1887

Abstract

The molecular epidemiology and resistance mechanisms of carbapenem-resistant (CRPA) were determined in hospitals in the countries of the Gulf Cooperation Council (GCC), namely, Saudi Arabia, the United Arab Emirates, Oman, Qatar, Bahrain and Kuwait.

Isolates were screened for common carbapenem-resistance genes by PCR. Relatedness between isolates was assessed using previously described genotyping methods: an informative-single nucleotide polymorphism MassARRAY iPLEX assay (iPLEX20SNP) and the enterobacterial repetitive intergenic consensus (ERIC)-PCR assay, with selected isolates being subjected to multilocus sequence typing (MLST). Ninety-five non-repetitive isolates that were found to be resistant to carbapenems were subjected to further investigation.

The most prevalent carbapenemase-encoding gene, , was found in 37/95 (39 %) isolates, while only 1 isolate (from UAE) was found to have . None of the CRPA were found to have or . We found a total of 14 sequence type (ST) clusters, with 4 of these clusters being observed in more than 1 country. Several clusters belonged to the previously recognized internationally disseminated high-risk clones ST357, ST235, ST111, ST233 and ST654. We also found the less predominant ST316, ST308 and ST823 clones, and novel MLST types (ST2010, ST2011, ST2012 and ST2013), in our collection.

Overall our data show that ‘high-risk’ CRPA clones are now detected in the region and highlight the need for strategies to limit further spread of such organisms, including enhanced surveillance, infection control precautions and further promotion of antibiotic stewardship programmes.

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2018-06-01
2020-04-01
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References

