title: Rectal carriage of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae among hospitalised neonates in a neonatal intensive care unit in Fez, Morocco.
abstract: The aim of this study was to investigate the faecal carriage and molecular epidemiology of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBLE) isolated from rectal samples of neonates hospitalised in a neonatal intensive care unit (NICU) of a university hospital in Fez, Morocco.
  
  
  
  From February-July 2013, all neonates hospitalised in the NICU were screened for ESBLE carriage at discharge. ESBLs were identified by double-disk synergy test, PCR and DNA sequencing analysis. ESBLE were analysed by pulsed-field gel electrophoresis (PFGE), and conjugation was performed by the broth mating method.
  
  
  
  In this study, 169 Enterobacteriaceae were collected from 164 neonates. The prevalence of faecal carriage of ESBLE was 58.0% (98/169), predominantly Klebsiella pneumoniae (65/98; 66.3%). A high rate of multiresistance in ESBLE was noted. blaCTX-M-1group (78.5%) was the most frequent ESBL gene detected, and all isolates harboured the CTX-M-15 variant. The prevalence of carbapenemase-producing Enterobacteriaceae was 1.8%, and blaOXA-48was the only gene found in these isolates. Sequencing revealed subgroups corresponding to bla(CTX-M-15,TEM-1,TEM-104,SHV-1,SHV-44,SHV-49andSHV-133)genes. Conjugation experiments showed the transferability of blaCTX-M-15and blaTEM, but not blaSHV. These genes were carried by a high-molecular-weight conjugative plasmid (ca. 125kb). PFGE profiles demonstrated high clonal dissemination of ESBL-positive strains in the NICU.
  
  
  
  These results demonstrate the existence of high clonal transmission of ESBLE in a Moroccan NICU. This finding provides useful information to implement a screening policy for resistant Enterobacteriaceae among neonates hospitalised in this ward.
authors.affiliation: Faculty of Medicine, Sidi Mohammed Ben Abdellah University, Fez, Morocco; Faculty of Sciences Dhar El Mahraz, Sidi Mohammed Ben Abdellah University, Fez, Morocco.
authors.forename: Btissam
authors.initials: B
authors.lastname: Arhoune
authors.affiliation: Faculty of Medicine, Sidi Mohammed Ben Abdellah University, Fez, Morocco. Electronic address: bouchra.oumokhtar@usmba.ac.ma.
authors.forename: Bouchra
authors.initials: B
authors.lastname: Oumokhtar
authors.affiliation: Faculty of Medicine, Sidi Mohammed Ben Abdellah University, Fez, Morocco; Neonatal Intensive Care Unit, University Hospital Hassan II, Fez, Morocco.
authors.forename: Fouzia
authors.initials: F
authors.lastname: Hmami
authors.affiliation: Research Department, Pasteur Institute of Morocco, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Sultan Moulay Slimane University, Beni Mellal, Morocco.
authors.forename: Abouddihaj
authors.initials: A
authors.lastname: Barguigua
authors.affiliation: Research Department, Pasteur Institute of Morocco, Casablanca, Morocco.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Timinouni
authors.affiliation: Faculty of Medicine, Sidi Mohammed Ben Abdellah University, Fez, Morocco.
authors.forename: Samira
authors.initials: S
authors.lastname: El Fakir
authors.affiliation: Faculty of Sciences Dhar El Mahraz, Sidi Mohammed Ben Abdellah University, Fez, Morocco.
authors.forename: Fouzia
authors.initials: F
authors.lastname: Chami
authors.affiliation: Faculty of Medicine, Sidi Mohammed Ben Abdellah University, Fez, Morocco; Neonatal Intensive Care Unit, University Hospital Hassan II, Fez, Morocco.
authors.forename: Abdelhak
authors.initials: A
authors.lastname: Bouharrou
mesh_terms: D001426:Bacterial Proteins / Q000096:biosynthesis / Q000378:metabolism; D000073182:Carbapenem-Resistant Enterobacteriaceae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004269:DNA, Bacterial / Q000032:analysis; D016521:Electrophoresis, Gel, Pulsed-Field; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology*; D005260:Female; D005798:Genes, Bacterial / Q000235:genetics; D005838:Genotype; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007710:Klebsiella Infections / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity; D008297:Male; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D009018:Morocco / Q000453:epidemiology; D010802:Phylogeny; D015995:Prevalence; D017422:Sequence Analysis, DNA; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics / Q000378:metabolism
chemical_list: D001426:Bacterial Proteins; D004269:DNA, Bacterial; C473109:beta-lactamase CTX-M-15; C054882:beta-lactamase PIT-2; D001618:beta-Lactamases; C494146:beta-lactamase SHV-49, Klebsiella pneumoniae; C034413:beta-lactamase TEM-1; C063912:carbapenemase
keywords: Enterobacteriaceae; Extended-spectrum β-lactamase; Intestinal carriage; Morocco; NICU; Neonate