Surveillance of Multidrug-resistant Bacteria at a Tunisian University Hospital in 2022

The development of antibiotics has significantly reduced mortality from bacterial infections; however, the emergence of antimicrobial-resistant bacteria poses a global threat. In response, an international action plan was launched, and Tunisia has participated by implementing a national program to monitor bacterial resistance to antibiotics. This study aimed to identify multidrug-resistant (MDR) bacteria isolated at Sahloul University Hospital in 2022, determine their prevalence and annual incidence, and describe their epidemiological and microbiological profiles. This cross-sectional study included all bacterial strains isolated from clinical specimens collected from patients at Sahloul University Hospital, Sousse, between January 1 and December 31, 2022. Among 3,207 clinical specimens analyzed, 865 MDR strains were identified, corresponding to an overall prevalence of 27%. Klebsiella pneumoniae and Acinetobacter baumannii accounted for 32.8% and 23.1% of the isolates, respectively. Extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) represented 37.3% of MDR isolates, followed by carbapenem-resistant A. baumannii (CRAB, 23.1%) and carbapenem-resistant Enterobacterales (CRE, 18.6%). The most affected departments were the surgical intensive care unit (22.5%), urology (13.4%), and nephrology (11.9%). MDR strains were mainly isolated from urine (44.2%), blood cultures (13.1%), and protected specimen brush samples (12.1%). Monthly trends showed fluctuations, with ESBL-E ranging from 16 to 37 cases per month and CRAB from 5 to 32 cases per month. Annual incidence rates were 0.67 per 100 admissions for CRAB, 0.47 per 100 admissions for CRE, and 0.26 per 100 admissions for methicillin-resistant Staphylococcus aureus (MRSA). All CRAB strains were resistant to ciprofloxacin, and 95.2% were resistant to gentamicin. Among the 33 CRE isolates tested for colistin susceptibility, 3 were resistant. In our hospital, the main MDR pathogens were ESBL-E, CRAB, and CRE, with the surgical intensive care unit, urology, and nephrology departments being the most affected. These findings highlight the need for urgent and targeted interventions to control the spread of MDR bacteria and strengthen antimicrobial resistance surveillance and infection prevention and control measures.