Carbapenem-resistant Enterobacterales and Causing Infection in Africa and the Middle East: a Surveillance Study from the ATLAS Programme (2018-20)

Overview

Journal JAC Antimicrob Resist

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2022 Jun 23

PMID 35733913

Authors

James A Karlowsky

Samuel K Bouchillon

Ramy El Mahdy Kotb

Naglaa Mohamed

Gregory G Stone

Daniel F Sahm

Affiliations

Soon will be listed here.

Abstract

Objectives: To determine the susceptibility of Enterobacterales (5457) and (1949) isolated from hospitalized patients in Africa (three countries) and the Middle East (five countries) in 2018-20 to a panel of 11 antimicrobials and to identify β-lactamase/carbapenemase genes in isolates with meropenem-non-susceptible and/or ceftazidime/avibactam-resistant phenotypes.

Methods: CLSI broth microdilution testing generated MICs that were interpreted using CLSI (2021) breakpoints. β-Lactamase/carbapenemase genes were identified using multiplex PCR assays.

Results: Enterobacterales isolates were highly susceptible to amikacin (96.7%), ceftazidime/avibactam (96.6%) and tigecycline (96.0%), and slightly less susceptible to meropenem (94.3%). In total, 337 Enterobacterales isolates (6.2% of all Enterobacterales isolates) carried one or more carbapenemase genes: 188 isolates carried a serine carbapenemase (178 OXA, 10 KPC) and 167 isolates carried an MBL (18 isolates carried both an MBL and an OXA). NDM-1 was the most common MBL identified (64.1% of NDM enzymes; 59.9% of all MBLs). OXA-48 (47.8%) and OXA-181 (38.8%) were the most common OXAs detected. isolates were most susceptible to ceftazidime/avibactam (89.1%) and amikacin (88.9%). Only 73.1% of isolates were meropenem susceptible. The majority (68.1%) of isolates tested for carbapenemase/β-lactamase genes were negative. In total, 88 isolates (4.5% of all isolates) carried one or more carbapenemase genes: 81 isolates carried an MBL and 8 carried a GES carbapenemase (1 isolate carried genes for both).

Conclusions: Carbapenemase detection was closely associated with meropenem-non-susceptible phenotypes for Enterobacterales (89.1%) but not for (24.2%). Wide geographic variation in carbapenemase type and frequency of detection was observed.

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