High rates of antimicrobial resistance (AMR) among Gram-negative pathogens (GNP) have been reported in Egypt. Antimicrobial surveillance and identifying the genetic basis of AMR provide important information to optimize patient care. In this study, we aimed to identify the beta-lactam resistance phenotypes and genotypes of multidrug-resistant (MDR) non-repetitive GNP from 3 tertiary hospitals in Egypt. WZe studied 495 non-repetitive MDR Gram-negative isolates from patients with complicated intra-abdominal infections (cIAI), complicated urinary tract infection (cUTI), and lower respiratory tract infection (LRTI), collected as part of the “Study for Monitoring Antimicrobial Resistance Trends” (SMART) conducted in 3 tertiary hospitals in Cairo, Egypt, from 2015 to 2016. Identification and susceptibility testing of GNP to antimicrobials were tested in each hospital laboratory and confirmed in a reference laboratory (International Health Management Associates (IHMA), Inc., Schaumburg, IL, USA). Molecular identification of extended-spectrum beta-lactamases (ESΒLs), AmpC, and carbapenem resistance genes was conducted in IHMA. Among the 495 MDR isolates, Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) were the most common (52.7% and 44.2%). K. pneumoniae was most susceptible to colistin, amikacin, ertapenem, and imipenem (92.7%, 72.7%, 69.3%, and 64%, respectively). E. coli was most susceptible to colistin (100%), amikacin (94.1%), imipenem (90.4%), and ertapenem (83.6%). ESBL was detected in 96.2% and ESBL genotypes included blaCTX-M-15 (70.1%), blaTEM-OSBL (48.5%), blaSHV-OSBL (27.9%), and blaCTX-M-14 (10.7%). AmpC resistance genes were identified in 9.7% of the isolates, dominated by blaCMY-2 (5.7%). Carbapenem resistance genes were detected in 45.3% of the isolates. In K. pneumoniae, blaOXA-48 dominated (40.6%), followed by blaNDM-1 (23.7%) and blaOXA-232 (4.5%). In E. coli, the most frequent genes were blaNDM-5 (9.6%), blaOXA-181 (5.5%), blaOXA-244 (3.7%), and blaNDM-1 (3.7%). blaKPC-2 was identified in 0.4% of isolates. Notably, 32.3% of isolates carried more than one resistance gene. Our findings emphasize the continued need for molecular surveillance of MDR pathogens, implementation of strict infection control measures, and antimicrobial stewardship policies in our hospitals.

BackgroundAntimicrobial resistance is an urgent healthcare threat. Monitoring and interventions to reduce antimicrobial resistance among Gram-negative rods (GNR) are essential.MethodsThe study was conducted over three years in three tertiary- care hospitals in Egypt during 2014- 2016. It included 578 GNR isolates from intra-abdominal infections (IAI), urinary tract infections (UTI) and respiratory tract infections (RTI). Identification of isolates was done by VITEK-2, and confirmed by MALDI-TOF at a central laboratory as part of Study for Monitoring Antimicrobial Resistance Trends (SMART). Susceptibility testing and molecular studies of resistance were conducted in the hospital laboratories. Starting from 2015, an antimicrobial stewardship (AMS) program was implemented in the 3 hospitals for fluoroquinolone restriction in empirical therapy, and early de-escalation of antimicrobial therapy.ResultsIn Phase 1 (before AMS), 578 isolates of Gram-negative bacilli (GNB) were studied. Enterobacteriaceae comprised 66% of the total isolates. K.pneumoniae and E.coli were the most common (29.8% and 29.4%), followed by Acinetobacter baumannii (21.1%) and P.aeruginosa (9.9%). K.pneumoniae and E.coli were the predominant organisms in IAI (30.5% and 30.1% respectively) and UTI (and 38.9% and 48.6% respectively), while Acinetobacter baumannii was the most prevalent in RTI (40.2%). ESBL producers were phenotypically detected in 53% of K.pneumoniae, 68% of E.coli and 64% of Proteus mirabilis. Amikacin, imipenem, ertapenem and piperacillin/tazobactam had the highest susceptibility (60.7%, 58%, 49.3% and 46.5% respectively).In Phase 2 (after AMS), 492 Gram-negative bacilli (GNB) were studied, showing similar distribution except for marked reduction in Acinetobacter baumannii(5.3% in IAI, 11.4% in RTI and 1% in UTI). ESBL continued to be high. Susceptibility to carbapenems increased to 87.1% for E.coli and 77.7% for all Enterobacteriaceae. PCR showed predominance of OXA-48- like (more than 50% and NDM (more than 40%), with low percentage of KPC2, VIM2 and IMP.ConclusionOur results show high ESBL and carbapenemases rates compared with the region that call for an urgent national AMS program and strict implementation of infection control measures.Disclosures A. El Kholy, MSD: Investigator, Research support; S. A. Girgis, MSD: Investigator, Research support; M. A. F. Shetta, MSD: Research Contractor, Research support; A. Ramadan, MSD: Investigator, Research support; D. H. AbdElhHamid, MSD: Investigator, Research support

BackgroundHigh rates of AMR among Gram-negative bacilli (GNB) have been reported from Egypt for almost 2 decades. Surveillance and identifying the genetic basis of AMR provide important information to optimize patient care. As there is no adequate data on the genetic basis of AMR in Egypt, we aimed to identify the molecular characterization of multi-drug-resistant (MDR) Gram-negative pathogens (GNP).MethodsThree major tertiary-care hospitals in Egypt participated in the “Study for Monitoring Antimicrobial Resistance Trends” (SMART) from 2014 to 2016. Consecutive GNPs were identified and their susceptibility to antimicrobials were tested. Molecular identification of ESBL, AmpC, and carbapenemase resistance genes was conducted on MDR isolates.ResultsWe enrolled 1,070 consecutive Gram-negative isolates; only one isolate per patient according to the standard protocol of (SMART). During 2014–2015, 578 GNP were studied. Enterobacteriaceae comprised 66% of the total isolates. K. pneumoniae and E. coli were the most common (29.8% and 29.4%). K. pneumoniae and E. coli were the predominant organisms in IAI (30.5% and 30.1%, respectively) and UTI (and 38.9% and 48.6%, respectively), while Acinetobacter baumannii was the most prevalent in RTI (40.2%). ESBL producers were phenotypically detected in 53% of K. pneumoniae, and 68% of E. coli. During 2016, 495 GNP were studied. ESBL continued to be high. For E. coli and K. pneunomiea, the most active antimicrobials were amikacin (≥93%), imipenem/meropenem (≥87%) and colistin (97%). Genetic study of ertapenem-resistant isolates and 50% of isolates with ESBL phenotype revealed ESβL production in more than 90% of isolates; blaCTXM-15 was detected in 71.4% and 68.5% in K. pneumoniae and E. coli, respectively, blaTEM-OSBL in 48.5% and47.5% of K. pneumoniae and E. coli, respectively. Carbapenem resistance genes were detected in 45.4% of isolates. In K. pneumoniae, OXA-48 dominated (40.6%), followed by NDM1 (23.7%) and OXA-232 (4.5%).ConclusionOur study detected alarming rates of resistance and identified many resistance mechanisms in clinical isolates from Egyptian hospitals. These high rates highlight the importance of continuous monitoring of the resistance trend and discovering the novel resistant mechanisms of resistance, and the underscores a national antimicrobial stewardship plan in Egypt.Disclosures All authors: No reported disclosures.