Molecular Characterization of Carbapenem-resistant in Thirteen Tertiary Care Hospitals in Saudi Arabia

Overview

Journal Ann Saudi Med

Specialty General Medicine

Date 2021 Apr 5

PMID 33818149

Citations 11

Authors

Hail Al-Abdely

Raed AlHababi

Hebah Mahmoud Dada

Hala Roushdy

Mishaal Mohammed Alanazi

Ali Abdullah Alessa

Niveen Mohamed Gad

Abdullah Mohammed Alasmari

Enas Elsabaee Radwan

Hussain Al-Dughmani

Bothina Koura

Mahmoud Mohammed Bader

Hany Mohammed Al Deen

Ahmed Bueid

Khalid Mohammed Elgaher

Majed F Alghoribi

Ahmed M Albarrag

Ali Mohammed Somily

Affiliations

Soon will be listed here.

Abstract

Background: Carbapenems are the antibiotics of last-resort for the treatment of bacterial infections caused by multidrug-resistant organisms. The emergence of resistance is a critical and worrisome problem for clinicians and patients. Carbapenem-resistant (CRE) are spreading globally, are associated with an increased frequency of reported outbreaks in many regions, and are becoming endemic in many others.

Objectives: Determine the molecular epidemiology of CRE isolates from various regions of Saudi Arabia to identify the genes encoding resistance and their clones for a better understanding of the epidemio-logical origin and national spread.

Design: Multicenter, cross-sectional, laboratory-based study.

Setting: Samples were collected from 13 Ministry of Health tertiary-care hospitals from five different regions of Saudi Arabia.

Methods: Isolates were tested using the GeneXpert molecular platform to classify CRE.

Main Outcome Measures: Prevalence of various types of CRE in Saudi Arabia.

Sample Size: 519 carbapenem-resistant isolates.

Result: Of 519 isolates, 440 (84.7%) were positive for CRE, with (410/456, 90%) being the most commonly isolated pathogen. The distribution of the CRE-positive resistance genes was as follows: OXA-48 (n=292, 71.2%), NDM-1 (n=85, 20.7%), and NDM+OXA-48 (n=33, 8%). The highest percentage of a single blaOXA-48 gene was detected in the central and eastern regions (77%), while the bla-gene was the predominant type in the northern region (27%). The southern regions showed the lowest percentages for harboring both blaOXA-48 and bla genes (4%), while the western region isolates showed the highest percentage of harboring both genes (14%).

Conclusion: The results illustrate the importance of molecular characterization of CRE isolates for patient care and infection prevention and control. Larger multicenter studies are needed to critically evaluate the risk factors and trends over time to understand the dynamics of spread and effective methods of control.

Limitations: Lack of phenotypic susceptibility and clinical data.

Conflict Of Interest: None.

Citing Articles

Systematic review of multidrug-resistant in the Arabian Peninsula: molecular epidemiology and resistance patterns.

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Molecular Screening of Carbapenem-Resistant (CRKP) Clinical Isolates for Concomitant Occurrence of Genes (CTX-M, TEM, and SHV) in the Kingdom of Bahrain.

Shahid M, Saeed N, Ahmad N, Shadab M, Joji R, Al-Mahmeed A J Clin Med. 2023; 12(24).

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Klebsiella pneumoniae bacteraemia epidemiology: resistance profiles and clinical outcome of King Fahad Medical City isolates, Riyadh, Saudi Arabia.

Hafiz T, Alanazi S, Alghamdi S, Mubaraki M, Aljabr W, Madkhali N BMC Infect Dis. 2023; 23(1):579.

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An Overview of Antimicrobial Resistance in Saudi Arabia (2013-2023) and the Need for National Surveillance.

Thabit A, Alabbasi A, Alnezary F, Almasoudi I Microorganisms. 2023; 11(8).

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Cracking the Code: Unveiling the Diversity of Carbapenem-Resistant Clones in the Arabian Peninsula through Genomic Surveillance.

Al Fadhli A, Mouftah S, Jamal W, Rotimi V, Ghazawi A Antibiotics (Basel). 2023; 12(7).

PMID: 37508177 PMC: 10376398. DOI: 10.3390/antibiotics12071081.

References

Khan M, Mohamed A, Faiz A, Ahmad J . Enterobacterial infection in Saudi Arabia: First record of Klebsiella pneumoniae with triple carbapenemase genes resistance. J Infect Dev Ctries. 2020; 13(4):334-341. DOI: 10.3855/jidc.11056. View

Potter R, DSouza A, Dantas G . The rapid spread of carbapenem-resistant Enterobacteriaceae. Drug Resist Updat. 2016; 29:30-46. PMC: 5140036. DOI: 10.1016/j.drup.2016.09.002. View

Nordmann P, Poirel L . The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect. 2014; 20(9):821-30. DOI: 10.1111/1469-0691.12719. View

Aktas Z, Kayacan C, Oncul O . In vitro activity of avibactam (NXL104) in combination with β-lactams against Gram-negative bacteria, including OXA-48 β-lactamase-producing Klebsiella pneumoniae. Int J Antimicrob Agents. 2011; 39(1):86-9. DOI: 10.1016/j.ijantimicag.2011.09.012. View

