INTRODUCTION: In the battle against multidrug-resistant bacterial infections, ceftazidime- avibactam (CZA) stands as a pivotal defense, particularly against carbapenemresistant (CR) Gram-negative pathogens. However, the rise in resistance against this drug poses a significant threat to its effectiveness, highlighting the critical need for in-depth studies about its resistance mechanisms. METHODS: This research focuses on the genomic characterization of CR- and CZA-resistant Escherichia coli (n=26) and Klebsiella pneumoniae (n=34) strains, harboring the blaNDM and/or blaOXA-48-like genes, at a major Lebanese tertiary care medical center, using whole genome sequencing (WGS). RESULTS: Our findings revealed a notable prevalence of blaNDM in all K. pneumoniae strains isolates, with 27 of these also harboring blaOXA-48. On the other hand, E. coli strains predominantly carried the blaNDM-5 gene. Whole genome sequencing (WGS) identified a predominance of ST383 among K. pneumoniae strains, which possessed a multi-replicon IncFIB-IncHI1B plasmid harboring the blaNDM-5. Additionally, various Inc group plasmids in K. pneumoniae across multiple sequence types were found to carry the blaNDM. Similarly, diverse STs of E. coli were observed to carry blaNDM-5 on different plasmids. DISCUSSION: The study underscores NDM carbapenemases as a paramount resistance mechanism in Lebanon,jeopardizing critical last-resort treatments. It also illuminates the role of varied sequence types and mobile genetic elements in the spread of NDM resistance,stressing the urgent need for strategies to mitigate this threat, especially in nosocomial infections.
- MeSH
- antibakteriální látky * farmakologie MeSH
- azabicyklické sloučeniny * farmakologie MeSH
- bakteriální proteiny genetika metabolismus MeSH
- beta-laktamasy * genetika metabolismus MeSH
- ceftazidim * farmakologie MeSH
- centra terciární péče MeSH
- Enterobacteriaceae rezistentní na karbapenemy genetika účinky léků izolace a purifikace MeSH
- Escherichia coli * genetika účinky léků MeSH
- fixní kombinace léků * MeSH
- genom bakteriální MeSH
- karbapenemy * farmakologie MeSH
- Klebsiella pneumoniae * genetika účinky léků MeSH
- lidé MeSH
- mikrobiální testy citlivosti MeSH
- mnohočetná bakteriální léková rezistence * genetika MeSH
- plazmidy genetika MeSH
- přenos genů horizontální MeSH
- sekvenování celého genomu * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Libanon MeSH
Enterobacterales produkující karbapenemázu (CPE – Carbapenemase-Producing Enterobacterales) představují globální zdravotnický problém. V Evropě dochází zejména v jižních státech ke zvyšování podílu enterobakterií rezistentních vůči karbapenemům. Od roku 2016 dochází také v České republice k plošnému nárůstu počtu případů, v roce 2019 bylo zaznamenáno 270 případů kolonizace nebo infekce CPE. Tento trend je zčásti způsoben několika epidemickými epizodami, odráží ale i zhoršující se endemickou situaci ve zdravotnických zařízeních. Přesto lze Českou republiku stále hodnotit jako stát s nízkým výskytem CPE.
Carbapenemase-producing Enterobacterales (CPE) are a global health problem. In Europe, the proportion of carbapenem-resistant enterobacteria is increasing, particularly in the southern states. Since 2016, there has also been a widespread increase in the number of cases in the Czech Republic, with 270 cases of colonization or CPE infection reported in 2019. This trend is partly due to several outbreaks, but it also reflects the deteriorating endemic situation in healthcare facilities. Nevertheless, the Czech Republic still remains a low CPE incidence country.
Dissemination of carbapenemase-producing Klebsiella pneumoniae along with 16S rRNA methyltransferase (16S-RMTase) has been caused as a great concern for healthcare settings. The aim of this study was to investigate the prevalence of resistance genes among K. pneumoniae isolates. During October 2015 to February 2016, 30 non-duplicative K. pneumoniae strains were isolated from clinical specimens in a burn center in Kerman, Iran. Antibiotic susceptibility tests of isolates, carbapenemase, extended-spectrum beta-lactamases (ESBLs) and AmpC beta-lactamase-producing isolates were determined by phenotypic methods. The beta-lactamase, oqxA/B efflux pumps, qnr A, B, S, 16S-RMTase (rmt A, B, and C), and mcr-1 resistance genes were determined by PCR. Enterobacterial repetitive intergenic consensus (ERIC)-PCR was used for molecular typing. According to our findings, tigecycline has been shown the most active agent against K. pneumoniae isolates. Antibiotic resistance genes, blaTEM-1, blaSHV-12, blaCTX-M-15, blaCTX-M-2, blaNDM-1, blaFOX, blaMOX, blaEBC, blaACC, blaCIT, rmtC, qnrB, qnrS, oqxA, and oqxB, were detected in 11 (36.7%), 13 (43.3%), 11 (36.6%), 5 (16.6%), 9 (30%), 1 (3.3%), 1 (3.3%), 1 (3.3%), 1 (3.3%), 2 (6.7%), 1 (3.3%), 9 (30%), 2 (6.7%), 18 (60%), and 13 (43.3%) of isolates, respectively. The blaNDM-1 with rmtC was simultaneously observed in one isolate. ERIC-PCR results revealed 25 distinct patterns in eight clusters (A-H) and five singletons. This study highlights the high prevalence of blaNDM and emergence of rmtC among carbapenem-resistant K. pneumoniae. The resistance genes are often co-located on the conjugative plasmids, so it might be the reason of the rapid spread of them. The prevalence of multidrug-resistant K. pneumoniae isolates limits the available treatment options and presents tremendous challenges to public health.
- MeSH
- antibakteriální látky farmakologie MeSH
- bakteriální léková rezistence genetika MeSH
- bakteriální proteiny genetika MeSH
- beta-laktamasy genetika MeSH
- Enterobacteriaceae rezistentní na karbapenemy účinky léků genetika izolace a purifikace MeSH
- infekce bakteriemi rodu Klebsiella mikrobiologie MeSH
- Klebsiella pneumoniae klasifikace účinky léků genetika izolace a purifikace MeSH
- lidé MeSH
- methyltransferasy genetika MeSH
- mikrobiální testy citlivosti MeSH
- molekulární typizace MeSH
- plazmidy genetika MeSH
- popáleninové jednotky * MeSH
- rozptýlené repetitivní sekvence genetika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Írán MeSH
- Klíčová slova
- panrezistence,
- MeSH
- antibakteriální látky MeSH
- bakteriální léková rezistence * MeSH
- beta-laktamasy izolace a purifikace MeSH
- cestování * MeSH
- Enterobacteriaceae rezistentní na karbapenemy izolace a purifikace MeSH
- fatální výsledek MeSH
- Klebsiella pneumoniae izolace a purifikace MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
