First Report of NDM and VIM Coproducing <i>Klebsiella pneumoniae</i> in Tunisia and Emergence of Novel Clones

Dziri, Raoudha; Ayari, Imen; Barguellil, Farouk; Ouzari, Hadda-Imen; Asli, Mohamed Selim El; Klibi, Naouel

doi:10.1089/mdr.2019.0115

Cited by 11 publications

(18 citation statements)

References 41 publications

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“…The type of causative pathogen and its rate of drug resistance may vary depending on the country, the region and the hospital [ 10 ]. A dramatic increase in third-generation cephalosporin resistance among GNB and carbapenem resistance in non-fermenters has been witnessed in a Tunisian hospital [ 11 , 12 , 13 ]. Carbapenem resistance leads to resistance to almost all β-lactams and is generally associated with other resistance mechanisms affecting other families of antibiotics, which illustrates a typical example of a multidrug-resistant (MDR) or even pan-drug-resistant (PDR) phenotype [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…A dramatic increase in third-generation cephalosporin resistance among GNB and carbapenem resistance in non-fermenters has been witnessed in a Tunisian hospital [ 11 , 12 , 13 ]. Carbapenem resistance leads to resistance to almost all β-lactams and is generally associated with other resistance mechanisms affecting other families of antibiotics, which illustrates a typical example of a multidrug-resistant (MDR) or even pan-drug-resistant (PDR) phenotype [ 11 , 12 ]. In North Africa, the prevalence of carbapenem-resistant Enterobacterales (CRE) isolates in the hospital setting ranged from 2.3% to 67.7% [ 14 ] and reached almost 90% for carbapenem-resistant A. baumannii [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial Susceptibility among Pathogens Isolated in Early- versus Late-Onset Ventilator-Associated Pneumonia

Lakhal

M’Rad²,

Naas

et al. 2021

Infectious Disease Reports

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Ventilator-associated pneumonia (VAP) is associated with increased hospital stay and high morbidity and mortality in critically ill patients. The aims of this study were to (i) determine the incidence of multidrug-resistant (MDR) pathogens in the first episodes of VAP and to assess potential differences in bacterial profiles of subjects with early- versus late-onset VAP. This was a retrospective cohort study over a period of 18 months including all patients who had a first episode of VAP confirmed by positive bacterial culture. Subjects were distributed into two groups according to the number of intubation days: early-onset VAP (<5 days) or late-onset VAP (≥5 days). The primary endpoint was the nature of causative pathogens and their resistance profiles. Sixty patients were included, 29 men and 31 women, with an average age of 38 ± 16 years. The IGS 2 at admission was 40.5 [32–44] and APACHE was 19 [15–22]. Monomicrobial infections were diagnosed in 77% of patients (n = 46). The most frequently isolated bacteria were A. baumannii, 53% (n = 32); P. aeruginosa in 37% (n = 22); Enterobacterales in 28% (n = 17) and S. aureus in 5% (n = 3). Ninety-seven percent of the bacteria were MDR. The VAP group comprised 36 (60%) episodes of early-onset VAP and 24 (40%) episodes of late-onset VAP. There was no significant difference in the distribution of the bacterial isolates, nor in terms of antibacterial resistances between early- and late-onset VAPs. Our data support recent observations that there is no microbiological difference in the prevalence of potential MDR pathogens or in their resistance profiles associated with early- versus late-onset VAPs, especially in countries with high rates of MDR bacteria.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antimicrobial Susceptibility among Pathogens Isolated in Early- versus Late-Onset Ventilator-Associated Pneumonia

Lakhal

M’Rad²,

Naas

et al. 2021

Infectious Disease Reports

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“…The first strain coproducing the NDM‐1 and OXA‐48 enzymes was isolated in 2013 from a Libyan patient in the intensive care unit of a Tunisian hospital isolated (Ben Nasr et al ., 2013). Later, an association between two metallo‐β‐lactamase genes ( bla NDM‐1 and bla VIM‐1 ) with other β‐lactamase types (CTXM‐15, SHV and OXA‐48) was observed in clinical samples from patients hospitalized in the Military hospital of Tunisia (Dziri et al ., 2019).…”

Section: Resultsmentioning

confidence: 99%

First report of cross resistance to silver and antibiotics in Klebsiella pneumoniae isolated from patients and polluted water in Tunisia

