TITLE:
Incidence of Extended-Spectrum Be-ta-Lactamase-Producing Klebsiella pneumoniae among Patients and in the Environment of Hassan II Hospital, Settat, Morocco
AUTHORS:
Samira Natoubi, Abouddihaj Barguigua, Sanaa Bouhali Zriouil, Nezha Baghdad, Mohammed Timinouni, Abderraouf Hilali, Souad Amghar, Khalid Zerouali
KEYWORDS:
ESBL-Producing K. pneumoniae Infections, Hospital Environment, Risk Factors
JOURNAL NAME:
Advances in Microbiology,
Vol.6 No.3,
March
11,
2016
ABSTRACT: Aim: The aim of the current study is to determine: (1)
the prevalence of extended-spectrum β-lactamase-producing K. pneumoniae (ESBL-Kp) isolated from clinical samples and a hospital environment
in Hassan II Hospital (Settat, Morocco); (2) the associated risk factors of ESBL-Kp
infections; (3) the link between clinical and environmental isolates. Methods: During the study period (April
2010 to March 2011), all patients infected and hospital environment sites contaminated
by K. pneumoniae were considered as the potential study population and environmental
site. The clinical data were collected to identify risk factors for ESBL carriage
of K. pneumoniae infection. Screening of ESBL-and carbapenemase-producing
isolates was performed by using a double-disk synergy test and the modified Hodge
test, respectively. ESBL-Kp isolates were tested for the presence of genes encoding β-lactamases and were investigated by PCR. The clonal relationship between ESBL-producing isolates was analysed by ERIC- and REP-PCR method. Results: The overall prevalence of ESBL-Kp
among clinical and environmental K. pneumoniae isolates was 35.13% (13/37)
and 4.04% (4/99), respectively. The main risk factors for carrying ESBL-Kp were
renal disease (46.15%), recent surgery (53.84%), previous hospitalisation (76.92%),
and the presence of many invasive devices (53.84%). All ESBL isolates were multidrug
resistant. The blaCTX-M group1and blaSHV (70.58%
for each) were the most prevalent followed by blaTEM (52.94%).
Thirteen strains expressed at least two bla genes. One isolate was positive
in the modified Hodge test and was a blaOXA-48 producer. ERIC
and Rep-PCR methods revealed an epidemic clonal dissemination of these isolates.
Conclusion: The emergence of OXA-48 carbapenemase, endemic clonal dissemination
and multi-drug resistance of ESBL-Kp isolates in our institution is highly alarming.