Antimicrobial susceptibility of urinary Klebsiella pneumoniae and the emergence of carbapenem-resistant strains: A retrospective study from a university hospital in Morocco, North Africa

Introduction: Urinary tract infections (UTIs) due to multi-drug resistant Klebsiella pneumoniae (K. pneumoniae) strains are increasing worldwide and have become a major public health problem.Objectives: The aim of this study was to determine the current and local antimicrobial susceptibility of urinary K. pneumoniae isolated from inpatients and outpatients in a university hospital.Subjects and methods: A retrospective study was carried out, covering a 3-year period from January 2010 to December 2012. It focused on all the K. pneumoniae strains isolated from the urine samples analyzed at the microbiology laboratory of the Avicenne Teaching Hospital, Marrakech, Morocco, North Africa.Results: K. pneumoniae represented 22% of all the urinary Enterobacteriaceae isolated during the study period. The bacterial resistance rates of K. pneumoniae isolates not producing extended spectrum - lactamase (ESBL) were as follows: trimethoprim sulfamethoxazole “T/S” (61%), amoxicillin/clavulanic acid (51%), ciprofloxacin (32%), gentamicin (21%) and amikacin (11%). ESBL producing K. pneumoniae strains accounted for 25.5% of all the urinary K. pneumoniae isolates and showed resistance to T/S (89%), gentamicin (89%), ciprofloxacin (84%) and amikacin (50%). For the first time in our region, we also noted the emergence of carbapenem-resistant strains that accounted for 7% of all the urinary ESBL-producing K. pneumoniae isolates.Keywords: Urinary; Klebsiella pneumoniae; Antimicrobial resistanc

Molecular characterization of extended spectrum β-lactamase-producing Escherichia coli in a university hospital in Morocco, North Africa

Introduction: β-Lactams are among the most widely prescribed antibiotics in human medicine. However, because of their massive and usually inappropriate use, resistance to these drugs has increased markedly, especially due to extended-spectrum β-lactamase (ESBL) production.Objectives: The aims of this study were to determine the prevalence of urinary Escherichia coli strains isolated from urine samples taken from patients diagnosed with urinary tract infections (UTIs), to evaluate their current antimicrobial susceptibility pattern and to look for blaSHV, blaTEM and blaCTX-M genes in these multi-drug resistant isolates.Subject and methods: A retrospective survey was made over 3 years from 2010 to 2012. It included all uropathogenic E. coli strains isolated from urine samples taken from consulting and hospitalized patients in the Avicenne Teaching Hospital in Marrakech, Morocco.Results: E. coli was the etiologic agent in 63% of reported UTIs due to Enterobacteriacae. In all, the prevalence of ESBL-producing E. coli reached 6% of all urinary Enterobacteriaceae isolates in 2012. The bacterial resistance rates of ESBL-producing E. coli isolates were as follows: amoxicillin/clavulanic acid (100%), trimethoprim/sulfamethoxazole (76%), gentamicin (66%), ciprofloxacin (82%) and amikacin (56%). None of these strains was resistant to carbapenems. The ESBL production patterns observed included single production of CTX-M (70%), SHV (12%) and TEM (0%). Some ESBL-producing E. coli isolates produced combinations of 2 ESBLs belonging to different groups: CTX-M+SHV (12%) and CTX-M+TEM (6%).Conclusion: The results of this work report, for the first time in the Marrakech region, the ESBL production pattern with CTX-M being most common among the ESBL-producing urinary E. coli. Moreover, a major finding is the production of multiple ESBL types by some urinary E. coli isolates.KEYWORDS Urinary; Extended-spectrum β-lactamase (ESBL); E. coli; Antibiotics; Resistanc

In vitro colonization of date palm plants by Rhizophagus irregularis during the rooting stage

The use of in vitro culture of date palm plants Phoenix dactylifera, associated with arbuscular mycorrhizal (AM) fungi is a novel approach for the production of bio-fortified plants that are free of pathogens. Here, we report, for the first time, the in vitro mycorrhization of in vitro date palm plants using the AM fungus Rhizophagus irregularis MUCL 41833. Date Plants were used in an in vitro cultured system that consisted of a root compartment (RC) containing germinated seeds of Barrel Clover, Medicago truncatula, and spores of Rhizophagus irregularis as a mycorrhizal donor, and a hyphal compartment (HC) with a barrier separating the RC from the HC. In vitro cultured date palm plants, at the two-leaf stage, were placed in the HC section of the culture plate that after 6 weeks contained an active growing extraradical mycelium network of the fungus. Roots of the date palm became colonized after 10 weeks and hyphae, vesicles, spores and arbuscules, were detected. No differences were noticed in above-ground parameters between mycorrhized and non-mycorrhized plants, in which there was no fungus in the HC. However, the total root length was significantly higher and secondary and tertiary roots were significantly more numerous, in the mycorrhized plants. It is hypothesized that these differences are related to stimulating molecules released by the profuse extraradical mycelium of the fungus growing in close contact with the palm root system. Root colonization percentages were of the same order as those reported in pots cultures of the date palm plants. This work opens the door for the large-scale in vitro mycorrhization of date palm plants, potentially better adapted to acclimatization phase and possibly to the field

Antimicrobial resistance in Africa: a systematic review

Background: Antimicrobial resistance (AMR) is widely acknowledged as a global problem, yet in many parts of the world its magnitude is still not well understood. This review, using a public health focused approach, aimed to understand and describe the current status of AMR in Africa in relation to common causes of infections and drugs recommended in WHO treatment guidelines. Methods: PubMed, EMBASE and other relevant databases were searched for recent articles (2013–2016) in accordance with the PRISMA guidelines. Article retrieval and screening were done using a structured search string and strict inclusion/exclusion criteria. Median and interquartile ranges of percent resistance were calculated for each antibiotic-bacterium combination. Results: AMR data was not available for 42.6% of the countries in the African continent. A total of 144 articles were included in the final analysis. 13 Gram negative and 5 Gram positive bacteria were tested against 37 different antibiotics. Penicillin resistance in Streptococcus pneumoniae was reported in 14/144studies (median resistance (MR): 26.7%). Further 18/53 (34.0%) of Haemophilus influenza isolates were resistant to amoxicillin. MR of Escherichia coli to amoxicillin, trimethoprim and gentamicin was 88.1%, 80.7% and 29.8% respectively. Ciprofloxacin resistance in Salmonella Typhi was rare. No documented ceftriaxone resistance in Neisseria gonorrhoeae was reported, while the MR for quinolone was 37.5%. Carbapenem resistance was common in Acinetobacter spp. and Pseudomonas aeruginosa but uncommon in Enterobacteriaceae. Conclusion: Our review highlights three important findings. First, recent AMR data is not available for more than 40% of the countries. Second, the level of resistance to commonly prescribed antibiotics was significant. Third, the quality of microbiological data is of serious concern. Our findings underline that to conserve our current arsenal of antibiotics it is imperative to address the gaps in AMR diagnostic standardization and reporting and use available information to optimize treatment guidelines.</p