Emergence and Outbreaks of CTX-M β-Lactamase-Producing
            <i>Escherichia coli</i>
            and
            <i>Klebsiella pneumoniae</i>
            Strains in a Tunisian Hospital

Mamlouk, Kelthoum; Boubaker, Ilhem Boutiba-Ben; Gautier, Valérie; Vimont, Sophie; Picard, Bertrand; Redjeb, S. Ben; Arlet, Guillaume

doi:10.1128/jcm.01076-06

Cited by 81 publications

(56 citation statements)

References 40 publications

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“…These results suggest that blaCTX-M-15 is the most common gene responsible for mediating extended-spectrum cephalosporin resistance in these isolates. These data confirm previous studies showing that this enzyme is widely present in Tunisia [11,21,[24][25][26][27][28][29][30][31] (Table 4). [34].…”

Section: Discussionsupporting

confidence: 92%

Carbapenemases and extended-spectrum β-lactamases producing Enterobacteriaceae isolated from Tunisian and Libyan hospitals

Mathlouthi

Al-Bayssari

Salabi

et al. 2016

J Infect Dev Ctries

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Introduction: The aim of the study was to investigate the prevalence of extended-spectrum β-lactamase (ESBL) and carbapenemase production among clinical isolates of Enterobacteriaceae recovered from Tunisian and Libyan hospitals. Methodology: Bacterial isolates were recovered from patients in intensive care units and identified by biochemical tests and MALDI-TOF. Antibiotic susceptibility testing was performed by disk diffusion and the E-test method. ESBL and carbapenemase activities were detected using standard microbiological tests. Antibiotic resistance-encoding genes were screened by PCR and sequencing. Clonal relationships between Klebsiella pneumoniae strains were carried out using multi-locus sequence typing (MLST). Results: A total of 87 isolates were characterized, with 51 and 36, respectively, identified as E. coli and K. pneumoniae. Overall the resistance prevalence was high for aminoglycosides (> 60%), fluoroquinolones (> 80%), and extended-spectrum cephalosporins (> 94%), and was low for imipenem (11.4%). Among this collection, 58 strains (66.6%) were ESBL producers and 10 K. pneumoniae strains (11.4%) were carbapenemase producers. The antibiotic resistance-encoding genes detected were blaCTX-M-15 (51.7%), blaTEM-1 (35.6%), several variants of blaSHV (21.8%), and blaOXA-48 (11.4%). The MLST typing of K. pneumoniae isolates revealed the presence of multiple clones and three novel sequence types. Also, close relationships between the OXA-48-producing strains from Tunisia and Libya were demonstrated. Conclusions: This study is the first paper describing the emergence of carbapenemase-and ESBL-producing Enterobacteriaceae, sensitive to colistin, isolated in Tunisia and Libya. Active surveillance and testing for susceptibility to colistin should be implementing because resistance to colistin, mainly in Klebsiella, has been recently reported worldwide.

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Section: Discussionsupporting

confidence: 92%

Carbapenemases and extended-spectrum β-lactamases producing Enterobacteriaceae isolated from Tunisian and Libyan hospitals

Mathlouthi

Al-Bayssari

Salabi

et al. 2016

J Infect Dev Ctries

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“…The presence of bla CTX-M-15 has previously been associated with E. coli strains of phylogroups B2 and D, and in some instances, with specifi c PFGE types (9)(10)(11)(12)16). We detected an emerging and globally disseminated CTX-M-15 phylogroup B2 E. coli strain corresponding to the ST131 that was responsible for clonal outbreaks in Canada, France, Spain, and Portugal (11,14,16,23).…”

Section: Discussionmentioning

confidence: 87%

Dissemination of Clonally RelatedEscherichia coliStrains Expressing Extended-Spectrum β-Lactamase CTX-M-15

Coque

Novais

Carattoli

et al. 2008

Emerg. Infect. Dis.

662

469

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“…Since 2003, a temporal shift in prevalence of ESBL types was noted in Tunisia with predominance of CTX-M instead of the SHV genotypes (Elhani et al, 2010). In another study carried out at Charles Nicole hospital, the detection rates of the ESBL-producing isolates sharply increased from 2.7% in 2000and reached 30% in 2003(Mamlouk et al, 2006. In our study, CTX-M-1 group β-lactamases accounted for more than 50% of K. pneumoniae isolates.…”

Section: Discussionmentioning

confidence: 73%

Epidemic diffusion of Klebsiella pneumoniae isolates producing extended-spectrum beta-lactamases in neonatal and pediatric wards in Rabta hospital of Tunisia

Harchay¹,

Rachid²,

Othman³

et al. 2013

Afr. J. Microbiol. Res.

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Klebsiella pneumoniae producing extended-spectrum β-lactamase (ESBL) cause severe life threatening infections resulting in considerable morbidity and mortality especially in neonatology ward. The aim of this study was to evaluate the epidemiology and resistance of 131 strains collected between 2007 and 2008 in neonatology and pediatric wards and to determine the mode of their epidemic spread. The isolates were identified, tested for antimicrobial susceptibility with the disk-diffusion on Mueller-Hinton agar. The type of ESBL was determined by polymerase chain reaction (PCR) followed by sequencing for CTX-M enzymes. The epidemiological relationships between epidemic strains were analysed by pulsedfield gel electrophoresis. In this study, antibiotic susceptibility testing showed resistance to all β-lactams except imipenem with a concomitant resistance to aminoglycosides, tetracycline and cotrimoxazole. Fluoroquinolones still have activity against strains. Characterization of β-lactamases encoding genes revealed that all strains have SHV β-lactamases. TEM-type and CTX-M-1 group were encoded, respectively, in 21 and 57% of ESBLs isolates. Among 84 strains tested by PFGE, 14 pulsotypes were identified. DNA sequencing of amplified CTX-M β-lactamase genes justified diffusion of CTX-M-15 between epidemic strains. In conclusion, this study revealed a high degree of clonal diversity of isolates and complexity of outbreaks that involve more than two epidemic pulsotypes and indicated that both clonal spread of epidemic strains and transfer of β-lactamases might contribute to epidemic dissemination of ESBL in neonatology ward.

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Emergence and Outbreaks of CTX-M β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Strains in a Tunisian Hospital

Abstract: Sixty-two isolates of

Cited by 81 publications

References 40 publications

Carbapenemases and extended-spectrum β-lactamases producing Enterobacteriaceae isolated from Tunisian and Libyan hospitals

Carbapenemases and extended-spectrum β-lactamases producing Enterobacteriaceae isolated from Tunisian and Libyan hospitals

Dissemination of Clonally RelatedEscherichia coliStrains Expressing Extended-Spectrum β-Lactamase CTX-M-15

Epidemic diffusion of Klebsiella pneumoniae isolates producing extended-spectrum beta-lactamases in neonatal and pediatric wards in Rabta hospital of Tunisia

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