Profil épidémiologique des entérobactéries uropathogènes productrices de bêta-lactamases à spectre élargi

Abstract

Urinary tract infections due to enterobacteria producing extended spectrum beta-lactamases (ESBL-E) constitute a infectious risk, a major therapeutic challenge and can even lead, in some cases, to a deadlock beacuse of their multi-resistance to antibiotics. This study aimed to determine the epidemiological profile of uropathogenic ESBL-E and to describe their current level of resistance to antibiotics for a better patient management according to local data. We conducted a retrospective study of all ESBL-E strains isolated from all cytobacteriogical testing of urine (CBEU) treated in the Microbiology Laboratory at the Military Hospital of Moulay Ismail, Meknes over a period of three years (from 1 January 2013 to 31 December 2015). Culture was performed according to conventional techniques and antibiogram was performed using Mueller-Hinten agar disk diffusion susceptibility test according to the recommendations from the Committee on Antimicrobial Susceptibility of the French Society for Microbiology (CA-SFM), year 2013/2014. This study allowed to report a significant overall prevalence of isolation of ESBL-E (12.2%), particularly among hospitalized patients (54.8%). The greater prevalence (72%) was registered in the Department of Urology. Among these, ESBL-E Escherichia coli constitutes the majority (61%) of the isolates, however Klebsiella pneumoniae is the major ESBL producer (25.8%) within the same species. The analysis of ESBL-E antibioresistance conducted during these three years revealed some co-resistances to ciprofloxacin (92.5%), sulfametoxazole-trimethoprim (88.4%), gentamycin (67.2%). Globally, our results are compliant with the data from the other Mediterranean countries, except for amikacin whose resistance was very low (6.1%) in our study. This study shows that the prevalence of ESBL-E in hospital is high and that its diffusion in community setting is a matter of concern. These ESBL-E are generally resistant to antibiotics, including molecules useful in urology.