,
Sameh Boughattas,
Lamia Tilouche,
Soumaya Ketata,
Yomna Ben Lamine,
Abdelhalim Trabelsi
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.
| Published in | Biomedical Sciences (Volume 12, Issue 3) |
| DOI | 10.11648/j.bs.20261203.12 |
| Page(s) | 58-79 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2026. Published by Science Publishing Group |
Multidrug-resistant Bacteria, Epidemiology, Microbiology, Prevalence, Surveillance
Germe | N MDR | % of total MDR isolates | Total N of bacterial species | % of isolates within the bacterial species |
|---|---|---|---|---|
Klebsiella pneumoniae | 284 | 32,8 | 668 | 42,5% |
Acinetobacter baumannii | 200 | 23,1 | 236 | 84,7% |
Escherichia coli | 177 | 20,5 | 1228 | 14,4% |
Staphylococcus aureus | 82 | 9,5 | 416 | 19,7% |
Enterobacter cloacae | 47 | 5,4 | 195 | 24,1% |
Pseudomonas aeruginosa | 43 | 5,0 | 308 | 14,0% |
Proteus mirabilis | 21 | 2,4 | 111 | 18,9% |
Enterococcus faecium | 11 | 1,3 | 45 | 24,4% |
Total | 865 | 100,0 | 3027 | - |
Phenotype | N | % |
|---|---|---|
ESBL-E | 323 | 37,3 |
CRAB | 200 | 23,1 |
CRE | 161 | 18,6 |
MRSA | 80 | 9,2 |
3GCRE | 45 | 5,2 |
CRPA/IR | 25 | 2,9 |
CRPA | 18 | 2,1 |
GRE | 11 | 1,3 |
GRSA | 2 | 0,2 |
Total | 865 | 100 |
Enterobacterales | ESBL-E N (%) | 3GCRE N (%) | CRE N (%) | Total |
|---|---|---|---|---|
Klebsiella pneumoniae | 154(47,7) | 15(33,3) | 115(71,4) | 284 |
Escherichia coli | 159 (49,2) | 12 (26,7) | 6 (3,7) | 177 |
Proteus mirabilis | 5 (1,5) | 1 (2,2) | 15 (9,3) | 21 |
Enterobacter cloacae | 5 (1,5) | 17 (37,8) | 25 (15,5) | 47 |
Total | 323 | 45 | 161 | 529 |
Department | N | % | ||
|---|---|---|---|---|
Surgical Intensive Care | Surgical Intensive Care Unit | 119 | 13,8 | 22,5 |
POG | 73 | 8,4 | ||
Anesthesia Outpatient Consultations | 3 | 0,3 | ||
Urology | Urology Inpatients | 49 | 5,7 | 13,4 |
Urology Outpatient Consultations | 67 | 7,7 | ||
Nephrology | Nephrology Inpatients | 50 | 5,8 | 11,9 |
Nephrology Outpatient Consultations | 48 | 5,5 | ||
DPC-Unit | 4 | 0,5 | ||
HD- Unit | 1 | 0,1 | ||
CVTS | CVTS Inpatients | 36 | 4,2 | 9,3 |
Post-Pediatric CVTS | 30 | 3,5 | ||
Post-Operative CVTS | 14 | 1,6 | ||
Orthopedics | 75 | 8,7 | ||
General Surgery | 55 | 6,4 | ||
Emergency Department | Emergency Admissions | 44 | 5,1 | 6,0 |
Emergency Outpatient Consultations | 8 | 0,1 | ||
Pediatrics | Pediatric Inpatients | 40 | 4,6 | 5,4 |
Pediatric Outpatient Consultations | 1 | 0,1 | ||
Pediatric Emergency | 6 | 0,7 | ||
Neurosurgery | 23 | 2,7 | ||
Physical Medicine | 19 | 2,2 | ||
Medical Intensive Care Unit | 18 | 2,1 | ||
Others | 82 | 9,4 | ||
Total | 865 | 100,0 | ||
