Emergence of Multidrug-Resistant Klebsiella pneumoniae Isolates Producing VIM-4 Metallo-β-Lactamase, CTX-M-15 Extended-Spectrum β-Lactamase, and CMY-4 AmpC β-Lactamase in a Tunisian University Hospital

Abstract

Klebsiella pneumoniae clinical isolates resistant to carbapenems were recovered from 11 patients in the hospital of Sfax, Tunisia. The isolates were closely related as shown by pulsed-field gel electrophoresis, and they produced VIM-4 metallo-enzyme, CTX-M-15 extended-spectrum ␤-lactamase, and CMY-4 AmpC enzyme. The bla VIM-4 gene is part of a class 1 integron.

Antimicrobial and molecular analysis of Salmonella serovar Livingstone strains isolated from humans in Tunisia and Belgium

“…In previous studies [8,13], genetic analysis by PFGE of serotype Livingstone isolates collected from different hospitals in Tunisia showed that a single clone of Salmonella enterica serotype Livingstone was responsible for an interhospital outbreak in the pediatric ward of Sfax hospital (South of Tunisia) and also the outbreaks in Monastir (central-east) and Tunis (north) hospitals. It seems that the ST543 clone identified in our study may be the same clone that emerged in different hospitals in Tunisia.…”

“…Numerous phenotypic and genotypic methods, among them biotyping, antimicrobial susceptibility profiling, plasmid profiling, ribotyping, random amplification of polymorphic DNA (RAPD-PCR), enterobacterial repetitive intergenic consensus (ERIC-PCR) and pulsed field gel electrophoresis (PFGE) have been used to subtype Salmonella serotype Livingstone and to investigate outbreaks caused by this serotype [7,9,13]. Currently, alternative molecular typing methods such as multilocus sequence typing (MLST) and virulotyping [1,[14][15] are used to characterize many Salmonella enterica serovars.…”

Dissemination and genetic support of broad-spectrum beta-lactam-resistant <i>Escherichia coli</i> strain isolated from two Tunisian hospitals during 2004-2012

“…, and the first report of the CTX-M-15 in Tunisia was cited in the Charles Nicolle Hospital in 1984 and it was described in various studies in Tunisia including that of coque et al, the gene has been found in E. coli strains in a Tunisian Hospital 17 , France 18 , and Central African Republic [19][20][21][22][23][24][25] .91% of the ESBL-producing isolates carried blaCTX-M-15 genes…”

Sensitive and Specific Phenotypic Assay for Metallo-β-Lactamase Detection in Enterobacteria by Use of a Moxalactam Disk Supplemented with EDTA

“…Previous studies suggested that this compound was poorly inactivated by class A, C, and D carbapenemases (14,16,17,24), whereas it was well hydrolyzed by class B enzymes (21). To confirm this statement, we determined the MIC values of several extended-spectrum ␤-lactams, including moxalactam, for Escherichia coli DH10B (bla KPC-3 ), E. coli DH10B (bla NDM-1 ), E. coli DH10B (bla VIM-4 ), E. coli TOP10 (pCMY-2), and E. coli J53-2 (bla OXA-48 ) recombinant or transconjugant strains, which produced KPC-3, NDM-1, VIM-4, CMY-2, and OXA-48 enzymes, respectively (7,8,12,14). MICs were determined using Etest strips according to the manufacturer's instructions (bioMérieux, Marcy l'Etoile, France), except those of moxalactam (Sigma-Aldrich, St. Quentin Fallavier, France), which were determined by an agar dilution technique according to the CLSI guidelines (4).…”

“…MBL producers may therefore be carbapenem susceptible, which means that a single carbapenem screening criterion cannot be set to detect all metallo-␤-lactamase-producing isolates (15,25). Moreover, due to the high cost and/or unavailability of the Etest strips, many clinical microbiology laboratories use alternative screen- ), E. coli TOP10 (pCMY-2), and E. coli J53-2 (bla OXA-48 ) recombinant or transconjugant strains produced KPC-3, NDM-1, VIM-4, CMY-2, and OXA-48 ␤-lactamases, respectively (7,8,12,14). E. coli DH10B (bla NDM-1 ) recombinant clone was obtained in this study from the E. coli clinical isolate producing NDM-1 and TEM-1 enzymes (G. Arlet, personal collection).…”