Abstract Objectives Carbapenemase-producing Klebsiella pneumoniae (CPKp) represents a major public health threat due to limited treatment options, especially in low- and middle-income countries where colistin often remains the last active antibiotic. Here we investigated clinical carbapenem and colistin-resistant Kp isolates (CCoRKp) from Tunisia between January and June 2023. Materials and methods Kp isolates were identified by MALDI-TOF, broth microdilution susceptibility testing, NG-Test CARBA5 lateral flow immunoassay, Carba NP test, plasmid analysis and by whole-genome sequencing (WGS) for MLST, genetic relatedness and resistome characterization. Results Among the 263 Kp isolates collected, 101 (38.4%) were carbapenem resistant and 34 (12.9%) were carbapenem and colistin resistant. Twelve isolates exhibited an extremely drug-resistant phenotype, with in vitro activity retained only for eravacycline and aztreonam/avibactam, two agents that are currently unavailable for clinical use in Tunisia. Nine out of 10 patients who were treated with broad-spectrum antibiotics, including colistin and imipenem, died. WGS revealed OXA-48 and NDM-5 (12/12), CTX-M-15 (9/12) and the 16SRNA methylase ArmA (11/12) and identified ST 101 (n = 5), ST147 (n = 3) and ST 383 (n = 4), suggesting multi-clonal outbreak. While OXA-48 producing ST101 and ST147 were already present in a 2013 collection, ST383 has never been reported in the hospital nor in Tunisia. Conclusion Here we report double carbapenemase producing and colistin-resistant Kps with limited therapeutic options. Major efforts are needed in infection control and availability of novel molecules in Tunisia to restore safe conditions in hospitals.
Jaidane et al. (Mon,) studied this question.