Molecular characterization of carbapenem-resistant Enterobacterales in thirteen tertiary care hospitals in Saudi Arabia-Reference-Cited by-同舟云学术

Molecular characterization of carbapenem-resistant Enterobacterales in thirteen tertiary care hospitals in Saudi Arabia

Published:2021-04 Issue:2 Volume:41 Page:63-70
ISSN:0256-4947
Container-title:Annals of Saudi Medicine
language:en
Short-container-title:Ann Saudi Med

Author:

Al-Abdely Hail¹,AlHababi Raed²,Dada Hebah Mahmoud³,Roushdy Hala⁴,Alanazi Mishaal Mohammed⁵,Alessa Ali Abdullah⁶,Gad Niveen Mohamed⁷,Alasmari Abdullah Mohammed⁸,Radwan Enas Elsabaee⁹¹⁰,Al-Dughmani Hussain¹¹,Koura Bothina¹²,Bader Mahmoud Mohammed¹³,Deen Hany Mohammed Al¹⁴,Bueid Ahmed¹⁵,Elgaher Khalid Mohammed¹⁶,Alghoribi Majed F.¹⁷¹⁸,Albarrag Ahmed M.¹⁹,Somily Ali Mohammed¹⁹^ORCID

Affiliation:

1. From the Department of Internal Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

2. From the Department of Microbiology, King Saud Medical City, Riyadh, Saudi Arabia

3. From the Medical Microbiology, National Antimicrobial Resistance, Saudi Centre for Disease Prevention and Control, Riyadh, Saudi Arabia

4. From the General Directorate of Infection Prevention and Control, Ministry of Health, Riyadh, Saudi Arabia

5. From the Department of Laboratories and Blood Bank, Algurayat Health Affairs, Riyadh, Saudi Arabia

6. From the Department of Microbiology, Aseer Central Hospital, Abha, Saudi Arabia

7. From the Department of Microbiology, King Fahad General Hospital, Madinah, Saudi Arabia

8. From the Department of Microbiology, King Salman bin Abdulaziz Hospital, Riyadh, Saudi Arabia

9. From the Department of Microbiology, King Khalid Hospital, Al Kharj, Saudi Arabia

10. From the Department of Clinical Pathology, Al-Azhar University, Cairo, Egypt

11. From the Gurayat Regional Laboratory and Blood Bank - Infectious Diseases, Gurayat, Saudi Arabia

12. From the Department of Microbiology, King Fahad Specialist Hospital, Qassim, Buraidah, Saudi Arabia

13. From the Department of Microbiology and Immunology, Hail General Hospital, Hail, Saudi Arabia

14. From the Department of Microbiology, King Faisal Medical Complex, Taif, Makkah, Saudi Arabia

15. From the Medical & Molecular Microbiology, Clinical Microbiology, Regional Laboratory and Blood Bank, Dammam, Saudi Arabia.

16. From the Department of Microbiology, Arar Central Hospital, Arar, Saudi Arabia

17. From the Department of Infectious Diseases Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

18. From the King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

19. From the Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia

Abstract

BACKGROUND: Carbapenems are the antibiotics of last-resort for the treatment of bacterial infections caused by multidrug-resistant organisms. The emergence of resistance is a critical and worrisome problem for clinicians and patients. Carbapenem-resistant Enterobacterales (CRE) are spreading globally, are associated with an increased frequency of reported outbreaks in many regions, and are becoming endemic in many others. OBJECTIVES: Determine the molecular epidemiology of CRE isolates from various regions of Saudi Arabia to identify the genes encoding resistance and their clones for a better understanding of the epidemio-logical origin and national spread. DESIGN: Multicenter, cross-sectional, laboratory-based study. SETTING: Samples were collected from 13 Ministry of Health tertiary-care hospitals from five different regions of Saudi Arabia. METHODS: Isolates were tested using the GeneXpert molecular platform to classify CRE. MAIN OUTCOME MEASURES: Prevalence of various types of CRE in Saudi Arabia. SAMPLE SIZE: 519 carbapenem-resistant isolates. RESULT: Of 519 isolates, 440 (84.7%) were positive for CRE, with Klebsiella pneumoniae (410/456, 90%) being the most commonly isolated pathogen. The distribution of the CRE-positive K pneumoniae resistance genes was as follows: OXA-48 (n=292, 71.2%), NDM-1 (n=85, 20.7%), and NDM+OXA-48 (n=33, 8%). The highest percentage of a single blaOXA-48 gene was detected in the central and eastern regions (77%), while the bla NDM -gene was the predominant type in the northern region (27%). The southern regions showed the lowest percentages for harboring both blaOXA-48 and bla NDM genes (4%), while the western region isolates showed the highest percentage of harboring both genes (14%). CONCLUSION: The results illustrate the importance of molecular characterization of CRE isolates for patient care and infection prevention and control. Larger multicenter studies are needed to critically evaluate the risk factors and trends over time to understand the dynamics of spread and effective methods of control. LIMITATIONS: Lack of phenotypic susceptibility and clinical data. CONFLICT OF INTEREST: None.

Publisher

King Faisal Specialist Hospital and Research Centre

Subject

General Medicine

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