Epidemiology of carbapenem-resistant Enterobacteriaceae in a Moroccan hospital from 2017 to 2022

Abstract

Background: Carbapenem-resistant Enterobacteriaceae is a growing global health concern, contributing to millions of deaths annually. The widespread use of carbapenems has led to the emergence of carbapenem-resistant organisms, posing significant challenges in healthcare settings worldwide. Our study aimed to determine the prevalence and progression of carbapenem-resistant Enterobacteriaceae in Moroccan hospital. Methods: We conducted a retrospective study over a six-year period (2017-2022) at the Mohammed V Military Hospital in Morocco. Enterobacteriaceae isolates from various clinical specimens were identified using standard microbiological methods. Antimicrobial susceptibility testing, employing a range of antibiotics recommended by the committee on Antimicrobial Susceptibility Testing of the French Society for Microbiology (CASFM). The production of Extended Spectrum Beta-Lactamases (ESBL) was evaluated using the double disk synergy test. Results: Out of the 20921 Enterobacteriaceae, carbapenems resistance was observed in 9%. The majority of CRE instances were attributed to K. pneumoniae (47.1%), followed by E. cloacae (22.5%) and E. coli (17.6%). The most frequently encountered types of specimens were urine (59.8%) and wound (15.3%), while blood accounted for only 8.5% of CRE isolates. The CRE isolates demonstrated multi-drug resistance, showing resistance to a majority of antibiotics, notably Ciprofloxacin (78%), Trimethoprim/sulfamethoxazole (69%), and Gentamicin (63%). Among all CRE isolates, 32.5% were expressing the ESBL phenotype. Conclusion: This study underscores the urgent need for surveillance and intervention strategies to curb the escalating rates of carbapenem-resistant Enterobacteriaceae. The findings provide valuable insights into the resistance landscape, informing clinical approaches and guiding future research aimed at combating this critical threat to global health.