Department | ESBL-E | 3GCRE | CRE | CRPA | CRPA/IR | CRAB | GRSA | MRSA | GRE | Total |
|---|---|---|---|---|---|---|---|---|---|---|
Medical Departments: n (%) | 98(30,3) | 14(31,1) | 17(10,6) | 3(16,7) | 5(20) | 14(7) | 0 | 19(23,7) | 2(18,2) | 172(19,9) |
Surgical Departments: n (%) | 83(25,7) | 12(26,7) | 41(25,5) | 8(44,4) | 12(48) | 43(21,5) | 1(50) | 51(63,7) | 5(45,5) | 256(29,6) |
ntensive Care Units: n (%) | 28(8,7) | 3(6,7) | 72(44,7) | 3(16,7) | 8(32) | 130(65) | 0 | 6(7,5) | 4(36,4) | 254(29,4) |
Outpatient Departments: n (%) | 79(24,5) | 12(26,7) | 24(14,9) | 1(5,6) | 0 | 9(4,5) | 0 | 0 | 0 | 125(14,5) |
Emergency Departments (Adult + Pediatric): n (%) | 35(10,8) | 4(8,9) | 7(4,3) | 3(16,7) | 0 | 4(2) | 1(50) | 4(5) | 0 | 58(6,7) |
Total: n (%) | 323(100) | 45(100) | 161(100) | 18(100) | 25(100) | 200(100) | 2(100) | 80(100) | 11(100) | 865(100) |
Service | ESBL-E | 3GCRE | CRE | CRPA | CRPA/IR | CRAB | GRSA | MRSA | GRE | Total |
|---|---|---|---|---|---|---|---|---|---|---|
Surgical Intensive Care: n (%) | 16(8,4) | 3(1,5) | 61(32,1) | 3(1,5) | 5(2,6) | 97(51) | 0 | 6(3,1) | 4(2,1) | 190(100) |
POG: n (%) | 7(9,6) | 0 | 26(35,6) | 1(1,4) | 2(2,7) | 37(50,7) | 0 | 0 | 0 | 73(100) |
Surgical Intensive Care Unit: n (%) | 9(7,6) | 2(1,7) | 33(27,7) | 2(1,7) | 3(2,5) | 60(50,4) | 0 | 6(5) | 4(3,4) | 119(100) |
Anesthesia Outpatient Consultations: n (%) | 0 | 1(33,3) | 2(66,7) | 0 | 0 | 0 | 0 | 0 | 0 | 3(100) |
Urology: n (%) | 67(57,7) | 10(8,6) | 21(18,1) | 2(1,7) | 0 | 14(12) | 0 | 1(0,8) | 1(0,8) | 116(100) |
Nephrology Outpatient Consultations: n (%) | 43(64,2) | 7(10,4) | 10(14,9) | 0 | 0 | 7(10,4) | 0 | 0 | 0 | 67(100) |
Urology Inpatients: n (%) | 24(49) | 3(6,1) | 11(22,4) | 2(4,1) | 0 | 7(14,3) | 0 | 1(2) | 1(2) | 49(100) |
Nephrology: n (%) | 65(61,9) | 10(9,5) | 19(18) | 1(0,95) | 0 | 7(6,66) | 0 | 3(2,85) | 0 | 105(100) |
Nephrology Outpatient Consultations: n (%) | 32(66,7) | 3(6,3) | 12(25) | 0 | 0 | 1(2,1) | 0 | 0 | 0 | 48(100) |
Nephrology Inpatients: n (%) | 30(60) | 5(10) | 7(14) | 1(2) | 0 | 6(12) | 0 | 1(2) | 0 | 50(100) |
DPC-Unit: n (%) | 2(50) | 0 | 0 | 0 | 0 | 0 | 0 | 2(50) | 0 | 4(100) |
HD- Unit: n (%) | 1(100) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1(100) |
CVTS (total): n (%) | 14(17,5) | 2(2,5) | 18(22,5) | 0 | 8(10) | 36(45) | 0 | 2(2,5) | 0 | 80(100) |
CVTS Inpatients: n (%) | 5(13,9) | 1(2,8) | 6(16,7) | 0 | 5(13,9) | 17(47,2) | 0 | 2(5,6) | 0 | 36(100) |
Post-Operative CVTS : n (%) | 1(7,1) | 0 | 3(21,4) | 0 | 1(7,1) | 9(64,3) | 0 | 0 | 0 | 14(100) |
Post-Pediatric CVTS: n (%) | 8(26,7) | 1(3,3) | 9(30) | 0 | 2(6,7) | 10(33,3) | 0 | 0 | 0 | 30(100) |
