The emergence of OXA-48- and NDM-1-positive Klebsiella pneumoniae in Riyadh, Saudi Arabia

Shibl, Atef M.; Al-Agamy, Mohamed H.; Memish, Ziad A.; Senok, Abiola; Khader, Shamshad Abdul; Assiri, Abdullah M.

doi:10.1016/j.ijid.2013.06.016

Cited by 113 publications

(126 citation statements)

References 37 publications

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“…bla CTX-M group1 genes were detected in eight of the nine isolates. In another study, of the 60 K. pneumoniae with reduced susceptibility to carbapenem collected in 2011 (Shibl et al, 2013), 47 (78 %) carried the OXA-48 gene, while NDM-1 and VIM were found in 20 and 1.6 % of the isolates, respectively. None of the isolates harboured a combination of the three resistance genes or KPC.…”

Section: Carbapenemase Productionmentioning

confidence: 95%

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The molecular basis of β-lactamase production in Gram-negative bacteria from Saudi Arabia

Yezli

Shibl

Memish

2015

Journal of Medical Microbiology

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Resistance to b-lactams among Gram-negative bacteria is a worldwide issue. Increased prevalence of extended-spectrum b-lactamase (ESBL)-producers and the dissemination of carbapenem-resistance genes are particularly concerning. ESBL-producing strains are common in the Kingdom of Saudi Arabia, particularly among the Enterobacteriaceae, and carbapenem resistance is on the increase, especially among the non-fermenters. b-lactamase production is a major mechanism of resistance to these agents and although b-lactamase-producing strains have been documented in the Kingdom, relatively few reports characterized the molecular basis of this production. Nevertheless, available data suggest that CTX-M (CTX-M-15 in particular) is the predominant ESBL in the Enterobacteriaceae, with SHV also being prevalent in Klebsiella pneumoniae. Carbapenem resistance in the latter is mainly due to OXA-48 and NDM-1. In Pseudomonas aeruginosa, VEB-like enzymes are the most common ESBLs, and VIM is the prevalent metallo-b-lactamase. OXA-10 extended-spectrum enzymes are also frequent. PER and GES ESBLs have been reported in Acinetobacter baumannii, and oxacillinases (OXA-23 in particular) are the dominant carbapanamases in this species. IntroductionInfections due to Gram-negative bacteria are a leading cause of morbidity and mortality worldwide (Giske et al., 2008). Antimicrobial agents are a major therapeutic tool in the treatment of such infections. However, antimicrobial resistance among Gram-negative bacteria, particularly among the Enterobacteriaceae and the non-fermenters, has become one of the most serious public health concerns worldwide (Giske et al., 2008;Livermore, 2012). The global dissemination of resistance has recently received much attention, especially following reports of the international spread of multi-resistant Enterobacteriaceae, particularly strains resistant to cephalosporins due to the production of CTX-M-type extended-spectrum b-lactamases (ESBLs) and strains producing carbapenemases such as KPC and NDM (Nordmann et al., 2011;Johnson & Woodford, 2013). The spread of resistance determinants is facilitated by a number of factors, including presence on genetic mobile elements, antibiotic misuse, poor infection control practices, and increased international travel. In this context Saudi Arabia is particularly relevant as it is annually a host for more than 4 million Muslim pilgrims from over 180 countries worldwide in the Hajj and Umra seasons. In addition, up to 6 million of the Kingdom's population are expatriates, mainly from south and east Asia, where antimicrobial resistance is rife, including to carbapenems (Yong et al., 2009). These factors could potentially make Saudi Arabia a hot spot for the collection of multidrug-resistant strains and the spread of antibiotic resistance around the world.We previously reported on the antimicrobial resistance among the key Gram-negative bacteria in Saudi Arabia and found increased prevalence of b-lactam-resistant strains, including ESBL-producers, and carbapenem resistance (Y...

