The first nationwide surveillance of carbapenem-resistant Enterobacterales in the United Arab Emirates – increased association of Klebsiella pneumoniae CC14 clone with Emirati patients

Early Years of Carbapenem-Resistant Enterobacterales Epidemic in Abu Dhabi

“…Only as recently as in 2018, a relatively small-scale research project revealed in Dubai the dominance of the highly resistant Klebsiella pneumoniae sequence type (ST) 14 strains [ 19 ]. This was subsequently confirmed by a recent, nationwide study detecting those strains in all major hospitals included in the study across the country [ 20 ]. The same study also identified the simultaneous high prevalence of K. pneumoniae ST147 and, in two regions, of K. pneumoniae ST231 strains.…”

“…The latest major clone appearing in Abu Dhabi was the K. pneumoniae ST231 in 2014. Importantly, the rate of neither of the three clones has significantly changed after 2014–2015 when compared with more recent data of 2018–2019 [ 20 ] ( Table 1 and Figure 1 ).…”

“…Systematic, continuous surveillance studies relying on strain typing have not addressed the unfolding of the CRE outbreak. Therefore, whether the features of the current CRE epidemic, i.e., dominance of a few K. pneumoniae clones (ST14, CC147, and ST231), and a high rate of double carbapenemase producers and MBLs [ 19 , 20 , 21 ] are a relatively recent phenomenon or have developed much earlier and have been maintained since remained unknown.…”

“…The current study clearly showed that the ratios of these three clones, albeit at different speed, increased over time practically from the very early years of the outbreak, and by as early as 2014–2015, their combined rate exceeded 60% with a slight, nonsignificant decline subsequently. This increasing trend was the most pronounced regarding ST14 isolates ( Figure 1 ), i.e., the clone was still the most prevalent type in 2018–2019 [ 20 ]. Furthermore, ST14 strains encountered between 2011 and 2015 were the most resistant ( Table 3 ), i.e., a feature continuously observed in the more recent strain collection [ 20 ].…”

“…In the current, retrospective study, we analyzed CRE strains collected in the hospitals of the Abu Dhabi Emirate in 2009–2015, i.e., during the early years of the local CRE epidemic. The data obtained were compared with those extracted from a recent, nationwide study [ 20 ] to reveal if the currently dominating clones had already been present from the beginning, or their emergence and spread were more recent events.…”