Prevalence of Carbapenemase-Producing Enterobacteriaceae in a University Hospital in Rabat, Morocco: A 19-Months Prospective Study.
Keywords:Carbapenemases, Enterobacteriaceae, Klebsiella, Prevalence, Resistance.
Objectives: This study aims to assess the prevalence of clinical isolates of enterobacteriaceae with carbapenem resistance as a result of carbapenemase production, and to characterize the types of enzymes produced.
Methods: All non-duplicate enterobacteriaceae (Klebsiella spp, Enterobacter spp and E. coli) clinical isolates collected over 19 months (i.e., in the period from May 2009 through December 2010) were included in the study. The modified Hodge test was performed on strains showing reduced ertapenem susceptibility. Isolates that tested positive were sent to the French reference center on emerging resistance for molecular characterization and clone determination.
Results: A total of 463 strains were investigated: E. coli 63.9%, Klebsiella spp 27.9% and Enterobacter spp 8.2%. Carbapenemase production occurred in 13 isolates (2.8%). Ten strains produced class D carbapenemases (OXA-48). These were 6 K. pneumoniae, 1 K. oxytoca and 3 E. cloacae. New Delhi metallo-Î²-lactamase-1 (NDM-1) metallo enzymes were produced by three K. pneumoniae strains.
Conclusion: A source of concern for Morocco can be found in both the high prevalence of carbapenemase producing Klebsiella and Enterobacter clinical isolates and detection of NDM-1 carbapenemases. This requires setting up an emerging resistance monitoring and surveillance scheme at national level.
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