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Section: Carbapenemase Productionmentioning

confidence: 95%

“…All these studies were from Riyadh and report the emergence of OXA-48 and NDM-1, especially among K. pneumoniae. Al- Agamy et al (2013) characterized nine resistant K. pneumoniae isolated from Riyadh hospitals in 2011. They detected OXA-48 and NDM carbapenemases in 77.7 and 22.2 % of the isolates, respectively.…”

Section: Carbapenemase Productionmentioning

confidence: 99%

The molecular basis of β-lactamase production in Gram-negative bacteria from Saudi Arabia

Yezli

Shibl

Memish

2015

Journal of Medical Microbiology

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“…Recent study from Riyadh confirmed the emergence of OXA-48 and NDM-1 among K. pneumoniae in which 12 out of 60 K. pneumoniae strains were NDM-1 producers and 47/60 strains were positive for OXA-48. No strain was positive for KPC [16]. Compared to above mentioned studies, current study reports a high percentage of K. pneumoniae (48.4%) isolates to be carbapenemase producers determined by Modified Hodge Test (MHT).…”

Section: Discussionmentioning

confidence: 58%

“…Recent studies conducted in Middle East countries also suggests that this region might be an additional reservoir of NDM producers as it has been reported from Oman [13], Lebanon [14], Saudi Arabia [15,16], and Qatar [17].…”

Section: Introductionmentioning

confidence: 81%

“…Molecular detection of carbapenemase genes using polymerase chain reaction (PCR) based methods was found to be quick, accurate and effective in the detection of specific carbapenemases genes, such as KPC, NDM-1, OXA-48, etc. [13][14][15][16][17]. Simple PCR assays targeting a single carbapenemase type have been used successfully in numerous studies.…”

Section: Introductionmentioning

confidence: 99%

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Frequency of Carbapenemase Producing Klebsiella pneumoniae in Makkah, Saudi Arabia

Khan¹

2016

Journal of Microbiology and Infectious Diseases

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Objective: Carbapenemase producing Klebsiella pneumoniae is emerging as an important pathogen worldwide which has alarming clinical threat with serious effects on patients' outcome. The aim of our study is to determine prevalence of carbapenemase producing K. pneumoniae and its antibiotic susceptibility pattern in tertiary care hospitals. Methods:A prospective study was performed on 260 clinical isolates of K. pneumoniae collected from five different hospitals of Makkah, Saudi Arabia from January to July 2015. All clinical isolates were confirmed as K. pneumoniae using Vitek 2 system. These isolates were then screened for potential carbapenemase producers by determining reduced susceptibility to carbapenems using representative antibiotic disks of third generation cephalosporins and carbapenems in the disk diffusion test following guidelines of Clinical and Laboratory Standards Institute. Minimum inhibitory concentration of isolates found positive in screening test were determined for cephalosporins, carbapenems, aminoglycosides and tigecycline and colistin using Vitek-2 system. Modified Hodge test was performed to detect carbapenemase production on the isolates suspected for carbapenemase production.Results: Out of 260 K. pneumoniae isolates, 31 (11.9%) have shown 100% resistance to all cephalosporins. Of 31 K. pneumoniae isolates, 15 (48.4%) were found positive for carbapenemase. All carbapenem resistant isolates were sensitive to colistin and tigecycline. However, these isolates have shown resistance to amikacin (41.9%) and gentamicin (51.6%), respectively. Conclusion:This is the first report from Makkah reporting carbapenamse producing K.pneumoniae. Of 12% potential carbapenemase producing K.pneumoniae, 48.4% were found positive for carbapenemase production. Molecular characterization of these strains will help to determine the type of carbapenemase prevalent in this area. J Microbiol Infect Dis 2016;6(3): 121-127

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NDM‐Type Carbapenemases in Gram‐Negative Rods

Dortet

Poirel

Nordmann

2015

Human Emerging and Re‐emerging Infections

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The emergence of OXA-48- and NDM-1-positive Klebsiella pneumoniae in Riyadh, Saudi Arabia

Abstract: Multidrug-resistant K. pneumoniae isolates harboring blaOXA-48, blaNDM, and colistin resistance are emerging in Saudi Arabia.

Cited by 113 publications

References 37 publications

The molecular basis of β-lactamase production in Gram-negative bacteria from Saudi Arabia

The molecular basis of β-lactamase production in Gram-negative bacteria from Saudi Arabia

Frequency of Carbapenemase Producing Klebsiella pneumoniae in Makkah, Saudi Arabia

NDM‐Type Carbapenemases in Gram‐Negative Rods

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