Orthopedics: n (%) | 17(22,7) | 2(2,7) | 11(14,7) | 2(2,7) | 3(4) | 9(12) | 0 | 31(41,3) | 0 | 75(100) |
General Surgery: n (%) | 27(49,1) | 3(5,5) | 8(14,5) | 1(1,8) | 1(1,8) | 4(7,3) | 1(1,8) | 6(10,9) | 4(7,3) | 55(100) |
Emergency Department : n (%) | 31(59,6) | 3(5,8) | 7(13,4) | 3(5,8) | 0 | 4(7,6) | 1(2) | 3(5,8) | 0 | 52(100) |
Emergency Admissions: n (%) | 27(61,4) | 3(6,8) | 5(11,4) | 2(4,5) | 0 | 3(6,8) | 1(2,3) | 3(6,8) | 0 | 44(100) |
Emergency Outpatient Consultations: n (%) | 4(50) | 0 | 2(25) | 1(12,5) | 0 | 1(12,5) | 0 | 0 | 0 | 8(100) |
Pediatrics: n (%) | 31(66) | 3(6,3) | 2(4,2) | 0 | 0 | 1(2,2) | 0 | 9(19,1) | 1(2,2) | 47(100) |
Pediatric Emergency: n (%) | 4(66,7) | 1(16,7) | 0 | 0 | 0 | 0 | 0 | 1(16,7) | 0 | 6(100) |
Pediatric Inpatients: n (%) | 26(65) | 2(5) | 2(5) | 0 | 0 | 1(2,5) | 0 | 8(20) | 1(2,5) | 40(100) |
Pediatric Outpatient Consultations: n (%) | 1(100) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1(100) |
Neurosurgery: n (%) | 9(39,1) | 2(8,7) | 4(17,4) | 0 | 1(4,3) | 4(17,4) | 0 | 3(13) | 0 | 23(100) |
Physical Medicine: n (%) | 4 (21,1) | 2(10,5) | 3(15,8) | 2(10,5) | 2(10,5) | 4(21,1) | 0 | 2(10,5) | 0 | 19(100) |
Medical Intensive Care Unit: n (%) | 3(16,7) | 0 | 1(5,6) | 0 | 0 | 14(77,8) | 0 | 0 | 0 | 18(100) |
Others*: n (%) | 40(48,7) | 5(6) | 6(7,3) | 4(4,9) | 5(6) | 6(7,3) | 0 | 15(18,2) | 1(1,2) | 82(100) |
Total | 323(37,3) | 45(5,2) | 161(18,6) | 18(2) | 25(2,9) | 200(23,1) | 2(0,2) | 80(9,2) | 11(1,3) | 865(100) |
Sample | N | % |
|---|---|---|
Urine | 382 | 44,2 |
Blood | 113 | 13,1 |
protected specimen brush | 105 | 12,1 |
Deep pus | 72 | 8,3 |
Catheter | 45 | 5,2 |
Operative site infection pus (ISO) | 24 | 2,8 |
Biopsy | 25 | 2,9 |
Swab pus | 20 | 2,3 |
Peritoneal pus | 10 | 1,2 |
Others* | 69 | 7,9 |
Total | 865 | 100 |
Sample | EBLSE: n (%) | 3GCRE: n (%) | CRE: n (%) | CRPA: n (%) | CRPA/I: n (%) | CRAB: n (%) | GRSA: n (%) | MRSA: n (%) | GRE: n (%) | Total |
|---|---|---|---|---|---|---|---|---|---|---|
Biopsy | 34(2,1) | 0 | 4(2,5) | 3(16,6) | 2(8) | 4(2) | 0 | 4(5,1) | 0 | |
PSB | 4(1,2) | 2(4,4) | 17(10,6) | 2(11,1) | 7(28) | 69(34,5) | 0 | 4(5,1) | 0 | |
Pleural fluid | 1(0,3) | 0 | 0 | 0 | 3(12) | 2(1) | 0 | 0 | 0 | |
Deep pus | 15(4,6) | 2(4,4) | 14(8,7) | 1(5,6) | 4(16) | 11(5,5) | 1(50) | 23(29,1) | 1(9,1) | |
Blood | 25(7,7) | 3(6,7) | 26(16,1) | 4(22,2) | 1(4) | 33(16,5) | 1(50) | 16(20,3) | 4(36,4) | |
Urine | 233(72,1) | 31(68,9) | 61(37,9) | 6(33,3) | 2(8) | 41(20,5) | 0 | 5(6,3) | 3(27,3) | |
Catheter | 3(0,9) | 1(2,2) | 18(11,2) | 0 | 2(8) | 17(8,5) | 0 | 4(5,1) | 0 | |
Others | 35(10,8) | 6(13,3) | 21(13) | 2(11,1) | 4(16) | 23(11,5) | 0 | 24(29,1) | 3(27,2) | |
