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.
Highlights
Klebsiella pneumoniae is an important pathogen known to cause nosocomial infections, such as urinary tract as well as respiratory tract infections and septicemia
The present study aims to determine the rate of ESBL-producing K. pneumoniae (ESBL-Kp) isolated from clinical samples and hospital environment sites, and to find the relation between them
Patients admitted to Hassan II Hospital were required to have nosocomial K. pneumoniae isolates coming from clinical specimens during their hospital stay
Summary
Klebsiella pneumoniae is an important pathogen known to cause nosocomial infections, such as urinary tract as well as respiratory tract infections and septicemia. The infections caused by this isolate can be extended by the hospital environment. K. pneumoniae persists to be the major ESBL-producing organism isolated in the hospital settings all over the world. Infections due to ESBL-producing K. pneumoniae (ESBL-Kp) increased mortality in hospitalised patients [1]. In Moroccan hospitals, the existence of ESBL-producing organisms has been reported and their prevalence varies from 8% to 51% [7] [8]. Various epidemiological factors combined with ESBL-producing strains acquire to be described. Nosocomial infections caused by K. pneumoniae may lead to a potentially lifethreatening condition [2] [9]. Knowledge of local epidemiology is required to define the practical treatment for patients with a hospital infection
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