Aboubakr Khazaz

Pseudomonas aeruginosa is an important opportunistic pathogen increasingly associated with multidrug resistance (MDR) and therapeutic failure. Data on MDR community-associated P. aeruginosa in southern Morocco remain limited. This study evaluated the contribution of urban diagnostic laboratories to the surveillance of MDR P. aeruginosa in this underrepresented region. A retrospective multicenter study was conducted between January and December 2024 using data collected from urban medical diagnostic laboratories in southern Morocco. Clinical isolates of P. aeruginosa recovered from community-associated patients were identified using standard microbiological methods, and antimicrobial susceptibility testing was performed according to EUCAST guidelines. MDR was defined as non-susceptibility to at least one agent in three or more antimicrobial classes according to the international criteria. Associations between MDR status and demographic variables were assessed using Chi-square and Fisher’s exact tests, with statistical significance set at p < 0.05. Among the 49 P. aeruginosa isolates included, 29 (59.2%, 95% CI: 45.4–72.0%) were classified as MDR. High resistance rates were observed for several β-lactams, whereas most isolates remained susceptible to amikacin and selected β-lactam/β-lactamase inhibitor combinations. No statistically significant association was found between MDR status and demographic variables. These findings highlight the circulation of MDR P. aeruginosa in southern Morocco and suggest that urban diagnostic laboratories may provide valuable complementary data for community-level antimicrobial resistance surveillance.

Introduction: Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are leading causes of urinary tract infections (UTIs). In Morocco, carbapenem resistance data are scarce and largely hospital-based. We investigated carbapenem-resistant E. coli and K. pneumoniae isolates from community settings in Morocco. Material and Methods: In this prospective multicentre study, we analysed 1296 non-duplicate E. coli and K. pneumoniae isolates recovered from outpatients with community-acquired UTIs (CA-UTIs) across 12 Moroccan cities (January 2022–December 2023). Antimicrobial susceptibility testing was performed following EUCAST guidelines. All phenotypically carbapenem-resistant isolates (n = 54, 13 E. coli, et 41 K. pneumoniae) were subjected to whole-genome sequencing (WGS) using Illumina technology to identify resistance determinants, mobile genetic elements and clonal lineages. Results: E. coli predominated [n = 1000, 77.2% (95% CI: 74.8–79.4)] while K. pneumoniae accounted for 22.8% [n = 296 (95% CI: 20.6–25.2)]. Carbapenem resistance rates were significantly higher in K. pneumoniae than in E. coli [ertapenem: 21.1% (95% CI: 16.6–26.4) versus 2.4% (95% CI: 1.6–3.6); imipenem: 15.0% (CI: 11.2–19.6) versus 1.9% (95% CI: 1.2–3.0)]. WGS revealed a high clonal diversity [eight sequence types (ST) in E. coli and 12 in K. pneumonnie]. Carbapenemase-mediated resistance was predominant in K. pneumoniae (notably blaNDM-14, blaNDM-7, blaNDM-5 and blaOXA-48). By contrast, E. coli primarily exhibited efflux and permeability defect mechanisms with sporadic carbapenemase-encoding gene carriage (blaNDM or blaOXA-48). The K. pneumoniae international high-risk clone ST147 producing NDM-14 was dominant (n = 23 isolates), followed by ST307 (n = 4), whereas ST410 was the most frequently identified among E. coli (n = 5). Conclusion: Carbapenem-resistant E. coli and K. pneumoniae in community UTIs in Morocco, are driven by multiple clones. These findings underscore the urgent need to expand community-based AMR surveillance beyond hospital settings.

Background: Globally disseminated high‐risk Escherichia coli ( E. coli ) clones are major drivers of multidrug resistance (MDR) and severe clinical infections. Their presence in aquatic ecosystems represents a growing One Health concern, particularly in regions where wastewater management remains limited. Objective: This study aimed to investigate the environmental circulation and genomic characteristics of high‐risk E. coli in Moroccan aquatic environments. Methods: Water samples were collected between February and June 2024 from seven major rivers and three wastewater treatment plants (WWTPs) across eight Moroccan cities. A total of 22 E. coli isolates were recovered and analyzed by whole‐genome sequencing to determine their sequence types (STs), antimicrobial resistance genes, virulence factors, and plasmid replicon profiles. Results: Sixteen isolates originated from rivers (72.7%) and six from WWTPs (27.3%). Thirteen distinct STs were identified, dominated by the globally disseminated high‐risk clones ST44 ( n = 4; 18.2%), ST410 ( n = 4; 18.2%), and ST131 ( n = 3; 13.6%). The most frequent extended‐spectrum β ‐lactamase (ESBL) gene was bla _CTX-M-15 ( n = 13; 59.1%). Carbapenemase genes were found in five isolates (22.7%), including bla _NDM-5 ( n = 2; 9.1%), bla _OXA-48 ( n = 1; 4.5%), bla _OXA-181 ( n = 1; 4.5%), bla _OXA-484 ( n = 2; 9.1%), and bla _OXA-244 ( n = 1; 4.5%), whereas mcr-1.1 was detected in one isolate (4.5%). Plasmid profiling showed a predominance of IncF‐type replicons (IncFIB 81.8%, IncFII 77.3%, and IncFIA 68.2%), along with IncI (36.4%), IncX (13.6%), and IncHI (9.1%). Conclusion: This study provides the first genomic evidence of clinically relevant high‐risk E. coli clones and mobile resistance determinants circulating in Moroccan aquatic environments. These findings highlight the urgent need to strengthen integrated One Health surveillance to prevent environmental dissemination and reduce the public health impact of antimicrobial resistance.

The Journal of Public Health in Africa (JPHiA) is a peer-reviewed, academic journal that focuses on health issues in the African continent. The journal editors seek high quality original articles on public health related issues, reviews, comments and more. The aim of the journal is to move public health discourse from the background to the forefront. The success of Africa’s struggle against disease depends on public health approaches.