Evaluation of susceptibility to colistin, fosfomycin and mecillinam in carbapenemase-producing Enterobacterales isolated in Marrakech in 2023
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Abstract
Background and Objectives: Carbapenemase-producing Enterobacterales (CPE) constitute a critical public health concern due to multidrug resistance and limited available treatment options. This study aimed to assess the in vitro susceptibility of CPE isolates to colistin, fosfomycin, and mecillinam.
Materials and Methods: Prospective study was conducted in 2023 at Mohammed VI University Hospital, Marrakech. A total sample of 180 non-duplicate CPE isolates were collected and identified by standard microbiological methods. Antimicrobial susceptibility testing was performed following recommended guidelines.
Results: Among the isolates, Klebsiella pneumoniae (60%) and Escherichia coli (14%) predominated. The most common carbapenemase was NDM (62%), followed by OXA-48 (26%) and co-producers (11%). Most isolates were obtained from intensive care (32%), plastic surgery (13%), and neonatology (12%) units. Skin and soft tissue (43%) and bloodstream (21%) were the predominant infected sites. Resistance rates were 25% for colistin, 48% for fosfomycin, and 64% for mecillinam, with frequent co-resistance to fluoroquinolones, aminoglycosides, and cotrimoxazole.
Conclusion: The high prevalence of NDM-producing Klebsiella pneumoniae and significant resistance to last-line agents suggest the urgent need for antimicrobial stewardship, optimized therapeutic strategies, and strengthened regional surveillance.
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13. Guo CH, Liu YQ, Li Y, Duan XX, Yang TY, Li FY, et al. High prevalence and genomic characteristics of carbapenem-resistant Enterobacteriaceae and colistin-resistant Enterobacteriaceae from large-scale rivers in China. Environ Pollut 2023; 331: 121869.
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15. Mashaly GE, Mashaly ME. Colistin-heteroresistance in carbapenemase-producing Enterobacter species causing hospital-acquired infections among Egyptian patients. J Glob Antimicrob Resist 2021; 24: 108-113.
16. Shrief R, El-Ashry AH, Mahmoud R, El-Mahdy R. Effect of colistin, fosfomycin and meropenem/vaborbactam on carbapenem-resistant Enterobacterales in Egypt: a cross-sectional study. Infect Drug Resist 2022; 15: 6203-6214.
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19. Perez-Palacios P, Girlich D, Soraa N, Lamrani A, Maoulainine FMR, Bennaoui F, et al. Multidrug-resistant Enterobacterales responsible for septicaemia in a neonatal intensive care unit in Morocco. J Glob Antimicrob Resist 2023; 33: 208-217.
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22. Anton-Vazquez V, Evans TJ, Fernando S, Somasunderam D, David K, Melzer M, et al. Clinical, microbiological characteristics and predictors of mortality in patients with carbapenemase-producing Enterobacterales bloodstream infections: a multicentre study. Infect Prev Pract 2023; 5: 100298.
23. Lee KH, Kim D, Hong JS, Park SY, Cho NH, Kim MN, et al. Prevalence of carbapenemase producing Enterobacterales colonization and risk factor of clinical infection. J Infect Public Health 2023; 16: 1860-1869.
24. Sanz Herrero F. Ceftazidime-avibactam. Rev Esp Quimioter 2022; 35(Suppl 1): 40-42.
2. Tompkins K, van Duin D. Treatment for carbapenem-resistant Enterobacterales infections: recent advances and future directions. Eur J Clin Microbiol Infect Dis 2021; 40: 2053-2068.
3. Zeb S, Nazir A, Hameed MF, Ikram S, Haider Naqvi SZ, Shoaib M, et al. Colistin resistance in Gram-negative bacteria: mechanisms, transmission, and novel intervention strategies. Microorganisms 2026; 14: 173.
4. Barber-Axthelm IM, Kent SJ, Juno JA. Understanding the role of mucosal-associated invariant T-cells in non-human primate models of HIV infection. Front Immunol 2020; 11: 2038.
5. Dilagui I, Loqman S, Lamrani Hanchi A, Soraa N. Antibiotic resistance patterns of carbapenemase-producing Enterobacterales in Mohammed VI University Hospital of Marrakech, Morocco. Infect Dis Now 2022; 52: 334-340.
6. Loqman S, Soraa N, Diene SM, Rolain JM. Dissemination of carbapenemases (OXA-48, NDM and VIM) producing Enterobacteriaceae isolated from the Mohammed VI University Hospital in Marrakech, Morocco. Antibiotics (Basel) 2021; 10: 492.
7. El Wartiti MA, Bahmani FZ, Zouhdi M, Benouda A. Prevalence of carbapenemase-producing Enterobacteriaceae in a university hospital in Rabat, Morocco: a 19-months prospective study. Open J Med Microbiol 2012; 2: 248-252.
