Profile of multidrug-resistant clinical bacterial isolates at the National Hospital of Zinder (NHZ), Niger Republic in 2021

Background: Today, bacterial resistance is a public health challenge throughout the world, and infections caused by resistant bacteria are associated with increased morbidity, mortality and health care costs. The objective of this descriptive study is to determine the prevalence and distribution of multi-drug resistant (MDR) clinical bacteria isolates at the National Hospital of Zinder, Niger Republic in 2021. Methodology: We conducted a descriptive cross-sectional study of in- and out-patients from whose clinical samples' bacteria were isolated at the bacteriology unit of the laboratory. Bacteria were isolated from the clinical samples following standard aerobic cultures and identified using conventional biochemical test schemes. Antibiotic susceptibility testing (AST) was performed by the agar disk diffusion technique, and categorization of the isolates into sensitive, intermediate or resistant was done according to the recommendations of the Antibiogram Committee of the French Society of Microbiology (CA-SFM) 2020 version 1.2. MDR was defined as resistance to at least one antibiotic in three or more categories, while selected MDR bacteria such as ESBL was identified using double disk synergy test, and MRSA by cefoxitin disk diffusion test. Results: Seventy-seven (6.7%) bacterial species were isolated from 1153 clinical samples processed at the bacteriology unit of the hospital laboratory between June and December 2021, of which 65.0% (50/77) were members of the order Enterobacteriales. Escherichia coli represented 40.3% (40/77) of the isolated bacteria, Staphylococcus aureus 13.0% (10/77) and Pseudomonas aeruginosa 11.7% (9/77). The overall prevalence of MDR was 44.2% (34/77), including 61.8% (21/34) ESBL-producing Enterobacteriales (ESBL-E), 26.5% (9/34) multi-resistant P. aeruginosa and 11.7% (4/34) MRSA, with 67.6% (23/34) of the MDR isolates from outpatients. Resistance rates of the Enterobacteriales to ciprofloxacin, gentamicin, amikacin and imipenem were 62.0%, 52.0%, 38.0% and 8.0% respectively. Resistance rates of P. aeruginosa were 100.0%, 88.9%, 77.8%, 33.3%, 22.2%, and 22.2% respectively to ceftazidime, ticarcillin, imipenem, ciprofloxacin, levofloxacin, and amikacin. Resistance rates of S. aureus were 100.0%, 50.0%, 40.0%, 10.0%, 0% and 0% to penicillin G,erythromycin, cefoxitin, tetracycline, fusidic acid, and chloramphenicol respectively. ESBL-E were 47.6%,85.7% and 0% resistant to amikacin, ciprofloxacin and imipenem, and MRSA resistance rates were 75.0%, 75.0%, 50.0% and 0% to erythromycin, tetracycline, gentamicin, and chloramphenicol respectively. Conclusion: This study reports high prevalence of MDR bacteria, mainly ESBL-E, with concerning high resistance to carbapenem. Rational use of antibiotics and implementation of surveillance system for MDR bacteria must be implemented in order to limit the emergence and spread of MDR bacteria in Niger Republic.

First characterisation of plasmid-mediated quinolone resistance-qnrS1 co-expressed bla CTX-M-15 and bla DHA-1 genes in clinical strain of Morganella morganii recovered from a Tunisian Intensive Care Unit.

