Carbapenem and colistin-resistant bacteria in North Lebanon: Coexistence of mcr-1 and NDM-4 genes in Escherichia coli

Abstract

Introduction: The increasing incidence of infections caused by multidrug-resistant bacteria is considered a global health problem. This study aimed to investigate this resistance in Gram-negative bacteria isolated from patients hospitalized in North-Lebanon.
 Methodology: All isolates were identified using the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antibiotic susceptibility testing was achieved using disk diffusion, E-test and Broth microdilution methods. Phenotypic detection of carbapenemase was carried out using the CarbaNP test. RT-PCR, standard-PCR and sequencing were performed to detect resistance genes and oprD gene. Conjugal transfer was carried out between our isolates and Escherichia coli J53 to detect the genetic localization of resistance genes. MLST was conducted to determine the genotype of each isolate.
 Results: Twenty-three carbapenem-resistant Enterobacterales of which eight colistin-resistant Escherichia coli, and Twenty carbapenem-resistant Pseudomonas aeruginosa were isolated. All isolates showed an imipenem MIC greater than 32 mg/mL with MICs for colistin greater than 2 mg/L for E. coli isolates. All the Enterobacterales isolates had at least one carbapenemase-encoding gene, with E. coli isolates coharboring blaNDM-4 and mcr-1 genes. Moreover, 16/20 Pseudomonas aeruginosa harbored the blaVIM-2 gene and 18/20 had mutations in the oprD gene. MLST revealed that the isolates belonged to several clones.
 Conclusions: We report here the first description in the world of clinical E. coli isolates coharboring blaNDM-4 and mcr-1 genes, and K. pneumoniae isolates producing NDM-6 and OXA-48 carbapenemases. Also, we describe the emergence of NDM-1-producing E. cloacae in Lebanon. Screening for these isolates is necessary to limit the spread of resistant microorganisms in hospitals.

Antimicrobial Resistance and Prevalence of Extended Spectrum β-Lactamase-Producing Escherichia coli from Dogs and Cats in Northeastern China from 2012 to 2021

“…Notably, for the first time, an E. coli resistant to all 13 categories of antibiotics tested (except aztreonam) was isolated from working dog samples, and it carried both mcr-1 and bla NDM-4 . E. coli carrying both genes has been previously isolated only from broiler feces in China [ 34 ] and from human patients in north Lebanon [ 35 ]. Study has shown that the fitness cost of bla NDM-4 carriage is not lower and that its presence might indicate rare occurrence and transmission among strains of different origins [ 34 ], but relevant genes were still detected in working dogs.…”

Screening of mcr-1 among Gram-Negative Bacteria from Different Clinical Samples from ICU Patients in Alexandria, Egypt: One-Year Study

“… Abd El-Baky et al (2020) reported the presence of mcr-1 among their P. aeruginosa isolates. Additionally, Yanat et al (2016) reported the presence of mcr-1 in E. coli clinical isolate in Algeria, Alghoribi et al (2019) also found mcr-1 gene in uropathogenic E. coli in Saudia Arabia, and mcr-1 was also reported from E. coli clinical isolate in Lebanon ( Al-Bayssari et al 2021 ). However, some studies could not detect mcr-1 among colistin-resistant bacterial isolates, Ramadan et al (2020) did not find any of the eight mcr family genes ( mcr-1 to mcr-8 ) among 65 Gram-negative bacterial isolates ( Soliman et al 2020b ).…”

“… Han et al (2020) reported the identification of the XDR E. coli clinical isolate co-harboring mcr-1 and bla NDM-1 . Al-Bayssari et al (2021) reported the co-existence of bla NDM-4 and mcr-1 among E. coli clinical isolates.…”

retrospecRisk factors of carbapenem-resistant Gram-negative bacteria pneumonia and mortality

“…Some scholars have pointed out in the study that patients with coronary heart disease often suffer from cardiac insufficiency under the blow of refractory infection, resulting in death (26)(27); Diabetic patients with vascular diseases of other organs, severe acute complications of diabetes will increase the mortality of patients. It is necessary to strengthen the monitoring of diabetic patients to prevent complications (28)(29). Shock patients themselves are in a state of circulatory failure and the condition is poor, so it is an important cause of death in patients with carbapenemresistant gram-negative bacteria pneumonia (30)(31).…”