AiM  Vol.6 No.3 , March 2016
Incidence of Extended-Spectrum Be-ta-Lactamase-Producing Klebsiella pneumoniae among Patients and in the Environment of Hassan II Hospital, Settat, Morocco
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.
Cite this paper: Natoubi, S. , Barguigua, A. , Zriouil, S. , Baghdad, N. , Timinouni, M. , Hilali, A. , Amghar, S. and Zerouali, K. (2016) Incidence of Extended-Spectrum Be-ta-Lactamase-Producing Klebsiella pneumoniae among Patients and in the Environment of Hassan II Hospital, Settat, Morocco. Advances in Microbiology, 6, 152-161. doi: 10.4236/aim.2016.63015.

[1]   Sader, H.S., Farrell, D.J., Flamm, R.K. and Jones, R.N. (2014) Antimicrobial Susceptibility of Gram-Negative Organisms Isolated from Patients Hospitalized in Intensive Care Units in United States and European Hospitals (2009-2011). Diagnostic Microbiology and Infectious Disease, 78, 443-448.

[2]   Vodovar, D., et al. (2013) Enterobacteriaceae Producing Extended Spectrum Beta-Lactamase: Epidemiology, Risk Factors, and Prevention. La Revue de Médecine Interne, 34, 687-693.

[3]   Philippon, A. (2013) Les bêta-lactamases à spectre élargi ou étendu (BLSE). Immuno-analyse & Biologie Spécialisée, 28, 287-296.

[4]   Ruppé, E. (2010) épidémiologie des bêta-lactamases à spectre élargi: l’avènement des CTX-M. Antibiotiques, 12, 3-16.

[5]   Barguigua, A., et al. (2013) Prevalence and Genotypic Analysis of Plasmid-Mediated Beta-Lactamases among Urinary: Klebsiella pneumoniae Isolates in Moroccan Community. Journal of Antibiotics, 66, 11-16.

[6]   Nedjai, S., et al. (2012) Prevalence and Characterization of Extended Spectrum Beta-Lactamases in Klebsiella-Enterobacter-Serratia Group Bacteria, in Algeria. Médecine et Maladies Infectieuses, 42, 20-29.

[7]   Lahlou Amine, I., Chegri, M. and L’Kassmi, H. (2009) épidémiologie et résistance aux antibiotiques des entéro-bactéries isolées d’infections urinaires à l’hospital militaire Moulay-Ismail de Meknès. Antibiotiques, 11, 90-96.

[8]   El Bouamri, M.C., et al. (2014) Recent Evolution of the Epidemiological Profile of Extended-Spectrum Beta-Lactamase Producing Uropathogenic Enterobacteria in Marrakech, Morocco. Progrès en Urologie, 24, 451-455.

[9]   Soraas, A., et al. (2013) Risk Factors for Community-Acquired Urinary Tract Infections Caused by ESBL-Producing Enterobacteriaceae—A Case-Control Study in a Low Prevalence Country. PLoS One, 8, e69581.

[10]   CLSI (2011) Clinical and Laboratory Standards Institute, Performance Standards for Antimicrobial Susceptibility Testing: Twenty-First Informational Supplement M100-S21. CLSI, Wayne, PA.

[11]   Garrec, H., et al. (2011) Comparison of Nine Phenotypic Methods for Detection of Extended-Spectrum Beta-Lactamase Production by Enterobacteriaceae. Journal of Clinical Microbiology, 49, 1048-1057.

[12]   Barguigua, A., et al. (2012) Emergence of Carbapenem-Resistant Enterobacteriaceae Isolates in the Moroccan Community. Diagnostic Microbiology & Infectious Diseases, 73, 290-291.

[13]   Lim, K.T., et al. (2009) Characterization of Multidrug Resistant ESBL-Producing Escherichia coli Isolates from Hospitals in Malaysia. J Biomed Biotechnol., 2009(10): p. 165637.

[14]   van’t Veen, A., et al. (2005) Outbreak of Infection with a Multiresistant Klebsiella pneumoniae Strain Associated with Contaminated Roll Boards In Operating Rooms. J Clin Microbiol., 43, 4961-4967.

[15]   Bisson, G., et al. (2002) Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella Species: Risk Factors for Colonization and Impact of Antimicrobial Formulary Interventions on Colonization Prevalence. Infect Control Hosp Epidemiol., 23, 254-260.

[16]   Arabaci, F., Oldacay, M. and Berber, D. (2009) Evaluation of ESBL Positivity Rates for Escherichia coli and Klebsiella pneumoniae Strains with the Sensititre ESBL Antimicrobic Susceptibility Plates in a Public Hospital, Turkey. Journal of Medical Sciences, 9, 4.

[17]   Guet-Revillet, H., et al. (2012) Environmental Contamination with Extended-Spectrum β-Lactamases: Is There Any Difference between Escherichia coli and Klebsiella spp? American Journal of Infection Control, 40, 845-848.

[18]   Jones, K. and Bradshaw, S.B. (1997) Synergism in Biofilm Formation between Salmonella enteritidis and a Nitrogen-Fixing Strain of Klebsiella pneumoniae. Journal of Applied Microbiology, 82, 663-668.

[19]   Poirel, L., Potron, A. and Nordmann, P. (2012) OXA-48-Like Carbapenemases: The Phantom Menace. Journal of Antimicrobial Chemotherapy, 67, 1597-1606.

[20]   Nordmann, P., Naas, T. and Poirel, L. (2011) Global Spread of Carbapenemase-Producing Enterobacteriaceae. Emerging Infectious Diseases, 17, 1791-1798.

[21]   Hays, C., et al. (2012) Nosocomial Occurrence of OXA-48-Producing Enterobacterial Isolates in a Moroccan Hospital. International Journal of Antimicrobial Agents, 39, 545-547.

[22]   Poirel, L., et al. (2011) Emergence of NDM-1-Producing Klebsiella pneumoniae in Morocco. Journal of Antimicrobial Chemotherapy, 66, 2781-2783.

[23]   Poirel, L., et al. (2011) Cross-Border Transmission of OXA-48-Producing Enterobacter cloacae from Morocco to France. Journal of Antimicrobial Chemotherapy, 66, 1181-1182.

[24]   Barlow, M., et al. (2008) High Rate of Mobilization for blaCTX-Ms. Emerging Infectious Diseases, 14, 423-428.

[25]   Livermore, D.M. (2008) Defining an Extended-Spectrum Beta-Lactamase. Clinical Microbiology and Infections, 14, 3-10.

[26]   Bouchakour, M., et al. (2010) Plasmid-Mediated Quinolone Resistance in Expanded Spectrum Beta Lactamase Producing Enterobacteriaceae in Morocco. Journal of Infection in Developing Countries, 4, 779-803.

[27]   Li, C.R., Li, Y. and Zhang, P.A. (2003) Dissemination and Spread of CTX-M Extended-Spectrum Beta-Lactamases among Clinical Isolates of Klebsiella pneumoniae in Central China. International Journal of Antimicrobial Agents, 22, 521-525.

[28]   Paterson, D.L., et al. (2000) Epidemiology of Ciprofloxacin Resistance and Its Relationship to Extended-Spectrum Beta-Lactamase Productionin Klebsiella pneumoniae Isolates Causing Bacteremia. Clinical Infectious Diseases, 30, 473-478.