Clonal emergence of Klebsiella pneumoniae ST14 co-producing OXA-48-type and NDM carbapenemases with high rate of colistin resistance in Dubai, United Arab Emirates

Moubareck, Carole Ayoub; Mouftah, Shaimaa F.; Pál, Tibor; Ghazawi, Akela; Halat, Dalal Hammoudi; Nabi, Anju; Al-Sharhan, M.; AlDeesi, Zulfa O.; Peters, Christabel C.; Celiloglu, Handan; Sannegowda, Manjunath; Sarkis, Dolla Karam; Sonnevend, Ágnes

doi:10.1016/j.ijantimicag.2018.03.003

Cited by 85 publications

(69 citation statements)

References 13 publications

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“…The eCIM combined with the mCIM have a Ͼ95% sensitivity and a Ͼ92% specificity (148). Strains with a coexistence of MBLs and non-MBL carbapenemases (e.g., KPC and OXA-48) have been increasingly reported (51,94,192). In such cases, the eCIM and SAM-mCIM may generate false-negative results.…”

Section: Detection Of Mblsmentioning

confidence: 99%

NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings

et al. 2019

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SUMMARYNew Delhi metallo-β-lactamase (NDM) is a metallo-β-lactamase able to hydrolyze almost all β-lactams. Twenty-four NDM variants have been identified in >60 species of 11 bacterial families, and several variants have enhanced carbapenemase activity.Klebsiella pneumoniaeandEscherichia coliare the predominant carriers ofblaNDM, with certain sequence types (STs) (forK. pneumoniae, ST11, ST14, ST15, or ST147; forE. coli, ST167, ST410, or ST617) being the most prevalent. NDM-positive strains have been identified worldwide, with the highest prevalence in the Indian subcontinent, the Middle East, and the Balkans. MostblaNDM-carrying plasmids belong to limited replicon types (IncX3, IncFII, or IncC). Commonly used phenotypic tests cannot specifically identify NDM. Lateral flow immunoassays specifically detect NDM, and molecular approaches remain the reference methods for detectingblaNDM. Polymyxins combined with other agents remain the mainstream options of antimicrobial treatment. Compounds able to inhibit NDM have been found, but none have been approved for clinical use. Outbreaks caused by NDM-positive strains have been reported worldwide, attributable to sources such as contaminated devices. Evidence-based guidelines on prevention and control of carbapenem-resistant Gram-negative bacteria are available, although none are specific for NDM-positive strains. NDM will remain a severe challenge in health care settings, and more studies on appropriate countermeasures are required.

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Section: Detection Of Mblsmentioning

confidence: 99%

NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings

et al. 2019

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“…The speed of emergence of AMR in the region has been as alarming as infectious disease outbreaks. Even in the past year, strains of Klebsiella pneumoniae carrying bla OXA-48-type and bla NDM gene for carbapenem-resistance have been detected in the United Arab Emirates (Moubareck et al 2018), Saudi Arabia (Al-Zahrani and Alsiri 2018), and Iraq (Hussein 2017). Other than the rapid emergence seen, most rates of drug resistance are increasing, such as the annual rise in methicillin resistance among Staphylococcus aureus isolates in Kuwaiti Hospitals from 906 in 2011 to 1771 in 2015 (Udo and Boswihi 2017).…”

Section: Infectious Diseases In the Arab Worldmentioning

confidence: 99%

The Rise of Antimicrobial Resistance in Mass Gatherings

Bokhary¹,

Rashid²,

Hill-Cawthorne³

et al. 2020

Handbook of Healthcare in the Arab World

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Mass gatherings (MGs) are a common human group behavior. Antimicrobial resistance (AMR) is a major public health issue. The Arab world hosts the annual Hajj pilgrimage, a MG with diverse attendees, and the region is also a layover hub for global travels. Although AMR surveillance is still insufficient, the available data on Hajj reveal that the AMR rate is generally high and is increasing each year. Enteric infections are common in Hajj and provide grounds for AMR acquisition and transmission, including emerging resistance to β-lactams. Respiratory infections are a major concern in Hajj, where incidences of outbreaks such as meningococcal disease being documented during the pilgrimage. With the recorded high usage of antimicrobials during Hajj, including mandatory prophylaxis for high-risk travelers and the availability of over-the-counter antimicrobials, the risk of AMR development is likely to increase.

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“…A study under the SENTRY Antimicrobial Surveillance Program (2006Program ( to 2009 showed that polymyxin B had in vitro characteristics similar to those of colistin against Gramnegative bacteria and the resistance rates were only < 0.1% -1.5% (46). However, over the last few decades, the resistance trends have been increasing in an alarming rate among the most common hospital and/or community pathogens including Klebsiella pneumoniae, Acinetobacter baumannii, multiple Pseudomonas spp., and Escherichia coli worldwide (Table 1) (47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57); in some cases, carbapenems-resistant microbial isolates also showed resistance to polymyxins (47,48), making such resistant organism-associated hospital infections difficult-to-treat (Table 1) (47).…”

Section: Dosage Minimum Inhibitory Concentration (Mic) and Resistanmentioning

confidence: 99%

“…Polymyxin B and Colistin Resistance Rate in Common Microbial Isolates(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57) …”

mentioning

confidence: 99%

Therapeutic Specification of the Last Resort Polymyxins: An Intelligent Approach

2019

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Polymyxins, especially polymyxin B and colistin (polymyxin E), are the last resort antibiotics among a few reserve antibiotics still showing potentiality against Gram-negative superbugs. Globally, during the alarming situation of fast-spreading antibiotic resistance in Gram-negative bacteria, the therapeutic application of polymyxins should be rational and target-specific considering their pharmacokinetic (PK) and pharmacodynamic (PD) characteristics. Intravenous polymyxin B shows relatively higher plasma protein binding and excessive renal tubular reabsorption; it invariably exists in the plasma for longer periods, maintaining the minimum inhibitory concentration (MIC) properly, and mostly are excreted out through a nonrenal pathway. On the other hand, intravenous inactive colistimethate sodium is bio-converted in the blood and kidneys into the active colistin moiety that manifests relatively higher colistin concentration in the urinary tract for longer duration possessing the MIC statically. This study comprehensively evaluated the PK and PD data of polymyxins assuming that the therapeutic specification of polymyxin B in bloodstream infections and colistin in urinary tract infections caused by multidrug-resistant Gram-negative bacteria may be an intelligent approach during the emergence of antibiotic resistance. The therapeutic specification of polymyxins may effectively reduce the progression of polymyxin resistance and optimize its therapeutic outcomes in the treatment of life-threatening infections.

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Clonal emergence of Klebsiella pneumoniae ST14 co-producing OXA-48-type and NDM carbapenemases with high rate of colistin resistance in Dubai, United Arab Emirates

Cited by 85 publications

References 13 publications

NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings

NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings

The Rise of Antimicrobial Resistance in Mass Gatherings

Therapeutic Specification of the Last Resort Polymyxins: An Intelligent Approach

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