  1. Jones RN. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis 2010;51:S81–S87 [CrossRef][PubMed]
    [Google Scholar]
  2. Lee MS, Walker V, Chen LF, Sexton DJ, Anderson DJ. The epidemiology of ventilator-associated pneumonia in a network of community hospitals: a prospective multicenter study. Infect Control Hosp Epidemiol 2013;34:657–662 [CrossRef][PubMed]
    [Google Scholar]
  3. Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol 2013;34:1–14 [CrossRef][PubMed]
    [Google Scholar]
  4. Chawla R. Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries. Am J Infect Control 2008;36:S93–S100 [CrossRef][PubMed]
    [Google Scholar]
  5. El-Saed A, Balkhy HH, Al-Dorzi HM, Khan R, Rishu AH et al. Acinetobacter is the most common pathogen associated with late-onset and recurrent ventilator-associated pneumonia in an adult intensive care unit in Saudi Arabia. Int J Infect Dis 2013;17:e696-701 [CrossRef][PubMed]
    [Google Scholar]
  6. Lister PD, Wolter DJ, Hanson ND. Antibacterial-resistant Pseudomonas aeruginosa: clinical impact and complex regulation of chromosomally encoded resistance mechanisms. Clin Microbiol Rev 2009;22:582–610 [CrossRef][PubMed]
    [Google Scholar]
  7. Correa A, del Campo R, Perenguez M, Blanco VM, Rodríguez-Baños M et al. Dissemination of high-risk clones of extensively drug-resistant Pseudomonas aeruginosa in Colombia. Antimicrob Agents Chemother 2015;59:2421–2425 [CrossRef][PubMed]
    [Google Scholar]
  8. Edelstein MV, Skleenova EN, Shevchenko OV, D'Souza JW, Tapalski DV et al. Spread of extensively resistant VIM-2-positive ST235 Pseudomonas aeruginosa in Belarus, Kazakhstan, and Russia: a longitudinal epidemiological and clinical study. Lancet Infect Dis 2013;13:867–876 [CrossRef][PubMed]
    [Google Scholar]
  9. Oliver A, Mulet X, López-Causapé C, Juan C. The increasing threat of Pseudomonas aeruginosa high-risk clones. Drug Resist Updat 2015;21-22:41–59 [CrossRef][PubMed]
    [Google Scholar]
  10. Wright LL, Turton JF, Livermore DM, Hopkins KL, Woodford N. Dominance of international 'high-risk clones' among metallo-β-lactamase-producing Pseudomonas aeruginosa in the UK. J Antimicrob Chemother 2015;70:103–110 [CrossRef][PubMed]
    [Google Scholar]
  11. Zowawi HM, Balkhy HH, Walsh TR, Paterson DL. β-Lactamase production in key gram-negative pathogen isolates from the Arabian Peninsula. Clin Microbiol Rev 2013;26:361–380 [CrossRef][PubMed]
    [Google Scholar]
  12. Al Johani SM, Akhter J, Balkhy H, El-Saed A, Younan M et al. Prevalence of antimicrobial resistance among gram-negative isolates in an adult intensive care unit at a tertiary care center in Saudi Arabia. Ann Saudi Med 2010;30:364–369 [CrossRef][PubMed]
    [Google Scholar]
  13. Peleg AY, Hooper DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 2010;362:1804–1813 [CrossRef][PubMed]
    [Google Scholar]
  14. Memish ZA, Assiri A, Almasri M, Roshdy H, Hathout H et al. Molecular characterization of carbapenemase production among gram-negative bacteria in saudi arabia. Microb Drug Resist 2015;21:307–314 [CrossRef][PubMed]
    [Google Scholar]
  15. Yezli S, Shibl AM, Memish ZA. The molecular basis of β-lactamase production in Gram-negative bacteria from Saudi Arabia. J Med Microbiol 2015;64:127–136 [CrossRef][PubMed]
    [Google Scholar]
  16. Zafer MM, Amin M, El Mahallawy H, Ashour MS, Al Agamy M. First report of NDM-1-producing Pseudomonas aeruginosa in Egypt. Int J Infect Dis 2014;29:80–81 [CrossRef][PubMed]
    [Google Scholar]
  17. Teo JW, La MV, Jureen R, Lin RT. Emergence of a New Delhi metallo-β-lactamase-1-producing Pseudomonas aeruginosa in Singapore. Emerg Microbes Infect 2015;4:e72 [CrossRef][PubMed]
    [Google Scholar]
  18. Mataseje LF, Peirano G, Church DL, Conly J, Mulvey M et al. Colistin-Nonsusceptible Pseudomonas aeruginosa Sequence Type 654 with blaNDM-1 Arrives in North America. Antimicrob Agents Chemother 2016;60:1794–1800 [CrossRef][PubMed]
    [Google Scholar]
  19. Kateete DP, Nakanjako R, Namugenyi J, Erume J, Joloba ML et al. Carbapenem resistant Pseudomonas aeruginosa and Acinetobacter baumannii at Mulago Hospital in Kampala, Uganda (2007–2009). Springerplus 2016;5:1308 [CrossRef][PubMed]
    [Google Scholar]
  20. Devarajan N, Köhler T, Sivalingam P, van Delden C, Mulaji CK et al. Antibiotic resistant Pseudomonas spp. in the aquatic environment: a prevalence study under tropical and temperate climate conditions. Water Res 2017;115:256–265 [CrossRef][PubMed]
    [Google Scholar]
  21. Carattoli A, Fortini D, Galetti R, Garcia-Fernandez A, Nardi G et al. Isolation of NDM-1-producing Pseudomonas aeruginosa sequence type ST235 from a stem cell transplant patient in Italy, May 2013. Euro Surveill 2013;18:20633 [CrossRef][PubMed]
    [Google Scholar]
  22. Vanegas JM, Cienfuegos AV, Ocampo AM, López L, del Corral H et al. Similar frequencies of Pseudomonas aeruginosa isolates producing KPC and VIM carbapenemases in diverse genetic clones at tertiary-care hospitals in Medellín, Colombia. J Clin Microbiol 2014;52:3978–3986 [CrossRef][PubMed]
    [Google Scholar]
  23. Paul D, Dhar Chanda D, Maurya AP, Mishra S, Chakravarty A et al. Co-Carriage of blaKPC-2 and blaNDM-1 in Clinical Isolates of Pseudomonas aeruginosa associated with hospital infections from India. PLoS One 2015;10:e0145823 [CrossRef][PubMed]
    [Google Scholar]
  24. Naas T, Bonnin RA, Cuzon G, Villegas MV, Nordmann P. Complete sequence of two KPC-harbouring plasmids from Pseudomonas aeruginosa. J Antimicrob Chemother 2013;68:1757–1762 [CrossRef][PubMed]
