Search

Background: The challenge of treating infections caused by multidrug-resistant Enterobacterales and Acinetobacter baumannii has significantly increased for medical professionals due to their resistance to conventional antibiotics. In such cases, colistin is employed as a final line of defense. This study was aimed to determine the in-vitro efficacy of colistin against multidrug-resistant gram-negative bacteria. Methods: The research was carried out in the bacteriology department of the Mohammed V Military Teaching Hospital in Rabat, Morocco. 321 isolates of multi-resistant Enterobacterales and Acinetobacter baumannii from various clinical samples were identified by standard microbiological protocols, and the Colistin minimum inhibitory concentrations value was determined using the microdilution method. Results: Of the 321 isolates included in the study, 76.3% were Enterobacterales and 23.6% were Acinetobacter baumannii. The minimum inhibitory analysis showed that 96.3% of the isolates were sensitive, while 3.7% were identified as resistant. The prevalence of resistance to colistin among multi-resistant Enterobacterales was 4.1%, and the MIC50 and MIC90 were 0.5 μg/ml and 1μg/ml respectively. Among the collected Acinetobacter baumannii isolates, the prevalence of colistin resistance was 2.6%, with the MIC50 and MIC90 of 0.5 μg/ml. Conclusion: The research indicates that colistin could be a viable treatment option for infections caused by multi-resistant Enterobacterales and Acinetobacter baumannii. [ABSTRACT FROM AUTHOR]

Hypervirulent Klebsiella pneumoniae is an emerging pathogen that has gained attention due to its increased ability to cause infections even in healthy individuals. The aim of this study is to investigate virulence factors in K. pneumoniae strains isolated from clinical specimens and their association with carbapenem resistance. The study was conducted on 260 isolates identified between 2018 and 2023 at the Mohammed V Military Teaching Hospital in Rabat, Morocco. The isolates were categorized based on their susceptibility to antibiotics. The hypermucoviscosity was determined by a string test, while the presence of capsular serotypes and virulence genes were identified by PCR. Among our strains, 6.2% (n = 16) exhibited hypervirulent characteristics, 56% were resistant to carbapenem. Notably, 5.7% (n = 6) of carbapenem-resistant isolates expressed the hypermucoviscous phenotype, while 1.5% (n = 2) of carbapenem-susceptible K. pneumoniae isolates exhibited the same trait. In our study, we found that a total of 10 isolates (3.8%) had virulent capsular serotypes, with K2 being the most prevalent 40% (n = 4) and K20 in 30% (n = 3). Furthermore, we detected the presence of the Aerobactin gene in 1.5% (n = 4) of the isolates examined. Based on our findings, it appears that there was no correlation between the presence of virulence factors and carbapenem resistance. In conclusion, identifying hypervirulent K. pneumoniae in clinical specimens and assessing their antibiotic resistance profiles are crucial to ensure effective therapy and to prevent outbreaks. [ABSTRACT FROM AUTHOR]

Bacteremia is responsible for high rates of morbidity and mortality. The increasing prevalence of multidrug-resistant (MDR) bacteria in intensive care units (ICU) is a growing concern. Hence, prior knowledge of bacterial epidemiology and resistance phenotypes is required to optimize these infections' management. The objective of this study was to determine the epidemiological profile of bacteremia in ICU settings, as well as the place occupied by MDR bacteria in these infections. It is a prospective study carried out over 10 months on episodes of bacteremia in the ICU of Mohammed V Military Teaching Hospital (Rabat, Morocco). Microorganism growth was detected using fluorescent technology, species identification was based on morphological and biochemical characteristics. Antimicrobial susceptibility testing was performed following the recommendations of the Antibiogram Committee of the French Society of Microbiology (CA-SFM) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Among 504 hospitalized patients, sixty-one (12.1%) presented at least one episode of bacteremia. Forty patients (65.6% of bacteremic patients) presented at least one episode of bacteremia due to MDR bacteria. Male gender, cardiovascular diseases, diabetes and previous hospitalization were significant risk factors for the acquisition of MDR bacteremia. Isolated bacteria were mainly Gram-negative bacilli (GNB) (n = 62; 68.9%) dominated by Acinetobacter baumannii (n = 19; 21.1%) and Klebsiella pneumoniae (n = 16; 17.8%). MDR bacteria were represented by multi-resistant Acinetobacter baumannii (n = 19; 44.2%), extended-spectrum beta-lactamases-producing Enterobacterales (n = 9; 20.9%) and carbapenem-resistant Enterobacterales (n = 7; 16.3%). Carbapenems (n = 40; 65.6%), Aminoglycosides (n = 32; 52.5%) and Polypeptides (n = 24; 39.3%) were the most used antimicrobials. Mortality rates were 66.6% (n = 40) and 85% (n = 43) in patients with non MDR bacteremia and MDR bacteremia respectively. Limiting the spread of MDR bacteria and improving the management of bacteremic patients require continuous monitoring of bacteremia as well as adapting the therapeutic and preventive strategy. [ABSTRACT FROM AUTHOR]

