analysis. Our analysis indicated that 287 (47.83%) were extended-spectrum beta-lactamase producers (ESBLE), and 102 (17%) as carbapenem-resistant Enterobacterales (CRE) isolates. A total of 424 isolates (70.67%) were identified as multidrug-resistant Enterobacterales (MDRE). The most prevalent ESBL species were K. pneumoniae (n = 124; 43.2%), E. coli (n = 119; 41.5%) and E. cloacae (n = 31; 10.8%). Among the CRE isolates, 85 (83.33%) were carbapenemase-producing Enterobacterales (CPE). The most frequent CRE species were K. pneumoniae (n = 63; 61.7%), E. coli (n = 25; 24.5%) and E. cloacae (n = 13; 12.8%). Additionally, 47 (7.83%) isolates exhibited resistance to colistin (CT), with 38 (37.62%) being CT-resistant CRE and 9 (3.14%) being CT-resistant ESBLE while sensitive to carbapenems. We noticed that 11 isolates (6 Klebsiella pneumoniae and 5 Enterobacter cloacae complex) demonstrated sensitivity to carbapenems by phenotype but carried silent CPE genes (1 blaOXA48, and 6 blaNDM, 4 blaOXA48, blaNDM). ESBL-producing Enterobacterales strains exhibited varied resistance patterns across different antibiotic classes. E. coli isolates showed notable 48% resistance to trimethoprim/sulfamethoxazole. K. pneumoniae isolates displayed a significant resistance to trimethoprim/sulfamethoxazole, nitrofurantoin, and fosfomycin (54%, 90%, and 70% respectively). E. cloacae isolates showed complete resistance to nitrofurantoin and fosfomycin. P. mirabilis isolates exhibited high resistance against fluoroquinolones (83%), and complete resistance to trimethoprim/sulfamethoxazole, nitrofurantoin and fosfomycin.
This study showed the high burden of the ESBLE and CRE among the samples collected from the participating hospitals. The most common species were K. pneumoniae and E. coli. There was a high prevalence of blaCTXm. Adopting both conventional and molecular techniques is essential for better surveillance of the emergence and spread of antimicrobial-resistant Enterobacterales infections in Palestine.
由多药耐药肠杆菌科（MDR-E）引起的感染对全球构成日益严重的威胁，给治疗带来挑战，并显著导致发病率和死亡率。本研究的主要目的是对从巴勒斯坦西岸 5 家政府医院采集的临床样本中分离的表型和遗传上扩展谱β-内酰胺酶和碳青霉烯酶产生的肠杆菌科（ESBLE 和 CPE 分别）进行特征描述。
2023 年 10 月，在巴勒斯坦西岸的五家政府医院的微生物实验室采集临床细菌分离株，进行了一项横断面研究。从参与医院的微生物实验室获得的分离株，使用 VITEK 2 Compact 系统进行鉴定和抗生素敏感性试验（AST）。通过 Vitek2 Compact 系统确定 ESBL 产生。采用改良的碳青霉烯灭活法（mCIM）来鉴定产碳青霉烯酶的肠杆菌科（CPE）。通过实时 PCR 检测耐药基因。
在总共采集的 1380 株分离株中，我们随机选择了 600 株进行分析。我们的分析表明，287 株（47.83%）为扩展谱β-内酰胺酶生产者（ESBLE），102 株（17%）为耐碳青霉烯肠杆菌科（CRE）分离株。共有 424 株（70.67%）为多药耐药肠杆菌科（MDRE）。最常见的 ESBL 物种是肺炎克雷伯菌（n=124；43.2%）、大肠杆菌（n=119；41.5%）和阴沟肠杆菌（n=31；10.8%）。在 CRE 分离株中，85 株（83.33%）为产碳青霉烯酶肠杆菌科（CPE）。最常见的 CRE 物种是肺炎克雷伯菌（n=63；61.7%）、大肠杆菌（n=25；24.5%）和阴沟肠杆菌（n=13；12.8%）。此外，47 株（7.83%）分离株对粘菌素（CT）表现出耐药性，其中 38 株（37.62%）为 CT 耐药 CRE，9 株（3.14%）为 CT 耐药 ESBLE，同时对碳青霉烯类敏感。我们注意到，11 株（6 株肺炎克雷伯菌和 5 株阴沟肠杆菌复合体）表现出对碳青霉烯类药物的表型敏感性，但携带沉默的 CPE 基因（1 株 blaOXA48，6 株 blaNDM，4 株 blaOXA48、blaNDM）。产 ESBL 肠杆菌科菌株对不同抗生素类别的耐药模式存在差异。大肠杆菌分离株对复方磺胺甲噁唑表现出显著的 48%耐药性。肺炎克雷伯菌分离株对复方磺胺甲噁唑、呋喃妥因和磷霉素表现出显著的耐药性（分别为 54%、90%和 70%）。阴沟肠杆菌分离株对呋喃妥因和磷霉素完全耐药。奇异变形杆菌分离株对氟喹诺酮类药物表现出高度耐药性（83%），对复方磺胺甲噁唑、呋喃妥因和磷霉素完全耐药。
本研究表明，在所参与医院采集的样本中，ESBLE 和 CRE 的负担很高。最常见的物种是肺炎克雷伯菌和大肠杆菌。blaCTXm 的流行率很高。采用传统和分子技术对于更好地监测巴勒斯坦出现和传播的耐抗生素肠杆菌科感染至关重要。
