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Abstract：
BACKGROUND: Infections resulting from multidrug-resistant Enterobacterales (MDR-E) pose a growing global threat, presenting challenges in treatment and contributing significantly to morbidity and mortality rates. The main objective of this study was to characterize phenotypically and genetically extended-spectrum β-lactamase- and carbapenemase- producing Enterobacterales (ESBLE and CPE respectively) isolated from clinical samples in the West Bank, Palestine.
METHODS: A cross sectional study was conducted in October 2023 on clinical bacterial isolates collected from five governmental hospitals in the West Bank, Palestine. The isolates obtained from the microbiology laboratories of the participating hospitals, underwent identification and antibiotic susceptibility testing (AST) using the VITEK® 2 Compact system. ESBL production was determined by the Vitek2 Compact system. A modified carbapenem inactivation method (mCIM) was employed to identify carbapenemase-producing Enterobacterales (CPE). Resistance genes were detected by real-time PCR.
RESULTS: Out of the total 1380 collected isolates, we randomly selected 600 isolates for analysis. Our analysis indicated that 287 (47.83%) were extended-spectrum beta-lactamase producers (ESBLE), and 102 (17%) as carbapenem-resistant Enterobacterales (CRE) isolates. A total of 424 isolates (70.67%) were identified as multidrug-resistant Enterobacterales (MDRE). The most prevalent ESBL species were K. pneumoniae (n = 124; 43.2%), E. coli (n = 119; 41.5%) and E. cloacae (n = 31; 10.8%). Among the CRE isolates, 85 (83.33%) were carbapenemase-producing Enterobacterales (CPE). The most frequent CRE species were K. pneumoniae (n = 63; 61.7%), E. coli (n = 25; 24.5%) and E. cloacae (n = 13; 12.8%). Additionally, 47 (7.83%) isolates exhibited resistance to colistin (CT), with 38 (37.62%) being CT-resistant CRE and 9 (3.14%) being CT-resistant ESBLE while sensitive to carbapenems. We noticed that 11 isolates (6 Klebsiella pneumoniae and 5 Enterobacter cloacae complex) demonstrated sensitivity to carbapenems by phenotype but carried silent CPE genes (1 blaOXA48, and 6 blaNDM, 4 blaOXA48, blaNDM). ESBL-producing Enterobacterales strains exhibited varied resistance patterns across different antibiotic classes. E. coli isolates showed notable 48% resistance to trimethoprim/sulfamethoxazole. K. pneumoniae isolates displayed a significant resistance to trimethoprim/sulfamethoxazole, nitrofurantoin, and fosfomycin (54%, 90%, and 70% respectively). E. cloacae isolates showed complete resistance to nitrofurantoin and fosfomycin. P. mirabilis isolates exhibited high resistance against fluoroquinolones (83%), and complete resistance to trimethoprim/sulfamethoxazole, nitrofurantoin and fosfomycin.
CONCLUSIONS: This study showed the high burden of the ESBLE and CRE among the samples collected from the participating hospitals. The most common species were K. pneumoniae and E. coli. There was a high prevalence of blaCTXm. Adopting both conventional and molecular techniques is essential for better surveillance of the emergence and spread of antimicrobial-resistant Enterobacterales infections in Palestine.
METHODS: A cross sectional study was conducted in October 2023 on clinical bacterial isolates collected from five governmental hospitals in the West Bank, Palestine. The isolates obtained from the microbiology laboratories of the participating hospitals, underwent identification and antibiotic susceptibility testing (AST) using the VITEK® 2 Compact system. ESBL production was determined by the Vitek2 Compact system. A modified carbapenem inactivation method (mCIM) was employed to identify carbapenemase-producing Enterobacterales (CPE). Resistance genes were detected by real-time PCR.