Traczewski M, Carretto E, Canton R, Moore N . Multicenter Evaluation of the Xpert Carba-R Assay for Detection of Carbapenemase Genes in Gram-Negative Isolates. J Clin Microbiol. 2018; 56(8). PMC: 6062815. DOI: 10.1128/JCM.00272-18. View

Thaden J, Lewis S, Hazen K, Huslage K, Fowler Jr V, Moehring R . Rising rates of carbapenem-resistant enterobacteriaceae in community hospitals: a mixed-methods review of epidemiology and microbiology practices in a network of community hospitals in the southeastern United States. Infect Control Hosp Epidemiol. 2014; 35(8):978-83. PMC: 4217156. DOI: 10.1086/677157. View

Tzouvelekis L, Markogiannakis A, Psichogiou M, Tassios P, Daikos G . Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. Clin Microbiol Rev. 2012; 25(4):682-707. PMC: 3485753. DOI: 10.1128/CMR.05035-11. View

Baraniak A, Izdebski R, Fiett J, Gawryszewska I, Bojarska K, Herda M . NDM-producing Enterobacteriaceae in Poland, 2012-14: inter-regional outbreak of Klebsiella pneumoniae ST11 and sporadic cases. J Antimicrob Chemother. 2015; 71(1):85-91. DOI: 10.1093/jac/dkv282. View

Poirel L, Bonnin R, Nordmann P . Genetic features of the widespread plasmid coding for the carbapenemase OXA-48. Antimicrob Agents Chemother. 2011; 56(1):559-62. PMC: 3256075. DOI: 10.1128/AAC.05289-11. View

10.

Shaw E, Rombauts A, Tubau F, Padulles A, Camara J, Lozano T . Clinical outcomes after combination treatment with ceftazidime/avibactam and aztreonam for NDM-1/OXA-48/CTX-M-15-producing Klebsiella pneumoniae infection. J Antimicrob Chemother. 2017; 73(4):1104-1106. DOI: 10.1093/jac/dkx496. View

11.

Salman J, Dabal L, Bassetti M, Alfouzan W, Al Maslamani M, Alraddadi B . Management of infections caused by WHO critical priority Gram-negative pathogens in Arab countries of the Middle East: a consensus paper. Int J Antimicrob Agents. 2020; 56(4):106104. DOI: 10.1016/j.ijantimicag.2020.106104. View

12.

Logan L, Weinstein R . The Epidemiology of Carbapenem-Resistant Enterobacteriaceae: The Impact and Evolution of a Global Menace. J Infect Dis. 2017; 215(suppl_1):S28-S36. PMC: 5853342. DOI: 10.1093/infdis/jiw282. View

13.

Kumarasamy K, Toleman M, Walsh T, Bagaria J, Butt F, Balakrishnan R . Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010; 10(9):597-602. PMC: 2933358. DOI: 10.1016/S1473-3099(10)70143-2. View

14.

Karakonstantis S, Kritsotakis E, Gikas A . Treatment options for K. pneumoniae, P. aeruginosa and A. baumannii co-resistant to carbapenems, aminoglycosides, polymyxins and tigecycline: an approach based on the mechanisms of resistance to carbapenems. Infection. 2020; 48(6):835-851. PMC: 7461763. DOI: 10.1007/s15010-020-01520-6. View

15.

Moghnieh R, Kanafani Z, Tabaja H, Sharara S, Awad L, Kanj S . Epidemiology of common resistant bacterial pathogens in the countries of the Arab League. Lancet Infect Dis. 2018; 18(12):e379-e394. DOI: 10.1016/S1473-3099(18)30414-6. View

16.

Hala S, Antony C, Alshehri M, Althaqafi A, Alsaedi A, Mufti A . First report of harboring in Saudi Arabia. Antimicrob Resist Infect Control. 2020; 8:203. PMC: 6923860. DOI: 10.1186/s13756-019-0653-9. View

17.

Bush K . Proliferation and significance of clinically relevant β-lactamases. Ann N Y Acad Sci. 2013; 1277:84-90. DOI: 10.1111/nyas.12023. View

18.

Villa L, Poirel L, Nordmann P, Carta C, Carattoli A . Complete sequencing of an IncH plasmid carrying the blaNDM-1, blaCTX-M-15 and qnrB1 genes. J Antimicrob Chemother. 2012; 67(7):1645-50. DOI: 10.1093/jac/dks114. View

19.

Mendelson M, Matsoso M . The World Health Organization Global Action Plan for antimicrobial resistance. S Afr Med J. 2015; 105(5):325. DOI: 10.7196/samj.9644. View

20.

Al-Agamy M, Aljallal A, Radwan H, Shibl A . Characterization of carbapenemases, ESBLs, and plasmid-mediated quinolone determinants in carbapenem-insensitive Escherichia coli and Klebsiella pneumoniae in Riyadh hospitals. J Infect Public Health. 2017; 11(1):64-68. DOI: 10.1016/j.jiph.2017.03.010. View