Molecular characterization of carbapenemases of clinical - complex isolates from a University Hospital in Tunisia.

The aim of this study was to identify the carbapenemases from clinical carbapenem-resistant complex (CRABC) isolates and to assess their potential dissemination by conjugation and natural transformation. CRABC ( = 101) were collected consecutively from inpatients of the University Hospital of Monastir, Tunisia, from 2013 to 2016. Antimicrobial susceptibility was determined by the disk diffusion method and E-test. Carbapenemase-encoding genes were screened by PCR. Genotyping was performed by Pasteur MLST scheme. Isolates were resistant to all beta-lactams, fluoroquinolones and aminoglycosides while 80 and 90% were susceptible to tigecycline and colistin, respectively. Resistance and intermediate resistance to imipenem were 87 and 13%, respectively. The genes -like, -like, -like, -like, , and were not found. The -like and -like genes were present in 100 and 82.17% isolates, respectively. One isolate (< 1%) carried and -like and belonged to Sequence Type 85 (ST85). Absence of transconjugants suggests a chromosomal location of NDM-1 determinant. The gene was inserted in a truncated form of Tn, which may explain the absence of carrier-transformants. To our knowledge, this is the first report of the finding of NDM-positive in Tunisian territory. The study shows that despite the low prevalence and potential spread of NDM-1 enzyme among CRABC, continuous regional antimicrobial resistance surveillance and improved infection control measures are required in Tunisia to prevent further dissemination.