Abstract
BackgroundCarbapenem-resistant Enterobacterales (CRE), currently listed by the World Health Organization (WHO) as top priority critical pathogens, are a major global menace to human health. In low- and middle-income countries (LMICs) the threat is mounting fueled by selective pressures caused by antibiotic abuse and inadequate diagnostic resources.MethodsThis study phenotypically and genotypically characterized carbapenem resistance among 115 Enterobacterales isolates including 76 Klebsiella (K.) pneumoniae, 19 Escherichia (E.) coli, 14 Shigella (S.) sonnei, 5 Enterobacter (E.) cloacae, and 1 Proteus (P.) mirabilis.ResultsNinety-three isolates (80.9%) were carbapenem-resistant with an alarming 57.5% carbapenem non-susceptibility in isolates collected from the outpatient department. Molecular characterization of the carbapenemases (CPases) encoding genes showed that blaNDM (80.5%) was the most prevalent; it was detected in 62 isolates (54 K. pneumoniae, 6 E. coli and 2 S. sonnei), followed by blaVIM (36.4%) which was observed in 28 isolates (24 K. pneumoniae, 3 E. coli and 1 E. cloacae). Other CPases included blaKPC (28.6%; in 20 K. pneumoniae, 1 E. coli and 1 S. sonnei), blaOXA-48 (26%; in 17 K. pneumoniae, 1 E. coli,1 E. cloacae and 1 P. mirabilis), blaIMP (6.5%; in 5 K. pneumoniae) and blaSPM (1.3%; in K. pneumoniae). Notably more than half of the Enterobacterales isolates (54.5%) co-harboured more than one CPase-encoding gene. Co-existence of blaNDM and blaVIM genes was the most dominant (31.2%), followed by association of blaNDM and blaKPC (24.7%), then blaVIM and blaKPC (13%). Moreover, the effects of different genotypes on meropenem MIC values were assessed, and a statistically significant difference between the genotype (Ambler classes A and B) and the genotype (Ambler classes B and D) was recorded.ConclusionThe current findings may serve for a better understanding of the context of CRE in Egypt, associated drivers and CPases.
Highlights
Carbapenem-resistant Enterobacterales (CRE), currently listed by the World Health Organization (WHO) as top priority critical pathogens, are a major global menace to human health
Studies have shown the association of these genes with other Antimicrobial resistance (AMR) encoding genes such as extended-spectrum beta-lactamases (ESBLs), genes mediating resistance to aminoglycosides and fluoroquinolones which results in the upsurge of multidrug-resistant phenotypes [9]
Collection of clinical isolates In this study, a total of 115 Enterobacterales isolates were obtained from the diagnostic microbiology laboratories of four Egyptian hospitals, namely Tanta University Hospital (TUH) (n = 47), National Cancer Institute (NCI) (n = 11), Memorial Souad Kafafi University Hospital (MSKUH) (n = 18), and El-Demerdash Hospital (DH) (n = 39) between March 2018 and September 2019
Summary
Carbapenem-resistant Enterobacterales (CRE), currently listed by the World Health Organization (WHO) as top priority critical pathogens, are a major global menace to human health. Production of CPases comprises the main mechanism of carbapenem resistance in Enterobacterales This further emphasizes the criticality of CRE, since CPases-encoding genes are typically found on mobile genetic elements (plasmids, transposons, etc.) which facilitates their dissemination [8]. In Egypt, several studies were conducted to explore the prevalence of CRE strains among inpatients, data concerning community acquired carbapenem resistance is lacking [11]. Considering all these challenges, we aimed to catch a glimpse of phenotype-genotype correlations among carbapenem-resistant Enterobacterales isolates from four Egyptian hospitals.
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