8. O’Connell NH, Gasior S, Slevin B, Power L, Barrett S, Bhutta SI, et al. Microbial epidemiology and clinical risk factors of carbapenemase-producing Enterobacterales amongst Irish patients from first detection in 2009 until 2020. Infect Prev Pract 2022; 4: 100230.
9. Maamar B, Messadi AA, Thabet L. Carbapenemase-producing Enterobacteriaceae in burns: phenotypic and molecular study. Ann Burns Fire Disasters 2019; 32: 203.
10. Zhang R, Liu L, Zhou H, Chan EW, Li J, Fang Y, et al. Nationwide surveillance of clinical carbapenem-resistant Enterobacteriaceae (CRE) strains in China. EBioMedicine 2017; 19: 98-106.
11. Shibabaw A, Sahle Z, Metaferia Y, Atlaw A, Adenew B, Gedefie A, et al. Epidemiology and prevention of hospital-acquired carbapenem-resistant Enterobacterales infection in hospitalized patients, Northeast Ethiopia. IJID Reg 2023; 7: 77-83.
12. Liu YC, Lu CY, Yen TY, Chang LY, Chen JM, Lee PI, et al. Clinical characteristics and outcomes of carbapenem-resistant Enterobacterales bacteremia in pediatric patients. J Microbiol Immunol Infect 2023; 56: 84-92.
13. Guo CH, Liu YQ, Li Y, Duan XX, Yang TY, Li FY, et al. High prevalence and genomic characteristics of carbapenem-resistant Enterobacteriaceae and colistin-resistant Enterobacteriaceae from large-scale rivers in China. Environ Pollut 2023; 331: 121869.
14. Livermore DM, Warner M, Mushtaq S, Doumith M, Zhang J, Woodford N. What remains against carbapenem-resistant Enterobacteriaceae? Evaluation of chloramphenicol, ciprofloxacin, colistin, fosfomycin, minocycline, nitrofurantoin, temocillin and tigecycline. Int J Antimicrob Agents 2011;37: 415-419.
15. Mashaly GE, Mashaly ME. Colistin-heteroresistance in carbapenemase-producing Enterobacter species causing hospital-acquired infections among Egyptian patients. J Glob Antimicrob Resist 2021; 24: 108-113.
16. Shrief R, El-Ashry AH, Mahmoud R, El-Mahdy R. Effect of colistin, fosfomycin and meropenem/vaborbactam on carbapenem-resistant Enterobacterales in Egypt: a cross-sectional study. Infect Drug Resist 2022; 15: 6203-6214.
17. Fuchs F, Ahmadzada A, Plambeck L, Wille T, Hamprecht A. Susceptibility of clinical Enterobacterales isolates with common and rare carbapenemases to mecillinam. Front Microbiol 2021; 11: 627267.
18. Emeraud C, Godmer A, Girlich D, Vanparis O, Mahamdi F, Creton E, et al. Activity of mecillinam against carbapenem-resistant Enterobacterales. J Antimicrob Chemother 2022;77: 2835-2839.
19. Perez-Palacios P, Girlich D, Soraa N, Lamrani A, Maoulainine FMR, Bennaoui F, et al. Multidrug-resistant Enterobacterales responsible for septicaemia in a neonatal intensive care unit in Morocco. J Glob Antimicrob Resist 2023; 33: 208-217.
20. Zykov IN, Frimodt-Møller N, Småbrekke L, Sundsfjord A, Samuelsen Ø. Efficacy of mecillinam against clinical multidrug-resistant Escherichia coli in a murine urinary tract infection model. Int J Antimicrob Agents 2020; 55:105851.
21. Felgueiras M, Alves V. Mecillinam: a possible alternative option for non-complicated urinary tract infections treatment caused by Enterobacterales. Acta Med Port 2023; 36: 607-608.
22. Anton-Vazquez V, Evans TJ, Fernando S, Somasunderam D, David K, Melzer M, et al. Clinical, microbiological characteristics and predictors of mortality in patients with carbapenemase-producing Enterobacterales bloodstream infections: a multicentre study. Infect Prev Pract 2023; 5: 100298.
23. Lee KH, Kim D, Hong JS, Park SY, Cho NH, Kim MN, et al. Prevalence of carbapenemase producing Enterobacterales colonization and risk factor of clinical infection. J Infect Public Health 2023; 16: 1860-1869.
24. Sanz Herrero F. Ceftazidime-avibactam. Rev Esp Quimioter 2022; 35(Suppl 1): 40-42.
| Files | ||
| Issue | Vol 18 No 3 (2026) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v18i3.21657 | |
| Keywords | ||
| Enterobacterales Carbapenem-resistant Enterobacterales Drug resistance Bacterial Colistin Fosfomycin | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Nordine W, Ame A, Benhoumich T, Lamrani Hanchi A, Soraa N. Evaluation of susceptibility to colistin, fosfomycin and mecillinam in carbapenemase-producing Enterobacterales isolated in Marrakech in 2023. Iran J Microbiol. 2026;18(3):332-337.
