The emergence and global spread of carbapenemase-producing Enterobacteriaceae and Acinetobacter baumannii are of great concern to health services worldwide. These β-lactamases hydrolyse almost all β-lactams, are plasmid-encoded, and are easily transferable among bacterial species. They are mostly of the KPC, VIM, IMP, NDM, and OXA-48 types. Their current extensive spread worldwide in Enterobacteriaceae is an important source of concern. Infections caused by these bacteria have limited treatment options and have been associated with high mortality rates. Carbapenemase producers are mainly identified among Klebsiella pneumoniae, Escherichia coli, and A. baumannii and still mostly in hospital settings and rarely in the community. The Mediterranean region is of interest due to a great diversity and population mixing. The prevalence of carbapenemases is particularly high, with this area constituting one of the most important reservoirs. The types of carbapenemase vary among countries, partially depending on the population exchange relationship between the regions and the possible reservoirs of each carbapenemase. This review described the epidemiology of carbapenemases produced by enterobacteria and A. baumannii in this part of the world highlighting the worrisome situation and the need to screen and detect these enzymes to prevent and control their dissemination.

c Here, we report the first autochthonous cases of infections caused by bla NDM-5 New Delhi metallo-␤-lactamase-producing Escherichia coli strains recovered from urine and blood specimens of three patients from Algeria between January 2012 and February 2013. The three isolates belong to sequence type 2659 and they coexpress bla CTX-M-15 with the bla TEM-1 and bla aadA2 genes. Escherichia coli is one of the most common causative agents of infection in humans, and the emergence of resistance to thirdgeneration cephalosporins by extended-spectrum ␤-lactamases (ESBLs) has led to an increased use of carbapenem compounds (1). The growing incidence of resistance to carbapenems among Enterobacteriaceae is of major concern worldwide (1). Carbapenemase producers are mainly identified in Klebsiella pneumoniae and, to a lesser extent, in E. coli and other enterobacterial species. Carbapenemases are classified into three different classes (A, B, and D) and are now a serious problem due to their rapid spread in Enterobacteriaceae (1). Among the newly emerged ␤-lactamases in the world, New Delhi metallo-␤-lactamase (NDM) represents the latest threat for public health (2). It was first reported from K. pneumoniae and E. coli isolates recovered from a Swedish patient previously hospitalized in India (2). Since then, seven additional NDM variants have been described worldwide (2) (Fig. 1). New Delhi metallo-␤-lactamase 1 (NDM-1), which can be produced by different Enterobacteriaceae, has been reported worldwide, including recently in Acinetobacter baumannii clinical isolates in Algeria (3). In this report, we describe the first detection of bla NDM-5 -containing New Delhi metallo-␤-lactamase-producing E. coli clinical isolates in Algeria.A total of 105 consecutive and nonduplicate E. coli clinical isolates were recovered from hospitalized and nonhospitalized patients at the University Hospital of Annaba, Algeria, and were screened for carbapenem resistance between January 2012 and February 2013. During the study period, out of the 105 isolates, a total of 3 isolates harbored the bla NDM-5 gene. Out of these 3 bla NDM-5 -positive isolates, one was isolated from the blood of a 5-month-old child hospitalized in the pediatric ward, while two were isolated from urine samples from a 63-year-old man and a 75-year-old man. The isolates were identified using the Bruker Daltonics Microflex matrix-assisted laser desorption ionizationtime of flight (MALDI-TOF) mass spectrometer (Bremen, Germany), as previously described (3).These three isolates were resistant to all ␤-lactams, with an imipenem MIC of Ͼ32 g/ml and a high level of resistance to aminoglycosides and fluoroquinolones. They were susceptible only to tigecycline, fosfomycin, and colistin. Thus, NDM-5-harboring strains might be highly multidrug resistant, and a previous report on NDM-5-producing E. coli sequence type 648 (ST648) (GenBank accession no. JN104597) demonstrated that the strain was resistant to all available antimicrobials except tigecycline and colistin (4), and we obser...

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