RESULTS: Out of the total 1380 collected isolates, we randomly selected 600 isolates for analysis. Our analysis indicated that 287 (47.83%) were extended-spectrum beta-lactamase producers (ESBLE), and 102 (17%) as carbapenem-resistant Enterobacterales (CRE) isolates. A total of 424 isolates (70.67%) were identified as multidrug-resistant Enterobacterales (MDRE). The most prevalent ESBL species were K. pneumoniae (n = 124; 43.2%), E. coli (n = 119; 41.5%) and E. cloacae (n = 31; 10.8%). Among the CRE isolates, 85 (83.33%) were carbapenemase-producing Enterobacterales (CPE). The most frequent CRE species were K. pneumoniae (n = 63; 61.7%), E. coli (n = 25; 24.5%) and E. cloacae (n = 13; 12.8%). Additionally, 47 (7.83%) isolates exhibited resistance to colistin (CT), with 38 (37.62%) being CT-resistant CRE and 9 (3.14%) being CT-resistant ESBLE while sensitive to carbapenems. We noticed that 11 isolates (6 Klebsiella pneumoniae and 5 Enterobacter cloacae complex) demonstrated sensitivity to carbapenems by phenotype but carried silent CPE genes (1 blaOXA48, and 6 blaNDM, 4 blaOXA48, blaNDM). ESBL-producing Enterobacterales strains exhibited varied resistance patterns across different antibiotic classes. E. coli isolates showed notable 48% resistance to trimethoprim/sulfamethoxazole. K. pneumoniae isolates displayed a significant resistance to trimethoprim/sulfamethoxazole, nitrofurantoin, and fosfomycin (54%, 90%, and 70% respectively). E. cloacae isolates showed complete resistance to nitrofurantoin and fosfomycin. P. mirabilis isolates exhibited high resistance against fluoroquinolones (83%), and complete resistance to trimethoprim/sulfamethoxazole, nitrofurantoin and fosfomycin.
CONCLUSIONS: This study showed the high burden of the ESBLE and CRE among the samples collected from the participating hospitals. The most common species were K. pneumoniae and E. coli. There was a high prevalence of blaCTXm. Adopting both conventional and molecular techniques is essential for better surveillance of the emergence and spread of antimicrobial-resistant Enterobacterales infections in Palestine.
摘要：
背景：多重耐药肠杆菌（MDR-E）引起的感染构成了日益严重的全球威胁，在治疗方面面临挑战，并显著增加发病率和死亡率。这项研究的主要目的是表征从西岸临床样品中分离出的表型和遗传超广谱β-内酰胺酶和碳青霉烯酶肠杆菌（分别为ESBLE和CPE），巴勒斯坦。
方法：2023年10月对从西岸五家政府医院收集的临床细菌分离株进行了横断面研究，巴勒斯坦。从参与医院的微生物实验室获得的分离株，使用VITEK®2Compact系统进行鉴定和抗生素药敏试验(AST)。ESBL产量由Vitek2Compact系统确定。采用改良的碳青霉烯类灭活方法（mCIM）鉴定产生碳青霉烯酶的肠杆菌（CPE）。通过实时PCR检测抗性基因。
结果：在总共收集的1380个分离株中，我们随机选取了600个分离株进行分析.我们的分析表明，287(47.83%)是超广谱β-内酰胺酶生产者(ESBLE)，和102（17％）为耐碳青霉烯类肠杆菌（CRE）分离株。共有424株（70.67％）被鉴定为耐多药肠杆菌（MDRE）。最普遍的ESBL物种是肺炎克雷伯菌（n=124；43.2％），大肠杆菌(n=119;41.5%)和阴沟肠杆菌(n=31;10.8%)。在CRE分离株中，85（83.33％）是产生碳青霉烯酶的肠杆菌（CPE）。最常见的CRE物种是肺炎克雷伯菌(n=63；61.7%)，大肠杆菌(n=25;24.5%)和阴沟肠杆菌(n=13;12.8%)。此外,47株(7.83%)对粘菌素(CT)表现出耐药性，38例（37.62％）对CT耐药的CRE和9例（3.14％）对CT耐药的ESBLE，但对碳青霉烯类敏感。我们注意到11个分离株（6个肺炎克雷伯菌和5个阴沟肠杆菌复合体）通过表型表现出对碳青霉烯类抗生素的敏感性，但携带沉默的CPE基因（1个blaOXA48和6个blaNDM，4blaOXA48，blaNDM）。产ESBL的肠杆菌菌株在不同的抗生素类别中表现出不同的抗性模式。大肠杆菌分离株对甲氧苄啶/磺胺甲恶唑的耐药性为48％。肺炎克雷伯菌分离株对甲氧苄啶/磺胺甲恶唑表现出显著的耐药性，呋喃妥因,和磷霉素(54%，90%,分别为70%)。阴沟肠球菌分离株对呋喃妥因和磷霉素表现出完全抗性。奇异假单胞菌分离株对氟喹诺酮类药物表现出高抗性(83%)，对甲氧苄啶/磺胺甲恶唑完全耐药，呋喃妥因和磷霉素.
