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Molecular characterization of carbapenem-resistant Gram-negative bacilli clinical isolates in Algeria

Authors Bourafa N, Chaalal W, Bakour S, Lalaoui R, Boutefnouchet N, Diene SM, Rolain JM

Received 25 August 2017

Accepted for publication 27 October 2017

Published 17 May 2018 Volume 2018:11 Pages 735—742


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Dr Sahil Khanna

Nadjette Bourafa,1–3 Wafaa Chaalal,1,4 Sofiane Bakour,1 Rym Lalaoui,1 Nafissa Boutefnouchet,2 Seydina M Diene,1 Jean-Marc Rolain1

1Aix Marseille Universite, MEPHI, IHU-Mediterranee Infection, Marseille, France; 2Laboratoire de Microbiologie et Biochimie Appliquée, Département de Biochimie, Faculté des Sciences, Université Badji Mokhtar Annaba, Algeria; 3Département de Biologie, Faculté des Sciences de la Nature et de la Vie, Université Mohamed Cherif Messaadia-Souk-ahras, Algeria; 4Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université d’Oran, Es Senia, Oran, Algeria

Objectives: The aims of this study were to investigate the occurrence of carbapenem-resistant Gram-negative bacilli (GNB) isolated from inpatients and outpatients in Algeria between July and September 2015, and to screen their resistance mechanisms and genetic relatedness.
Materials and methods: A total of 68 non-redundant isolates were identified using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) antibiotic susceptibility testing was performed using disk diffusion and Etest methods. Carbapenemase activity was carried out using modified Carba NP test, EDTA assay, and the modified Hodge test. Molecular characterization of carbapenemases and extended-spectrum β-lactamase (ESBL) genes were detected by standard PCR and sequencing. Genotyping of carbapenem-resistant isolates was performed by multilocus sequence typing (MLST) analysis.
Results: Of the 68 GNB isolates, 13 (19%) showed reduced susceptibility to carbapenems, including, four Klebsiella pneumoniae, one Escherichia coli, six Acinetobacter baumannii, and two Pseudomonas aeruginosa. blaOXA-48 gene was detected in the five Enterobacteriaceae isolates, and blaOXA-23 was identified in all A. baumannii isolates. OprD mutations were revealed in the two P. aeruginosa isolates. A total of 11 out of the 13 carbapenem-resistant GNB were detected in inpatients, and the two remaining strains were isolated from outpatients. Molecular typing showed the presence of four sequence types (STs) among the OXA-48-producing K. pneumoniae isolates: ST101, ST147, ST163, and ST2017. ST533 was identified for the OXA-48 producing E. coli isolate. All of the A. baumannii and P. aeruginosa were assigned to the international clonal lineages ST2 and ST654, respectively.
Conclusion: This study reports the first detection of the epidemic multidrug-resistant lineage, K. pneumoniae ST147 coproduced blaOXA-48 and ESBL genes in Algeria and represents the first description of OXA-48-producing E. coli ST533 and K. pneumoniae ST163 and ST2017. In addition, this study describes for the first time the emergence of OXA-48-producing E. coli and K. pneumoniae in the community in Algeria, leading to major problems for managing microbial infections.

Keywords: Gram-negative bacilli, carbapenem resistance, epidemic lineages, Algeria

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