Total | 323(100) | 45(100) | 161(100) | 18(100) | 25(100) | 200(100) | 2(100) | 80(100) | 11(100) | 865 |
Antibiotic | E.coli ESBL n/N (%) | K.pneumoniae ESBL n/N (%) | P.mirabilis ESBL n/N (%) | E.cloacae ESBL n/N (%) | Total ESBL-E n/N (%) |
|---|---|---|---|---|---|
Ampicillin | 159/159(100) | - | 5/5 | - | 164/164(100) |
Ticarcillin | 159/159(100) | - | NT | 5/5 | 164/164(100) |
Piperacillin | 159/159(100) | - | 0/1 | 5/5 | 164/165(99) |
Amoxicillin/Clavulanic acid | 108/155(69,7) | 95/153(62,1) | 2/2 | - | 205/310(66) |
Amoxicillin/Clavulanic acid (Cystitis) | 14/61(22,9) | 19/67(28,3) | 3/3 | - | 36/131(27) |
Ampicillin/sulbactam | NT | 1/5 | NT | 1/5 | |
Piperacillin/tazobactam | 35/158(22,2) | 35/154(22,7) | NT | 5/5 | 75/317(23,6) |
Cephalexin | 159/159(100) | 154/154(100) | 4/4 | - | 317/317(100) |
Cefoxitin | 12/159(7,8) | 33/153(21,6) | 1/3 | - | 46/315(14,6) |
Cefuroxime | NT | 5/5 | NT | 5/5 | |
Cefixime (Cystitis) | NT | 2/5 | NT | 2/5 | |
Ceftriaxone | NT | 0/5 | NT | 0/5 | |
Cefotaxime | 152/156(97,4) | 149/153(97,3) | NT | 5/5 | 306/314(97,4) |
Ceftazidime | 131/159(82,5) | 142/152(93,4) | NT | 4/4 | 277/315(88) |
Cefepime | NT | 7/7(100) | NT | NT | 7/7 |
Ertapenem | 0/152(0) | 0/150(0) | 0/3 | 0/3 | 0/305(0) |
Imipenem | 0/144(0) | 0/145(0) | - | 0/5 | 0/294(0) |
Meropenem | 1/10(10) | 0/5(0) | NT | NT | 1/15 |
Aztreonam | 9/11(81,8) | 1/6(16,7) | NT | 1/1 | 11/18(61) |
Nalidixic acid | 10/13(76,9) | 14/15(93,3) | 4/5 | 1/1 | 29/34(85,3) |
Ofloxacin | 18/25(72) | 15/21(71,5) | 4/4 | 1/1 | 38/51(74,5) |
Norfloxacin | 2/2(100) | 0/1(0) | 5/5 | NT | 7/8 |
Ciprofloxacin | 99/150(66) | 72/152(47,4) | NT | 5/5 | 176/307(57) |
Levofloxacin | 3/5(60) | 0/1(0) | NT | 1/1 | 4/7 |
Moxifloxacin | NT | 3/3 | NT | 3/3 | |
Amikacin | 7/142(4,9) | 4/147(2,7) | 0/1 | 1/5 | 12/295(4) |
Gentamicin | 26/54(48,1) | 34/144(23,6) | NT | 4/4 | 64/202(31,6) |
Tobramycin | 5/15(33,3) | 4/15(26,7) | NT | 1/1 | 10/31(32,2) |
Fosfomycin IV | 9/144(6,3) | 1/12(8,3) | 1/5 | 0/1 | 11/162(6,7) |
Nitrofurantoin (cystitis) | 3/25(12) | 13/15(86,7) | - | 0/1 | 16/41(39) |
Tigecycline | 0/139(0) | 0/5(0) | - | NT | 0/144(0) |
Chloramphenicol | 0/6(0) | 0/2(0) | NT | NT | 0/8 |
Trimethoprim/sulfamethoxazole | 97/156(62,2) | 95/151(62,9) | 1/5 | 5/5 | 198/317(62,4) |
Total | 159 | 154 | 5 | 5 | 323 |
Antibiotic | E. coli CRE n/N (%) | K.pneumoniae CRE n/N (%) | P.mirabilis CRE n/N (%) | E. cloacae CRE n/N (%) | Total CRE n/N (%) |
|---|---|---|---|---|---|
Ampicillin | 6/6 | - | 15/15 | - | 21/21 |
Ticarcillin | 6/6 | - | 13/13 | 23/23 | 42/42(100) |
Piperacillin | 6/6 | - | 12/12 | 25/25 | 43/43(100) |
