Emergence of NDM and OXA-48-like producing Enterobacterales in Northern Morocco

Carbapenemase-producing Enterobacterales (CPE) have widely emerged as a global health threat due to the spread of resistance genes such as New Delhi metallo-β-lactamase (blaNDM) and oxacillinase-48-like β-lactamases (blaOXA-48-like). Data on the molecular epidemiology of CPE in northern Morocco remain limited. Hence, this study aimed to report the epidemiological profile of carbapenem-resistant Enterobacterales and their molecular analysis.

A prospective study was conducted from July 2024 to July 2025 at Mohammed VI University Hospital, Tangier. Ninety-two non-duplicate Enterobacterales isolates were collected across different departments. Species were identified via the matrix-assisted laser desorption/ionization - time-of-flight (MALDI-TOF MS) technique and antimicrobial susceptibility testing was performed according to the guidelines of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Carbapenemase production was screened using GeneXpert® Carba-R (Cepheid, Sunnyvale, USA). Associations between clinical, microbiological, and molecular data were assessed using Chi square or Fisher's exact tests.

Klebsiella pneumoniae dominated across all isolates (75/92; 81.5%), followed by Escherichia. coli (8/92; 8.7%). BlaNDM was found in 65/92 (70.6%), blaOXA-48-like in 17/92 (18.5%), and both in 10/92 (10.9%). Most cases occurred in neonatal (38%) and intensive care units (31.5%). Resistance exceeded 70% for several major antibiotics; 29.3% were colistin-resistant. Mortality was 46.7%. Diabetes (p < 0.01) and severe burns (p < 0.01) were significantly associated with carbapenemase carriage.

CPE, especially NDM-producing Klebsiella pneumoniae, represent a major threat in northern Morocco, notably in neonatal and critical care units. Their high resistance and mortality highlight the urgent need for reinforced infection control, molecular surveillance, and rapid diagnostics.