Evolution of carbapenem-resistant Enterobacterales strains isolated in Dakar
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Introduction: Antibiotic resistance is now one of the most serious threats to global health, food security and development. We have seen an increase in the number of antibiotic-resistant bacteria, especially in hospitals over the last few decades. The objective of this study was to investigate carbapenem-resistant Enterobacteriaceae strains isolated in Senegal. Methodology: In this retrospective study conducted at the Medical Biology Laboratory of the Pasteur Institute of Dakar from January 2017 to December 2019, we describe carbapenem-resistant Enterobacteriaceae (CRE) isolates obtained from 144 patients as part of efforts to monitor and control the emergence of antibiotic-resistant Enterobacteriaceae strains. Data was analyzed using Microsoft Excel 2010 for processing. Results: A total of 144 strains of ertapenem-resistant Enterobacteriaceae were isolated during the study period and number of strains increased considerably from year to year : 26 strains in 2017, 45 in 2018 and 73 in 2019. Most frequently isolated species were E. coli (38%), K. pneumoniae (28.5%) and E. cloacae (25.7%) and majority of samples were urine samples (93% ; n=134). The strains were isolated from patients in the 70-79 and 60-69 age groups, which were most represented with 27.8% and 24.3% respectively. The strains of enterobacteria were all resistant to amoxicillin, amoxicillin-clavulanic acid, ticarcillin, ticarcillin-clavulanic acid, piperacillin, cefalotin, cefuroxime, cefotaxime, ceftazidime and aztreonam, with the exception of the piperacillin-tazobactam and cefoxitin, where 10 strains were sensitive. All strains were resistant to ertapenem, while the rates of resistance to meropenem and imipenem were 91.7% and 68.1% respectively. For fluoroquinolones, almost all strains were resistant to the four compounds tested: nalidixic acid (97.9%), norfloxacin (97.9%), ofloxacin (97.2%) and ciprofloxacin (96.5%). The rate of resistance to tobramycin, gentamicin and amikacin was 79.9%, 54.2% and 18.1% respectively. Amikacin was the most active compound against E. cloacae (86.5%), K. pneumoniae (82.9%), E. coli (78.2%) and C. freundii (75%). Conclusion: This study supports the need to monitor CRE in Senegal and draws attention to the significant increase of ertapenem resistance in Enterobacteriaceae. Future surveillance analysis should include a genetic description of carbapenem resistance to provide new strategies.