Purpose: Aim of this study was to show the emergence of the qnr genes among fluoroquinolone-resistant, AMPC and ESBL (extended-spectrum-beta-lactamase) co-producing Morganella morganii isolate. Materials and Methods: A multi resistant Morganella morganii SM12012 isolate was recovered from pus from a patient hospitalized in the intensive care unit at the Military hospital, Tunisia. Antibiotic susceptibility was tested with the agar disk diffusion method according to Clinical and Laboratory Standards Institute guidelines. ESBLs were detected using a standard double-disk synergy test. The characterization of beta-lactamases and associated resistance genes were performed by isoelectric focusing, polymerase chain reaction and nucleotide sequencing. Results: The antimicrobial susceptibility testing showed the high resistance to penicillins, cephalosporins (MICs: 64-512 μg/ml) and fluoroquinolones (MICs: 32-512 μg/ml). But M. morganii SM12012 isolate remained susceptible to carbapenems (MICs: 4-<0.25 μg/ml). The double-disk synergy test confirmed the phenotype of extended-spectrum β-lactamases (ESBLs). Three identical β-lactamases with pI values of 6.5, 7.8 and superior to 8.6 were detected after isoelectric focusing analysis. These β-lactamases genes can be successfully transferred by the conjugative plasmid. Molecular analysis demonstrated the co-production of bla DHA-1, bla CTX-M-15 and qnrS1 genes on the same plasmid. The detection of an associated chromosomal quinolone resistance revealed the presence of a parC mutation at codon 80 (Ser80-lle80). Conclusion: This is the first report in Tunisia of nosocomial infection due to the production of CTX-M-15 and DHA-1 β-lactamases in M. morganii isolate with the association of quinolone plasmid resistance. The incidence of these strains invites continuous monitoring of such multidrug-resistant strains and the further study of their epidemiologic evolution.

First detection of TEM-116 extended-spectrum β-lactamase in a Providencia stuartii isolate from a Tunisian hospital.

Purpose: To study the resistance to third-generation cephalosporins in Providencia stuartii strain isolated from hospitalized patient in Tunisia and to identify the responsible genes Materials and Methods: This strain was analysed by PCR and sequencing to identify the genes responsible for the β-lactamase resistance phenotypes. The transferability of the phenotypes was tested by conjugation to Escherichia coli J53. The isoelectric point was determinate by isoelectrofocalisation. Results: This resistance was carried by a 60 kb plasmid that encoded a β-lactamase with a pI of 5.4. This β-lactamase revealed identity with the blaTEM-1 gene encoding the TEM-1 β-lactamase, except for a replacement of the Val residue at position 84 by Ile, and the Ala residue at position 184 by Val. These two mutations were encountered in TEM-116 β-lactamase. Conclusion: This study demonstrates the first description of TEM-116 in the P. stuartii species in the world and the first one in a Tunisian hospital.

Hepatitis C in fasciolial patients

Seroprevalence of HCV antibodies [anti-HCV] and HBV antigens [HBs Ag] were investigated in 33 patients with proved fascioliasis and 20 normal subjects control. In the whole fasciolial patients, 75.8% and 36.4% showed anti-HCV and Hbs Ag positivity, while in controls they were 15% and 5%, respectively. Mixed infection with HCV and HBV was found in about 30% of fasciolial patients. However, the HCV virus was still present [HCV-RNA antigen] in only about 24% of the whole fasciolial patients and 32% of those having anti-HCV positivity. Thus fasciolial patients showed higher of having viral hepatitis than non fasciolial group. It could be concluded that fasciolial patients are good candidate for HCV rather than HBV infection and there is a high association between fascioliasis and HCV infection which accelerates the dearrangement of liver function and the occurance of complications

effect of chlorpromazine and peserpine on sex hormone level in serum and on liver function tests

The effect of the major tranquilizer [chlorpromazine] and the antihypertensive agent [reserpine] on serum testosterone [TS], follicular stimulating hormone [FS H], leutinizing hormone [LEE] and liver enzymes [AST, ALT] as well as total protein [UP], albumin [ALB] and free amino acids [AA] in male albino rats were investigated. Drug treatment was given s.c. for 30 days after which, animals were sacrificed, the testes from each animal were carefull9 removed and weighed. Both drugs caused a significant reduction in testicular weight. Chlorpromazine resulted in a significant decrease [p<0.01] in the levels of [TS], [FSH] [LEE] and [ALT]. Reserpine resulted in a significant' decrease [p<0.01] in serum