Acinetobacter baumannii and Pseudomonas aeruginosa are two pathogens with an important power of adaptation to antibiotics thus, both pose a real public health problem. Our study investigated epidemiological characteristics, antibiotic sensitivity profile and resistance genes of imipenem resistant A. baumannii and P. aeruginosa. This was a retrospective study carried out in the bacteriology laboratory of Mohammed V military training hospital, spanning from January 2018 to April 2021. Antibiotic susceptibility was studied by Mueller Hilton agar diffusion method with OXOID® type antibiotic discs and interpreted according to the recommendations of EUCAST 2021. Carbapenemase detection was performed by CarbaNP-test®. The molecular study was performed using conventional PCR. During the study period, we collected 1,072 imipenem-resistant isolates namely, 820 A. baumannii and 252 P. aeruginosa. The molecular study showed that out of 108 A. baumannii isolates 102 carried the bla OXA-51 and 100 isolates carried the bla OXA-23 gene. The coexistence of bla OXA-23 and bla NDM genes was detected in only 4 isolates. Altogether 50% of P. aeruginosa strains carried bla VIM-2. All investigated A. baumannii and P. aeruginosa strains were colistin susceptible in this study. Multiresistant bacterial infections are associated with longer hospitalization, higher hospital costs and higher mortality rates. Therefore, a collective action including the different actors of the healthcare system is necessary. [ABSTRACT FROM AUTHOR]

Introduction: Urinary tract infection is very common and is the second most frequent reason for consultation in office-based practice. The incidence varies from one country to another. The diffusion of MDR in the community complicates therapeutic management. The objective of this study was to describe the bacterial epidemiology and to determine the risk factors for the acquisition of MDR in community urinary tract infections in our region. Methods: This was a retrospective case-control study conducted in the bacteriology laboratory of the Mohammed V Military Teaching Hospital over an 8-month period from 01 October 2015 to 31 May 2016. Cases were defined as patients with community-acquired urinary tract infection with MDR and controls were defined as patients with a urinary tract infection without MDR. Results: Out of 373 isolates, enterobacteria represented 80%. E. coli represented 59.2%, followed by K. pneumoniae at 15%. The rate of MDR represented 13.4% of which ESBL enterobacteria represented 12.1%. Univariate analysis showed a statistically significant association between male sex (p=0.001), age >65 years (p=0.007), urban origin (p=0.003), previous hospitalization within 3 months (p=0.001) and antibiotic therapy within 6 months (p=0.001) with MDR community-acquired urinary tract infection. On the other hand, multivariate analysis by logistic regression showed that age >65 years (OR=8.4, CI: 2.1-42), previous hospitalization within 3 months (OR=13.4, CI: 3.3-140.2) and antibiotic therapy within 6 months (OR=9.2, CI: 4.1-60.1) were significantly associated to MDR community-acquired urinary tract infection. Conclusions: The increase in resistance to enterobacteria in the community prompts a review of the list of antibiotics prescribed for probabilistic management of these infections in our region. [ABSTRACT FROM AUTHOR]

Introduction Escherichia coli is the most commonly isolated species in both community and healthcare-associated infections. Our study's purpose was to determine the rates of antibiotic resistance of E. coli isolates in hospital and community populations, track the kinetics of resistance rates of E. coli isolates to major antibiotics, particularly those prescribed for urinary tract infections and study the occurrence and evolution of multi-resistant phenotypes. Methods We conducted a retrospective study at the Bacteriological Department of the Mohammed V Military Hospital of Instruction, over a period of 7 years. All isolates of E. coli from inpatients and outpatients were included. Identification of bacterial isolates was based on culture, morphological and biochemical identification characteristics. Antibiotic susceptibility was studied using the Mueller Hilton agar diffusion method by using OXOID® type antibiotic discs and interpreted according to the recommendations of EUCAST/CA-SFM 2019. Results The rate of resistance of E. coli isolates to 3rd generation cephalosporins, imipenem and fluoroquinolones was 12%, 1% and 34%, respectively. The difference between the resistance rates of inpatient and outpatient E. coli isolates was statistically significant for most antibiotics (p<0.05). The rate of extended-spectrum beta-lactamase phenotype (ESBL) was 6.73%. The carbapenemase phenotype was 1.25%. The ESBL phenotype rate increased from 3% in 2012 to 11.16% in 2018. Conclusions The progression of the ESBL phenotype in both hospital and community settings, due to the increase in the resistance rate to 3rd generation cephalosporin, is prompting a review of the strategy for the therapeutic management of urinary tract infections with these molecules as probabilistic treatment. [ABSTRACT FROM AUTHOR]