    [Google Scholar]
  25. Kos VN, Déraspe M, McLaughlin RE, Whiteaker JD, Roy PH et al. The resistome of Pseudomonas aeruginosa in relationship to phenotypic susceptibility. Antimicrob Agents Chemother 2015;59:427–436 [CrossRef][PubMed]
    [Google Scholar]
  26. Hu YY, Gu DX, Cai JC, Zhou HW, Zhang R. Emergence of KPC-2-producing Pseudomonas aeruginosa sequence type 463 isolates in Hangzhou, China. Antimicrob Agents Chemother 2015;59:2914–2917 [CrossRef][PubMed]
    [Google Scholar]
  27. Correa A, Del Campo R, Perenguez M, Blanco VM, Rodríguez-Baños M et al. Dissemination of high-risk clones of extensively drug-resistant Pseudomonas aeruginosa in colombia. Antimicrob Agents Chemother 2015;59:2421–2425 [CrossRef][PubMed]
    [Google Scholar]
  28. Carrara-Marroni FE, Cayô R, Streling AP, da Silva AC, Palermo RL et al. Emergence and spread of KPC-2-producing Pseudomonas aeruginosa isolates in a Brazilian teaching hospital. J Glob Antimicrob Resist 2015;3:304–306 [CrossRef][PubMed]
    [Google Scholar]
  29. Woodford N, Turton JF, Livermore DM. Multiresistant Gram-negative bacteria: the role of high-risk clones in the dissemination of antibiotic resistance. FEMS Microbiol Rev 2011;35:736–755 [CrossRef][PubMed]
    [Google Scholar]
  30. Kapiszewski A. Arab versus Asian migrant workers in the GCC countries. In South Asian Migration to Gulf Countries: History, Policies, Development Abingdon, UK: Taylor & Francis Group; 2006; pp.46–70
    [Google Scholar]
  31. Memish ZA. The Hajj: communicable and non-communicable health hazards and current guidance for pilgrims. Euro Surveill 2010;15:19671[PubMed]
    [Google Scholar]
  32. Rogers BA, Aminzadeh Z, Hayashi Y, Paterson DL. Country-to-country transfer of patients and the risk of multi-resistant bacterial infection. Clin Infect Dis 2011;53:49–56 [CrossRef][PubMed]
    [Google Scholar]
  33. Zowawi HM, Ibrahim E, Syrmis MW, Wailan AM, Abdulwahab A et al. PME-1-producing Pseudomonas aeruginosa in Qatar. Antimicrob Agents Chemother 2015;59:3692–3693 [CrossRef][PubMed]
    [Google Scholar]
  34. Zowawi HM, Sartor AL, Balkhy HH, Walsh TR, Al Johani SM et al. Molecular characterization of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae in the countries of the Gulf cooperation council: dominance of OXA-48 and NDM producers. Antimicrob Agents Chemother 2014;58:3085–3090 [CrossRef][PubMed]
    [Google Scholar]
  35. Zowawi HM, Sartor AL, Sidjabat HE, Balkhy HH, Walsh TR et al. Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii isolates in the Gulf Cooperation Council States: dominance of OXA-23-type producers. J Clin Microbiol 2015;53:896–903 [CrossRef][PubMed]
    [Google Scholar]
  36. European Committee on Antimicrobial Susceptibility Testing (EUCAST) 2014; Breakpoint tables for interpretation of MICs and zone diameters, version4. www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/Breakpoint_table_v_4.0.pdf
  37. Anuj SN, Whiley DM, Kidd TJ, Bell SC, Wainwright CE et al. Identification of Pseudomonas aeruginosa by a duplex real-time polymerase chain reaction assay targeting the ecfX and the gyrB genes. Diagn Microbiol Infect Dis 2009;63:127–131 [CrossRef][PubMed]
    [Google Scholar]
  38. Zhao WH, Hu ZQ. IMP-type metallo-β-lactamases in Gram-negative bacilli: distribution, phylogeny, and association with integrons. Crit Rev Microbiol 2011;37:214–226 [CrossRef][PubMed]
    [Google Scholar]
  39. Syrmis MW, Kidd TJ, Moser RJ, Ramsay KA, Gibson KM et al. A comparison of two informative SNP-based strategies for typing Pseudomonas aeruginosa isolates from patients with cystic fibrosis. BMC Infect Dis 2014;14:307 [CrossRef][PubMed]
    [Google Scholar]
  40. Kidd TJ, Grimwood K, Ramsay KA, Rainey PB, Bell SC. Comparison of three molecular techniques for typing Pseudomonas aeruginosa isolates in sputum samples from patients with cystic fibrosis. J Clin Microbiol 2011;49:263–268 [CrossRef][PubMed]
    [Google Scholar]
  41. Larsen MV, Cosentino S, Rasmussen S, Friis C, Hasman H et al. Multilocus sequence typing of total-genome-sequenced bacteria. J Clin Microbiol 2012;50:1355–1361 [CrossRef][PubMed]
    [Google Scholar]
  42. El-Mahdy TS. Identification of a novel metallo-β-lactamase VIM-28 located within unusual arrangement of class 1 integron structure in Pseudomonas aeruginosa isolates from Egypt. Jpn J Infect Dis 2014;67:382–384 [CrossRef][PubMed]
    [Google Scholar]
  43. Zafer MM, Al-Agamy MH, El-Mahallawy HA, Amin MA, Ashour MS. Antimicrobial resistance pattern and their beta-lactamase encoding genes among Pseudomonas aeruginosa strains isolated from cancer patients. Biomed Res Int 2014;2014:1–8 [CrossRef][PubMed]
    [Google Scholar]
  44. Zafer MM, Al-Agamy MH, El-Mahallawy HA, Amin MA, El Din Ashour S. Dissemination of VIM-2 producing Pseudomonas aeruginosa ST233 at tertiary care hospitals in Egypt. BMC Infect Dis 2015;15:122 [CrossRef][PubMed]
    [Google Scholar]
  45. Cornaglia G, Giamarellou H, Rossolini GM. Metallo-β-lactamases: a last frontier for β-lactams?. Lancet Infect Dis 2011;11:381–393 [CrossRef][PubMed]
    [Google Scholar]
  46. Al-Agamy MH, Jeannot K, El-Mahdy TS, Samaha HA, Shibl AM et al. Diversity of molecular mechanisms conferring carbapenem resistance to Pseudomonas aeruginosa isolates from Saudi Arabia. Can J Infect Dis Med Microbiol 2016;2016:4379686 [CrossRef][PubMed]
    [Google Scholar]
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