title: Rectal Carriage of Extended-Spectrum Beta-Lactamase and Carbapenemase Producing Gram-Negative Bacilli in Intensive Care Units in Tunisia.
abstract: This study was conducted to evaluate the rate of fecal carriage of Gram-negative bacilli (GNB) resistant to third-generation cephalosporins (third GC) in patients hospitalized in the intensive care unit (ICU) of Charles Nicolle Hospital of Tunis and to identify the enzymatic mechanisms involved. From February to April 2014, rectal swabs were collected from all patients (n = 38) at admission and once weekly thereafter to identify acquisition. They were cultured on desoxycholate-lactose-agar plates supplemented with cefotaxime (2 mg/L). The rate of fecal carriage of GNB resistant to third GC was 0% (0/38) at admission and the acquisition rate was 45.16% (14/31). Nineteen GNB resistant to C3G were collected from 14 patients. The major species collected were Acinetobacter baumannii (n = 5), Klebsiella pneumoniae (n = 5), and Enterobacter cloacae (n = 5). Thirteen extended-spectrum β-lactamase (ESBL) producing GNB were found; CTX-M-15 (n = 10) and CTX-M-14 (n = 1) among Enterobacteriacae and GES-12 (n = 2) among A. baumannii. Ten strains were carbapenem resistant. OXA-48 (n = 4) and NDM-1 (n = 1) were detected among Enterobacteriacae and OXA-23 (n = 5), and GES-11 (n = 1) were detected in A. baumannii. Gene encoding the ACT-16 AmpC-type-β-lactamase was detected in two isolates. All Escherichia coli isolates were assigned to group B2. Among virulence genes, prevalence of fimH, fuyA, ompT, pai, and usp were highest observed in all E. coli isolates. Among K. pneumoniae mrkD and entB were the most frequent (n = 5) followed by ybtS (n = 4) and kfu (n = 2). This study revealed a high prevalence of fecal carriage of multidrug-resistant GNB, including ESBLs, carbapenemases, and cephalosporinases producing bacteria in patients hospitalized in ICU.
authors.affiliation: 1 LR99ES09 Laboratoire de Recherche "Résistance aux Antimicrobiens," Faculté de Médecine de Tunis, Université de Tunis El Manar , Tunis, Tunisie.|2 Faculté des Sciences de Bizerte, Université de Carthage , Bizerte, Tunisie.
authors.forename: Samia
authors.initials: S
authors.lastname: Hammami
authors.affiliation: 1 LR99ES09 Laboratoire de Recherche "Résistance aux Antimicrobiens," Faculté de Médecine de Tunis, Université de Tunis El Manar , Tunis, Tunisie.
authors.forename: Chaima
authors.initials: C
authors.lastname: Dahdeh
authors.affiliation: 1 LR99ES09 Laboratoire de Recherche "Résistance aux Antimicrobiens," Faculté de Médecine de Tunis, Université de Tunis El Manar , Tunis, Tunisie.
authors.forename: Kelthoum
authors.initials: K
authors.lastname: Mamlouk
authors.affiliation: 1 LR99ES09 Laboratoire de Recherche "Résistance aux Antimicrobiens," Faculté de Médecine de Tunis, Université de Tunis El Manar , Tunis, Tunisie.
authors.forename: Sana
authors.initials: S
authors.lastname: Ferjeni
authors.affiliation: 1 LR99ES09 Laboratoire de Recherche "Résistance aux Antimicrobiens," Faculté de Médecine de Tunis, Université de Tunis El Manar , Tunis, Tunisie.
authors.forename: Elaa
authors.initials: E
authors.lastname: Maamar
authors.affiliation: 1 LR99ES09 Laboratoire de Recherche "Résistance aux Antimicrobiens," Faculté de Médecine de Tunis, Université de Tunis El Manar , Tunis, Tunisie.
authors.forename: Zeineb
authors.initials: Z
authors.lastname: Hamzaoui
authors.affiliation: 1 LR99ES09 Laboratoire de Recherche "Résistance aux Antimicrobiens," Faculté de Médecine de Tunis, Université de Tunis El Manar , Tunis, Tunisie.|3 Laboratoire de Microbiologie, Hôpital Charles Nicolle de Tunis , Tunis, Tunisie.
authors.forename: Mabrouka
authors.initials: M
authors.lastname: Saidani
authors.affiliation: 4 Service de Reanimation Medico-chirurgicale-Hôpital, Charles Nicolle de Tunis , Tunis, Tunisie.
authors.forename: Salma
authors.initials: S
authors.lastname: Ghedira
authors.affiliation: 4 Service de Reanimation Medico-chirurgicale-Hôpital, Charles Nicolle de Tunis , Tunis, Tunisie.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Houissa
authors.affiliation: 1 LR99ES09 Laboratoire de Recherche "Résistance aux Antimicrobiens," Faculté de Médecine de Tunis, Université de Tunis El Manar , Tunis, Tunisie.|3 Laboratoire de Microbiologie, Hôpital Charles Nicolle de Tunis , Tunis, Tunisie.
authors.forename: Amin
authors.initials: A
authors.lastname: Slim
authors.affiliation: 1 LR99ES09 Laboratoire de Recherche "Résistance aux Antimicrobiens," Faculté de Médecine de Tunis, Université de Tunis El Manar , Tunis, Tunisie.|3 Laboratoire de Microbiologie, Hôpital Charles Nicolle de Tunis , Tunis, Tunisie.
authors.forename: Ilhem
authors.initials: I
authors.lastname: Boutiba-Ben Boubaker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000378:metabolism*; D002353:Carrier State / Q000382:microbiology*; D002439:Cefotaxime / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D005243:Feces / Q000382:microbiology*; D005260:Female; D006090:Gram-Negative Bacteria / Q000378:metabolism*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D014416:Tunisia; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C048795:AmpC beta-lactamases; D001618:beta-Lactamases; C063912:carbapenemase; D002439:Cefotaxime
keywords: Gram-negative bacilli; fecal carriage; intensive care unit