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

Etiological Frequency of MDR Bacteremia and Antibiotic Resistance: Experience of the Avicenna Hospital in Marrakech

This work aims to study the bacteriological profile of Multi drug resistant bacteremia, as well as the current state of their resistance to antibiotics. It is a retrospective, descriptive study, which was spread over 8 years (January 2014-December 2021), relating to hospitalized patients having a positive blood culture, confirmed at microbiological laboratory of the Avicenna Military Hospital of Marrakesh. A total of 1923 blood cultures were performed, 17% of which came back positive. 68 MDRs bacterias were isolated, which is 20% of all isolates. Enterobacteriaceae resistant to third generation cephalosporins and imipenem resistant Acinetobacter baumanii are the most frequently found MDRs bacterias with rates of 47% and 30% respectively. Hospital units are mainly represented by resuscitation-intensive care, followed by medical services. MDR bacteria represent a worrying problem underlining the need for the application of hygiene measures and the rational prescription of antibiotics

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

Anti-SMN autoantibodies in mixed connective tissue disease are associated with a severe systemic sclerosis phenotype

Objectives The survival of motor neuron (SMN) complex has an essential role in the assembly of small nuclear ribonucleoproteins (RNP). Recent reports have described autoantibodies (aAbs) to the SMN complex as novel biomarkers in anti-U1RNP+ myositis patients. The aim of this study was to compare phenotypic features of anti-U1RNP+ mixed connective tissue disease (MCTD) patients with and without anti-SMN aAbs.Methods A retrospective MCTD cohort was studied. Addressable laser bead immunoassay was used to detect specific anti-SMN aAbs with <300 mean fluorescence intensity (MFI) as normal reference range, 300–999 MFI as low-titre and ≥1000 MFI as high-titre positivity. Comparison of clinical features between anti-SMN+ and anti-SMN− subgroups used two-tailed Fisher’s exact test, and logistic regression analyses.Results Sixty-six patients were included. Median age at MCTD diagnosis was 40.6 years, and duration of follow-up was 12 years. Based on the highest available titre, 39 (59%) were anti-SMN+: 10 (26%) had low titre and 29 (74%) had high titre. Anti-SMN+ patients had a higher frequency of fingertip pitting scars (anti-SMN+ 23% vs anti-SMN− 4%, p=0.04), lower gastrointestinal (GI) involvement (26% vs 4%, p=0.04), and myocarditis (16% vs 0%, p=0.04). The combined outcome of pitting scars and/or lower GI involvement and/or myositis and/or myocarditis was highest among high-titre anti-SMN+ patients: adjusted OR 7.79 (2.33 to 30.45, p=0.002).Conclusions Anti-SMN aAbs were present in 59% of our MCTD cohort. Their presence, especially at high-titres, was associated with a severe systemic sclerosis (scleroderma) phenotype including myositis, myocarditis and lower GI involvement