<p>Carbapenemase Producing Gram-Negative Bacteria in Tunisia: History of Thirteen Years of Challenge</p>

Abstract

The wide spread of multidrug-resistant bacteria, particularly carbapenem-resistant Gram-negative bacteria (CR-GNB), constitutes a major public health threat worldwide, owing to the limited therapeutic options. This review will describe and uncover the Tunisian experience in the challenge against carbapenem resistance. Indeed, we illuminate on the dissemination of CR-GNB in different hospitals, animals, and other natural environments in this country. We resumed the different carbapenemase variants detected from various bacterial species and mapped their regional distribution, basing on Tunisian published data during a period extended from 2006, the date of its first description in Tunisia, to February 2019. We also resumed the different mobile genetic elements implicated in their dissemination. This review shows that the majority of the research reports focused in the north and the coastal cities in spite of the fact that KPC and IMP carbapenemases were uncommonly detected in our country. However, VIM, NDM-1, and OXA-48 enzymes were usually reported with the predominance of OXA-48 among Enterobacteriaceae. Furthermore, OXA-23, OXA-51, and OXA-58 carbapenemases constituted the main mechanism conferring carbapenem resistance among Acinetobacter baumannii in Tunisia. Collaborative efforts and raising awareness of the threat of antibiotic resistance are required in order to minimize the spread of multidrug-resistant bacteria.

Whole Genome Sequencing of a Citrobacter freundii Strain Isolated from the Hospital Environment: An Extremely Multiresistant NDM-1 and VIM-48 Coproducing Isolate

“…Actually, most of the acquired resistance genes are mobilized by these plasmids that favor the spread of these resistance genes between various species. 16 Discussion C. freundii was seldom studied not only in Tunisia but also all over the world and has usually been considered as an environmental contaminant. 1 Nevertheless, with the general increase of antimicrobial resistance, it has been reported that multiresistant C. freundii has been responsible for severe infections in neonates and in immunocompromised patients with therapeutic impasses.…”

“…In Tunisia, it has been reported that the most common species acquiring carbapenemase encoding genes were Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. 16 Only one carbapenemase producing C. freundii strain has been hitherto detected in Tunisia. 16,17 Many carbapenemases are encoded on plasmids, which facilitate the spread of resistance genes among microorganisms of the same species or even among different bacterial species.…”

“…16 Only one carbapenemase producing C. freundii strain has been hitherto detected in Tunisia. 16,17 Many carbapenemases are encoded on plasmids, which facilitate the spread of resistance genes among microorganisms of the same species or even among different bacterial species. 18 In this study, we investigate the whole genome sequence of a carbapenem-resistant C. freundii isolated from the environment of a university hospital in Tunisia.…”

High occurrence of carbapenem‐resistant Escherichia coli isolates from healthy rabbits ( Oryctolagus cuniculus ): first report of bla IMI and bla VIM type genes from livestock in Tunisia

“…The remaining genes were not detected despite several repetition of PCR amplification of the corresponding genes. VIM variants, especially VIM-1, are largely found in clinical Gramnegative bacteria in Italy and Greece and are the main metallo-carbapenemase detected in Tunisia among clinical Pseudomonas aeruginosa and K. pneumoniae; however, they are scarily reported in E. coli and Enterobacter complex (Dziri et al 2020). The IMI carbapenemases, belonging to Ambler class A carbapenemases and typically associated with the Enterobacter cloacae complex, have never been reported in Tunisia (Madec et al 2017;Dziri et al 2020;Bonnin et al 2021).…”

Polymyxin E–Resistant Gram-Negative Bacteria in Tunisia and Neighboring Countries: Are There Commonalities?

“…1,2 Indeed, it is considered one of the last-resort antibiotics used for the treatment of severe infections, caused in particular by carbapenem-resistant Gram-negative bacteria. 3,4 Several studies have revised and evaluated the colistin dosing regimen, as well as the best way to use and minimize its toxicity, sos as to ensure its safety and efficacy. [5][6][7][8] Colistin consumption has been continuously increasing since 2000 worldwide, including low-income countries.…”