Profil moléculaire et résistance aux antibiotiques des entérobactéries productrices de carbapénèmases chez le brûlé.

ABSTRACT

Carbapenemase-producing Enterobacteriaceae (CPE) pose an emerging threat worldwide. The purpose of our work was to determine their prevalence among patients hospitalized in the Trauma and Burn Centre's Burn Unit, and to study their microbiological and molecular characteristics. Our study was longitudinal, conducted at the Trauma and Burn Centre's laboratory between January and June 2017. It focused on 42 CPE strains isolated from 34 patients. These strains were made up of K. pneumoniae (24), P. mirabilis (13), K. oxytoca (2), P. stuartii (1), E. coli (1), and E. cloacae (1). The overall prevalence of CPE among Enterobacteriaceae was 14.43% with a monthly decline. The blaNMD gene (59%) predominated on blaOXA-48 (33%) and 7% of strains co-expressed these two genes. We describe the first case of P. stuartii carrying blaNDM in Tunisia. Resistance to ertapenem, imipenem and meropenem was 83%, 57%, and 10% respectively. The antibiotics showing the highest resistant rates were third-generation cephalosporins (97%), gentamicin (98%) and norfloxacin (90%). Colistin and fosfomycin had the best-preserved activity in vitro with 4% and 33% resistance, respectively. The prevalence of EPCs is high among burns. Screening efforts, hygiene measures and the preservation of the few molecules still active are a vital issue.