结论：这项研究表明，在从参与医院收集的样本中，ESBLE和CRE的负担很高。最常见的物种是肺炎克雷伯菌和大肠杆菌。blaCTXm的患病率很高。采用常规和分子技术对于更好地监测巴勒斯坦耐药肠杆菌感染的出现和传播至关重要。
方法：2023年10月对从西岸五家政府医院收集的临床细菌分离株进行了横断面研究，巴勒斯坦。从参与医院的微生物实验室获得的分离株，使用VITEK®2Compact系统进行鉴定和抗生素药敏试验(AST)。ESBL产量由Vitek2Compact系统确定。采用改良的碳青霉烯类灭活方法（mCIM）鉴定产生碳青霉烯酶的肠杆菌（CPE）。通过实时PCR检测抗性基因。
结果：在总共收集的1380个分离株中，我们随机选取了600个分离株进行分析.我们的分析表明，287(47.83%)是超广谱β-内酰胺酶生产者(ESBLE)，和102（17％）为耐碳青霉烯类肠杆菌（CRE）分离株。共有424株（70.67％）被鉴定为耐多药肠杆菌（MDRE）。最普遍的ESBL物种是肺炎克雷伯菌（n=124；43.2％），大肠杆菌(n=119;41.5%)和阴沟肠杆菌(n=31;10.8%)。在CRE分离株中，85（83.33％）是产生碳青霉烯酶的肠杆菌（CPE）。最常见的CRE物种是肺炎克雷伯菌(n=63；61.7%)，大肠杆菌(n=25;24.5%)和阴沟肠杆菌(n=13;12.8%)。此外,47株(7.83%)对粘菌素(CT)表现出耐药性，38例（37.62％）对CT耐药的CRE和9例（3.14％）对CT耐药的ESBLE，但对碳青霉烯类敏感。我们注意到11个分离株（6个肺炎克雷伯菌和5个阴沟肠杆菌复合体）通过表型表现出对碳青霉烯类抗生素的敏感性，但携带沉默的CPE基因（1个blaOXA48和6个blaNDM，4blaOXA48，blaNDM）。产ESBL的肠杆菌菌株在不同的抗生素类别中表现出不同的抗性模式。大肠杆菌分离株对甲氧苄啶/磺胺甲恶唑的耐药性为48％。肺炎克雷伯菌分离株对甲氧苄啶/磺胺甲恶唑表现出显著的耐药性，呋喃妥因,和磷霉素(54%，90%,分别为70%)。阴沟肠球菌分离株对呋喃妥因和磷霉素表现出完全抗性。奇异假单胞菌分离株对氟喹诺酮类药物表现出高抗性(83%)，对甲氧苄啶/磺胺甲恶唑完全耐药，呋喃妥因和磷霉素.
结论：这项研究表明，在从参与医院收集的样本中，ESBLE和CRE的负担很高。最常见的物种是肺炎克雷伯菌和大肠杆菌。blaCTXm的患病率很高。采用常规和分子技术对于更好地监测巴勒斯坦耐药肠杆菌感染的出现和传播至关重要。