Amoxicillin/Clavulanic acid | 4/6 | 113/115(98,3) | 14/14 | - | 131/135(97) |
Amoxicillin/Clavulanic acid (Cystitis) | 2/2 | 35/35(100) | 3/3 | - | 40/40(100) |
Piperacillin/tazobactam | 4/5 | 113/115(98,3) | 14/14 | 25/25 | 156/159(98,1) |
Cephalexin | 5/5 | 100/100(100) | 15/15 | - | 120/120(100) |
Cefoxitin | 6/6 | 109/111(98,2) | 15/15 | - | 130/132(98,4) |
Cefotaxime | 4/6 | 112/114(98,2) | 15/15 | 25/25 | 156/160(97,5) |
Ceftazidime | 4/6 | 111/112(99,1) | 15/15 | 25/25 | 155/158(98,1) |
Cefepime | NT | 9/9 | 1/1 | 3/3 | 13/13 |
Ertapenem | 5/5 | 106/106(100) | 15/15 | 25/25 | 151/151 |
Imipenem | 2/6 | 101/111(91) | 11/14 | 14/23 | 128/154(83,1) |
Meropenem | NT | 5/5 | NT | NT | 5/5 |
Aztreonam | NT | 6/6 | 0/1 | 1/1 | 7/8 |
Nalidixic acid | 1/1 | 10/10 | NT | 2/2 | 13/13 |
Ofloxacin | 1/1 | 16/16 | NT | 4/4 | 21/21 |
Norfloxacin | NT | 1/1 | NT | 1/1 | 2/2 |
Ciprofloxacin | 3/6 | 106/112(94,6) | 15/15 | 22/25 | 149/158(94,3) |
Levofloxacin | NT | 4/4 | NT | 1/1 | 5/5 |
Moxifloxacin | NT | NT | NT | 1/1 | 1/1 |
Amikacin | 1/6 | 90/112(80,4) | 14/14 | 0/22 | 105/154(68,1) |
Gentamicin | 1/1 | 83/111(74,8) | 14/14 | 18/23 | 116/149(77,8) |
Tobramycin | 1/1 | 10/11 | NT | 0/2 | 11/14 |
Colistin | 0/1 | 3/27 | - | 0/3 | 3/31 |
Fosfomycin IV | 1/5 | 2/14 | 1/1 | 4/4 | 8/24 |
Nitrofurantoin (cystitis) | NT | 12/12 | - | 4/4 | 16/16 |
Tigecycline | 0/5 | 2/8 | - | NT | 2/13 |
Chloramphenicol | NT | 2/3 | 1/1 | 1/1 | 4/5 |
Trimethoprim/sulfamethoxazole | 3/6 | 93/114(81,6) | 15/15 | 19/25 | 130/160(81,2) |
Total | 6 | 115 | 15 | 25 | 161 |
Antibiotic | CRAB n/N (%) | CRPA n/N (%) | CRPA/IR n/N (%) |
|---|---|---|---|
Ticarcillin | 196/198(99) | 18/18 | 25/25(100) |
Piperacillin | 195/195(100) | 18/18 | 24/24(100) |
Ticarcillin- Clavulanic acid | 10/12 | 6/6 | 6/6 |
Piperacillin/tazobactam | 200/200(100) | 17/18 | 25/25(100) |
Ceftazidime | 200/200(100) | 18/18 | 25/25(100) |
Cefepime | 13/13 | 5/5 | 7/7 |
Ceftazidime/avibactam | NT | NT | 1/1 |
Imipenem | 193/193(100) | 0/18 | 24/24(100) |
Meropenem | 10/11(90,9) | 0/11 | 8/9 |
Aztreonam | NT | 5/6 | 6/7 |
Ciprofloxacin | 189/189(100) | 4/18 | 23/25(92) |
Levofloxacin | NT | 5/7 | 5/6 |
Amikacin | 131/193(67,9) | 1/18 | 21/25(84) |
Gentamicin | 178/187(95,2) | 4/17 | 23/25(92) |
Tobramycin | 9/9 | 0/6 | 5/7 |
Colistin | 1/58 | NT | 0/9 |
Tigecyclin | 11/11 | - | - |
Fosfomycin IV | - | NT | 2/4 |
Trimethoprim/sulfamethoxazole | 117/197(59,4) | - | - |
Total | 200 | 18 | 25 |
Antibiotique | SARM n/N (%) |
|---|---|
Benzylpenicill | 80/80(100) |
Oxacillin | 80/80(100) |
Ampicillin | 79/79(100) |
Amoxicillin/Clavulanic acid | 80/80(100) |
Cefotaxime | 72/72(100) |
