Screening for carbapenemases in ertapenem-resistant Enterobacteriaceae collected at a Tunisian hospital between 2014 and 2018

Abstract

Background Carbapenem-resistance is frequently detected in Enterobacteriaceae isolated from patients in Tunisia. The study was performed to identify frequent carbapenemases in Tunisian isolates. Methods Between May 2014 and January 2018, 197 ertapenem-resistant Enterobacteriaceae were isolated at the microbiological department of the Military Hospital of Tunis. The strains were phenotypically characterized and then subjected to in-house polymerase chain reaction (PCR) targeting the carbapenemase genes bla IMP , bla VIM , bla NDM , bla SPM , bla AIM , bla DIM ,bla GIM , bla SIM , bla KPC , bla BIC , and bla OXA-48 . Results The assessed 197 ertapenem-resistant Enterobacteriaceae from Tunis comprised 170 Klebsiella pneumoniae , 19 Enterobacter cloacae , 6 Escherichia coli , 1 Citrobacter sedlakii , and 1 Enterobacter asburiae. Thereby, 55 out of 197 isolates (27.9%) were from blood cultures, suggesting a systemic disease. The carbapenemase gene bla OXA-48 quantitatively dominated by far with 153 detections, followed by bla NDM with 14 detections, which were distributed about the whole study interval. In contrast, bla BIC and bla VIM were only infrequently identified in 5 and 3 cases, respectively, while the other carbapenamases were not observed. Conclusions The carbapenemase gene bla OXA-48 was identified in the vast majority of ertapenem-resistant Tunisian Enterobacteriaceae while all other assessed carbapenemases were much less abundant. In a quantitatively relevant minority of isolates, the applied PCR-based screening approach did not identify any carbapenemases.

Prevalence of Pathogenic Klebsiella Pneumoniae based on PCR Capsular Typing Harbouring Carbapenemases Encoding Genes in Ugandan Tertiary Hospitals

“…Among the ve genes which were detected by multiplex PCR, the most encountered gene was OXA-48like at a genotypic frequency of 36.4%. This corroborates well with recent studies which documented OXA-48-like gene and its variants as the most prevalent genes [27,31,33,35]. OXA-48.…”

“…OXA-48 producers spread sporadically to the neighboring countries located in the southern and eastern part of the Mediterranean Sea, and north Africa [36]. This provides an insight why the occurrence of OXA-48 is predominantly high in Egypt and Tunisia [27,33]. Previous studies reported NDM as the most dominant gene in South Africa [30,37], VIM and IMP as the most prevalent genes in East Africa [23][24][25]38] in contrast with the results of this study.…”

“…Through molecular characterization, we detected carbapenem genotypic resistance frequency ranging from 32.4% at KIU-TH to 70.8% at MRRH and overall genotypic resistance prevalence of 43.2% in Uganda. In contrast, the overall genotypic prevalence was lower than that reported in Tunisia (86.3%) [33], Egypt (56%) [27], South Africa (86.0%), [31], India (76.3%) [34]. Among the ve genes which were detected by multiplex PCR, the most encountered gene was OXA-48like at a genotypic frequency of 36.4%.…”

Carbapenem resistance profiles of Pathogenic Escherichia coli in Uganda

“…KPC, VIM, NDM, OXA-48 and IMP are the commonest carbapenemases worldwide [42]. Findings of this study revealed the existence of all those carbapenemases encoding genes in Uganda and OXA-48 was the most predominant gene in contrast with previous studies in the region [18,25] but in agreement with recent studies in carried out in Africa ( [31,33,36,40]. OXA-48 carbapenemase was rst detected in Turkey and it became epidemic in the Middle East and Mediterranean countries [41].…”

“…This genotypic carbapenem resistance prevalence corroborates with earlier studies conducted in the East African region [18,25,38] and elsewhere [27,39] that reported levels ranging from 25% to 40%. Contrary, this frequency is signi cantly lower than carbapenem genotypic levels reported by studies in Tunisia (76.7%) [40], South Africa (68% and 86%) [33,34] , Egypt (89.6%) [37], Turkey (49.5%) [41]. KPC, VIM, NDM, OXA-48 and IMP are the commonest carbapenemases worldwide [42].…”