Miloud

Ali

Boutiba³

et al. 2020

Water & Environment J

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Klebsiella pneumoniae, ubiquitously found in a variety of environmental sources, is an important pathogen in burn wounds and nosocomial infections. Burn wounds have been commonly treated with silver compounds, which are also used in a multitude of (non)medical products. As the latter increased silver discharge into different environments, we evaluated and compared silver resistance in K. pneumoniae isolates collected from patients hospitalized at the Charles‐Nicolle hospital (Tunis, Tunisia) with isolates collected from different metal polluted waters in the north and south of Tunisia. All K. pneumoniae isolates harboured blaTEM‐1 and blaSHV‐1. In addition, all clinical isolates showed a multidrug phenotype and harboured the blaCTX‐M‐15, blaOXA‐1 and blaNDM‐1. Furthermore, all isolates showed resistance to silver nitrate. The silver resistance determinant, screened via the silE gene, was located for all isolates on a large plasmid with a size similar to pMG101. This study showed cross‐resistance between silver and beta‐lactams in clinical as well as environmental K. pneumoniae isolates from Tunisia and showed for the first time that NDM‐1‐producing K. pneumoniae developed resistance to silver.

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“…In our study, the Vitek 2 system demonstrated a similar rate of accuracy in the identification of Klebsiella and identified the isolates to the species level. Similar studies have employed the Vitek 2 system for the identification of carbapenem-resistant Enterobacteriaceae and the investigation of antibiotic susceptibility of Gram-negative rods and Gram-positive cocci [6].…”

Section: Vol 8 Nomentioning

confidence: 99%

“…Generally, carbapenemase enzymes, identified in Enterobacteriaceae, belong to one of the three classes of ß-lactamase, i.e., class A, B, or D [5]. To date, in class B carbapenemases, various types of metallo-β-lactamases (MBL) have been recognized, including IMP, VIM, NDM, SPM, and GIM [6]. New Delhi Metallo-β-lactamase (NDM) and Verona Integron-Mediated Metallo-β-lactamase (VIM) are the most common MBL in Enterobacteriaceae species [7].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Resistance among Klebsiella pneumoniae Isolates by Detecting blaVIM and blaNDM Genes

Bandari

Keyvani

Abootaleb

2020

JoMMID

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Introduction: The emergence of extended-spectrum β-lactamase (ESBL) and carbapenem-resistant Enterobacteriaceae, especially Klebsiella pneumoniae isolates, has become a severe concern worldwide. This study aimed to determine the prevalence of blaVIM and blaNDM genes among K. pneumoniae isolates. Methods: One hundredeighty-one K. pneumoniae isolates were obtained from different clinical specimens of patients hospitalized at Firoozgar hospital, Tehran, Iran. The isolates were identified by standard biochemical tests, and their identity was confirmed by Vitek 2 (bioMérieux, France), a fully automated system for bacterial identification. The isolates were subjected to antimicrobial susceptibility testing and screened for ESBL by double-disc synergy test (DDST) and modified Hodge test (MHT) for the detection of carbapenemase. PCR was also used to detect the presence of blaVIM and blaNDM resistance genes in the isolates. Results: The Vitek 2 system confirmed the biochemical test results. The highest and lowest rates of resistance to antibiotics belonged to cefepime (83.9%) and imipenem (55.2%). Eighty-six and 100 isolates showed to produce ESB and KPC by DDST and MHT, respectively. About 71% and 97% of the 100 isolates were positive for blaVIM and blaNDM genes, respectively. Conclusion: The high rate of ESBL-and KPC-producing K. pneumoniae isolates in our hospital setting revealed resistance to conventional antibiotics, which limit our options in choosing appropriate antimicrobials. Although the management of infections associated with these organisms is challenging, it is essential to control such strains to prevent the outbreak.

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First Report of NDM and VIM Coproducing Klebsiella pneumoniae in Tunisia and Emergence of Novel Clones

Cited by 11 publications

References 41 publications

Antimicrobial Susceptibility among Pathogens Isolated in Early- versus Late-Onset Ventilator-Associated Pneumonia

Antimicrobial Susceptibility among Pathogens Isolated in Early- versus Late-Onset Ventilator-Associated Pneumonia

First report of cross resistance to silver and antibiotics in Klebsiella pneumoniae isolated from patients and polluted water in Tunisia

Antibiotic Resistance among Klebsiella pneumoniae Isolates by Detecting blaVIM and blaNDM Genes

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