EC Clinical and Medical Case Reports

Carbapenemase producing Enterobacteriaceae are a family of gram-negative bacteria found in the gastrointestinal tract, responsible for the production of carbapenemase enzymes, which render carbapenems and several other classes of antibiotics inactive. The emergence of these bacteria poses a threat to public health, particularly in the hospital environment, given their resistance profile and the significant risk of therapeutic impasse. Indeed, their prevalence among nosocomial infections is significant, and has risen sharply over the last decade.

This is a retrospective study spread over a two-year period, from October 2021 to 2023, carried out in the bacteriology department of the medical biological analysis laboratory at the Hassan II University Hospital in Fez.

This study was carried out on different types of samples received during this period, notably urinary, respiratory, blood samples from blood culture bottles, pus, puncture fluids and catheters.

Each sample was processed in several stages:

• Direct examination.
• Culture for 24 to 48 hours, followed by direct examination with GRAM staining for any cultures that had grown.
• Identification of the bacterial species using the Api 20 E gallery or the bactec BD automated system, in accordance with CASFM/EUCAST recommendations.
• An antibiogram selected and performed according to the bacterial species identified.

In the event of a carbapenem-resistant bacterial profile, screening for carbapenemases is necessary, using a rapid immunochromatography test.

Of the 9205 strains of Enterobacteriaceae identified in the above-mentioned samples, 110 were found to produce carbapenemases, i.e. 1%. This percentage still seems very low in comparison with other studies, which we'll be detailing as we go along.

The most clinically and epidemiologically significant carbapenemases are Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-betalactamase (NDM-1) and Oxacillinase (OXA-48). Several countries not considered endemic have experienced recurrent epidemics of EPCs, which can be exported to neighboring countries. Most carbapenemase-producing Enterobacteriaceae are multiresistant to other antibiotic classes, which limits their therapeutic potential. In practical terms, the antibiotics of choice are colimycin, tigecycline, fosfomycin and a few quinolones. Mortality seems to be even lower when treatment combines two antibiotics to which the strain remains sensitive.

  Keywords: Enterobacteriaceae; Carbapenemases; Resistance; OXA-NDM

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