High burden of Carbapenem-resistant Enterobacterales: A prospective cross-sectional study at a tertiary hospital in Morocco.

Objectives

The present study aimed to determine and update the prevalence of Carbapenem-resistant Enterobacterales, to characterize carbapenemase production, and to assess antimicrobial susceptibility in a Moroccan tertiary hospital. PATIENTS AND

Methods

A prospective cross-sectional study was conducted from January 2021 to December 2022, during which time 6672 Enterobacteriaceae isolates were recovered from clinical specimens from patients with suspected bacterial infections. Species were identified using MALDI-TOF-MS and the BD Phoenix® M50 for antimicrobial susceptibility according to EUCAST screening criteria. NG-Test® CARBA 5 assay was used for carbapenemase detection and characterization.

Results

Among the 6672 Enterobacteriaceae isolates, 1289 showed decreased susceptibility to ertapenem (19.3%). Klebsiella pneumoniae was the predominant species (47.4%), followed by Enterobacter cloacae complex (20.8%). The neonatal intensive care unit was the main reservoir of cases (22.0%). Blood and purulent specimens were the most frequent sources of isolation (62.8% combined). Among the 322 non-duplicate isolates tested, 252 (78.3%) were carbapenemase producers. Antibiotic susceptibility profile displayed high rates of resistance to ciprofloxacin (91.0%), gentamicin (85.1%), and cotrimoxazole (86.6%). NDM (34.8%) and OXA-48-like (30.1%) were the predominant enzymes. NDM and OXA-48-like co-production was observed in 12.1% of isolates. A novel VIM + OXA-48-like combination was detected in an Enterobacter cloacae complex isolate.

Conclusions

This study demonstrates an alarming increase in the proportion of Enterobacterales exhibiting decreased susceptibility to carbapenems, highlighting a need for robust infection prevention measures, rapid diagnostics, and continuous epidemiological surveillance in high-dependency units.