Ofloxacin | 10/69(14,4) |
Levofloxacin | 12/78(15,3) |
Ciprofloxacin | 10/74(13,5) |
Moxifloxacin | 10/71(14) |
Gentamicin | 11/78(14,1) |
Kanamycin | 2/5(40) |
Tobramycin | 11/77(14,2) |
Teicoplanin | 0/73(0) |
Vancomycin | 0/74(0) |
Erythromycin | 17/78(21,8) |
Clindamycin | 8/79(10) |
Lincomycin | 4/23(17,4) |
Tetracycline | 27/72(37,5) |
Doxycyclin | 28/70(40) |
Tigecyclin | 3/79(3,7) |
Minocyclin | 1/44(2,3) |
Fusidic acid | 40/76(52) |
Fosfomycin IV | 6/73(8,2) |
Nitrofurantoin | 0/72(0) |
Rifampicin | 3/8(37,5) |
Linézolid | 0/79(0) |
Chloramphenicol | 1/5(20) |
Trimethoprim/sulfamethoxazole | 8/76(10,5) |
Total | 80 |
3GCRE | Enterobacterales Resistant to Third-generation Cephalosporins (other than ESBL) |
BMD | Broth Microdilution |
CA-SFM/EUCAST | Antibiogram Committee of the French Society of Microbiology / European Committee on Antimicrobial Susceptibility Testing |
CPE | Carbapenemase-producing Enterobacterales |
CRAB | Carbapenem-resistant Acinetobacter Baumannii |
CRE | Carbapenem-resistant Enterobacterales |
CRPA | Pseudomonas Aeruginosa Resistant to Ceftazidime |
CRPA/IR | Pseudomonas Aeruginosa Resistant to Both Ceftazidime and Imipenem |
CSF | Cerebrospinal Fluid |
CVTS | Cardiovascular and Thoracic Surgery |
DPC | Continuous Peritoneal Dialysis Unit |
ESBL | Extended-spectrum β-lactamase |
ESBL-E | Extended-spectrum β-lactamase-producing Enterobacterales |
ESKAPE | Enterococcus Faecium, Staphylococcus Aureus, Klebsiella Pneumoniae, Acinetobacter Baumannii, Pseudomonas Aeruginosa, Enterobacter spp. (+ Escherichia Coli) |
ESKAPEE | Enterococcus Faecium, Staphylococcus Aureus, Klebsiella Pneumoniae, Acinetobacter Baumannii, Pseudomonas Aeruginosa, Enterobacter spp. Escherichia Coli |
GLASS | Global Antimicrobial Resistance and Use Surveillance System |
GRE | Enterococcus Faecium Resistant to Glycopeptides |
GRSA | Glycopeptide-resistant Staphylococcus Aureus |
HD | Hemodialysis Unit |
ICU | Intensive Care Unit |
ISO | Operative Site Infection |
KPC | Klebsiella Pneumoniae Carbapenemase-producing |
MDR | Multidrug-resistant |
MIC | Minimum Inhibitory Concentration |
MRSA | Methicillin-resistant Staphylococcus Aureus |
NDM | New Delhi Metallo-β-lactamase |
OPC | Outpatient Consultations |
OXA | Oxacillinase (Carbapenemase Family) |
PARES | National Mission for Surveillance of Antibiotic Consumption and Bacterial Resistance (Tunisia) |
POG | General Post-operative Unit |
PSB | Protected Specimen Brush |
SHV | Sulfhydryl Variable (β-lactamase family) |
SPSS | Statistical Package for the Social Sciences |
SSI | Surgical Site Infection |
TEM | Temoneira (β-lactamase Family) |
