Prevalence and characterization of Carbapenem-Resistant Enterobacterales among inpatients and outpatients in Skikda, Algeria.

Abstract

The spread of Carbapenemase-producing Enterobacterales (CPEs) has become a significant concern in Algeria, with limited data available on their presence in community settings. This research investigated the resistance mechanisms of carbapenem-resistant Enterobacterales (CREs) collected from hospitals and the community in Skikda city, Algeria, between December 2020 and June 2022. The study collected Enterobacterales strains resistant to ertapenem from inpatient and outpatient populations. An automated system was used for identification and antibiotic susceptibility testing. β-lactamase production was evaluated through phenotypic tests and confirmed by standard PCR. Lastly, the carbapenemase genes were sequenced using the Sanger method. 17 CRE were isolated, with 9 from inpatients and 8 from outpatients. These isolates belonged to four species: Klebsiella pneumoniae (n = 8), Escherichia coli (n = 6), Enterobacter cloacae (n = 1), and Proteus mirabilis (n = 1). Of 15 CPEs, 11 were extended-spectrum β-lactamases (ESBLs) positive, 5 were plasmid-mediated cephalosporinase (AmpC) positive, and 1 harbored all three β-lactamases. All metallo-β-lactamase-producing strains carried the New Delhi metallo-beta-lactamase gene (blaNDM), including 5 NDM-1 and 7 NDM-5 variants. The presence of blaOXA-48 and blaOXA-244 was observed in one outpatient strain each. NDM was associated with Cefotaximase Munich (CTX-M) ESBL in 8 isolates, while Cephamycinase (CMY) was detected in 3 NDM-5-producing E. coli. This research highlights the rising prevalence of carbapenemases NDM-1 and NDM-5 among inpatients and outpatients and supports the notion that OXA-48 is becoming increasingly widespread beyond Algerian hospitals.