RESUMO
The spread of carbapenemase-producing Enterobacteriaceae in the Southwest Indian Ocean islands is poorly known. Here we describe an outbreak of colistin-resistant Enterobacter cloacae harbouring blaIMI-1 in the French overseas department of Mayotte. Between October 2015 and January 2017, all isolates of imipenem-non-susceptible E. cloacae at Mayotte Medical Center and University Hospital of Reunion Island were screened for carbapenemase production. Positive isolates were typed by pulsed-field gel electrophoresis and whole-genome sequencing (WGS)-based multilocus sequence typing (MLST), and all ß-lactamase genes were identified by PCR and sequencing. Resistance profiles were determined by agar diffusion and Etest. Genetic support of the blaIMI-1 gene was determined by WGS. A total of 18 E. cloacae isolates harbouring blaIMI-1 were detected in 17 patients from Mayotte. Pulsed-field gel electrophoresis (PFGE) analysis showed 16 of the 18 strains to be clonally related and belonging to ST820. Based on clinical data, this outbreak most likely had a community origin. The blaIMI-1 gene in the 18 isolates was carried by a new variant of an integrative mobile element involving the Xer recombinases, called EcloIMEX-8. The mcr-1-mcr-5 genes were absent from the collection. The isolates belonged to E. cloacae cluster XI, known to be colistin heteroresistant. Here we report the first outbreak of IMI-1-producing Enterobacteriaceae. IMI-1-producers may be underdetected in microbiology laboratories because of their unusual antimicrobial resistance profile (resistant to imipenem but with intermediate resistance to ertapenem and susceptible to extended-spectrum cephalosporins) and the absence of blaIMI-1 in the panel of genes targeted by molecular diagnostic kits.
Assuntos
Proteínas de Bactérias/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Enterobacter cloacae/efeitos dos fármacos , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , beta-Lactamases/genética , Adolescente , Adulto , Antibacterianos/farmacologia , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Carbapenêmicos/farmacologia , Cefalosporinas/farmacologia , Colistina/farmacologia , Comores/epidemiologia , Surtos de Doenças , Eletroforese em Gel de Campo Pulsado , Enterobacter cloacae/genética , Ertapenem/farmacologia , Feminino , Genoma Bacteriano/genética , Humanos , Imipenem/farmacologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Adulto JovemRESUMO
Epidemiology of diphtheria in the southwestern Indian Ocean is poorly documented. We analyzed 14 cases of infection with toxigenic Corynebacterium diphtheriae reported during 2007-2015 in Mayotte, a French department located in this region. Local control of diphtheria is needed to minimize the risk for importation of the bacterium into disease-free areas.
Assuntos
Corynebacterium diphtheriae , Difteria/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Comores/epidemiologia , Corynebacterium diphtheriae/isolamento & purificação , Difteria/história , Difteria/transmissão , Feminino , História do Século XXI , Humanos , Lactente , Masculino , Adulto JovemRESUMO
Although skin infections are common in tropical countries, there is scant data quantifying the relationship with climate conditions. The aim of this study was to assess the incidence and seasonality of skin abscess in Mayotte, Comoros. We collected data on patients with cutaneous abscesses requiring surgical drainage from January 2009 to December 2010. A total of 3423 abscesses were recorded. The overall annualized incidence was 785 cases per 100,000 population (95% confidence interval 754-814). The incidence rate peaked in children and abscesses were highest during the rainy season (964 cases per 100,000 population per 6 months). A greater frequency of insects bites, a lower level of sensitization and lack of access to adequate hygiene are potential explanations for these findings. A community-based intervention strategy should target vulnerable children in order to combat this disease.