WHO | World Health Organization |
XDR | Extensively Drug-resistant |
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APA Style
Fehri, Z., Azouzi, F., Ghali, H., Boughattas, S., Tilouche, L., et al. (2026). Surveillance of Multidrug-resistant Bacteria at a Tunisian University Hospital in 2022. Biomedical Sciences, 12(3), 58-79. https://doi.org/10.11648/j.bs.20261203.12
ACS Style
Fehri, Z.; Azouzi, F.; Ghali, H.; Boughattas, S.; Tilouche, L., et al. Surveillance of Multidrug-resistant Bacteria at a Tunisian University Hospital in 2022. Biomed. Sci. 2026, 12(3), 58-79. doi: 10.11648/j.bs.20261203.12
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Download@article{10.11648/j.bs.20261203.12,
author = {Zied Fehri and Farah Azouzi and Hela Ghali and Sameh Boughattas and Lamia Tilouche and Soumaya Ketata and Yomna Ben Lamine and Abdelhalim Trabelsi},
title = {Surveillance of Multidrug-resistant Bacteria at a Tunisian University Hospital in 2022},
journal = {Biomedical Sciences},
volume = {12},
number = {3},
pages = {58-79},
doi = {10.11648/j.bs.20261203.12},
url = {https://doi.org/10.11648/j.bs.20261203.12},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.bs.20261203.12},
abstract = {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.},
year = {2026}
}
TY - JOUR T1 - Surveillance of Multidrug-resistant Bacteria at a Tunisian University Hospital in 2022 AU - Zied Fehri AU - Farah Azouzi AU - Hela Ghali AU - Sameh Boughattas AU - Lamia Tilouche AU - Soumaya Ketata AU - Yomna Ben Lamine AU - Abdelhalim Trabelsi Y1 - 2026/11/11 PY - 2026 N1 - https://doi.org/10.11648/j.bs.20261203.12 DO - 10.11648/j.bs.20261203.12 T2 - Biomedical Sciences JF - Biomedical Sciences JO - Biomedical Sciences SP - 58 EP - 79 PB - Science Publishing Group SN - 2575-3932 UR - https://doi.org/10.11648/j.bs.20261203.12 AB - 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. VL - 12 IS - 3 ER -
¹Department of Medical Microbiology, Faculty of Medicine of Sousse, Sousse, Tunisia
¹Department of Medical Microbiology, Faculty of Medicine of Sousse, Sousse, Tunisia
Department of Preventive and Community Medicine, Faculty of Medicine of Sousse, Sousse, Tunisia
Department of Medical Microbiology, Faculty of Pharmacy of Monastir, Sousse, Tunisia
Department of Medical Microbiology, Faculty of Pharmacy of Monastir, Sousse, Tunisia
Department of Medical Microbiology, Faculty of Pharmacy of Monastir, Sousse, Tunisia
Department of Medical Microbiology, Faculty of Pharmacy of Monastir, Sousse, Tunisia
Department of Medical Microbiology, Faculty of Pharmacy of Monastir, Sousse, Tunisia
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