Molecular characterization of carbapenem-resistant
            <i>Enterobacterales</i>
            in thirteen tertiary care hospitals in Saudi Arabia

Al-Abdely, Hail M.; Alhababi, R.; Dada, Hebah; Roushdy, Hala; Alanazi, Mishaal Mohammed; Gad, Niveen Mohamed; Radwan, Enas E; Al-Dughmani, Hussain; Koura, Bothina; Bader, Mahmoud Mohammed; Deen, Hany Mohammed Al; Bueid, Ahmed S.; Elgaher, Khalid Mohammed; Alghoribi, Majed F.; Albarrag, Ahmed; Somily, Ali M.

doi:10.5144/0256-4947.2021.63

Cited by 22 publications

(31 citation statements)

References 64 publications

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“…The majority of CRE is Klebsiella pneumoniae, which are carbapenem resistant due to the production of carbapenemases (CRKP) [2]. This worldwide trend is also observed in countries of the Arabian Peninsula [3][4][5]. Spread of CRKP is mainly driven by clonal dissemination of so called high-risk multi-drug resistant (HiR MDR) clones [2].…”

Section: Introductionmentioning

confidence: 99%

Diversity of carbapenem-resistant Klebsiella pneumoniae ST14 and emergence of a subgroup with KL64 capsular locus in the Arabian Peninsula

Mouftah

Pál

Higgins

et al. 2021

Eur J Clin Microbiol Infect Dis

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To understand the reasons of successful spread of carbapenem-resistant Klebsiella pneumoniae ST14 (CRKP-ST14) in countries of the Arabian Peninsula, the resistome, capsular locus, carbapenemase carrying plasmid types, and core genome of isolates from the region were compared to global isolates. Thirty-nine CRKP-ST14 strains isolated from 13 hospitals in the United Arab Emirates, Bahrain, and Saudi Arabia were selected for whole genome sequencing on Illumina MiSeq platform based on the variety of carbapenemase genes carried and plasmids bearing these genes. Their resistome, capsular locus, and core genome MLST were compared to 173 CRKP-ST14 genomes available in public databases. The selected 39 CRKP-ST14 produced either NDM-1, OXA-48, OXA-162, OXA-232, KPC-2, or co-produced NDM-1 and an OXA-48-like carbapenemase. cgMLST revealed three clusters: 16 isolates from five UAE cities (C1), 11 isolates from three UAE cities and Bahrain (C2), and 5 isolates from Saudi Arabia (C3), respectively, and seven singletons. Resistance gene profile, carbapenemase genes, and their plasmid types were variable in both C1 and C2 clusters. The majority of CRKP-ST14 had KL2, but members of the C2 cluster and two further singletons possessed KL64 capsular locus. Based on cgMLST comparison of regional and global isolates, CRKP-ST14 with KL64 from four continents formed a distinct cluster, suggesting a recent emergence and spread of this variant. Our findings confirmed clonal transmission coupled with likely horizontal gene transfer in carbapenem-resistant Klebsiella pneumoniae ST14. Dissemination of this genetically flexible, highly resistant clone warrants further monitoring.

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Section: Introductionmentioning

confidence: 99%

Diversity of carbapenem-resistant Klebsiella pneumoniae ST14 and emergence of a subgroup with KL64 capsular locus in the Arabian Peninsula

Mouftah

Pál

Higgins

et al. 2021

Eur J Clin Microbiol Infect Dis

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“…Consistent with our study, previous studies showed that OXA-48 was the most common gene encoding for carbapenemase- producing K pneumoniae in the Kingdom of Saudi Arabia ranging between 68% and 78% of all carbapenemase genes. 16 , 34 , 35 Moreover, in one study, all OXA-48 carbapenemase-producing Enterobacterales were susceptible to CAZ-AVI with good profile for safety and effectiveness. 36 This emphasizes the importance of having CAZ-AVI formulary available in all hospitals in the Kingdom and to be used over colistin-based regimen for the treatment of infections caused by CRE.…”

Section: Discussionmentioning

confidence: 99%

“…carbapenemase genes. 16,34,35 Moreover, in one study, all OXA-48 carbapenemase-producing Enterobacterales were susceptible to CAZ-AVI with good profile for safety and effectiveness. 36 This emphasizes the importance of having CAZ-AVI formulary available in all hospitals in the Kingdom and to be used over colistin-based regimen for the treatment of infections caused by CRE.…”

mentioning

confidence: 99%

“…32 Our findings are consistent with the Infectious Diseases Society of America Guidance recommendations which supported the preferential use of novel β-lactam /β-lactamase inhibitors over colistin-based regimen for the treatment of infections caused by CRE and CAZ-AVI in particular for OXA-48-like carbapenemase. 33 Given that NDM-1 is the second most common genes encountered in Saudi Arabia, 16,34,35 CAZ-AVI should only be recommended if either susceptibility, or at least the absence of the most common MBL genes are proven. Around half of the CRE isolates in this study were carbapenemase producers.…”

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confidence: 99%

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Ceftazidime-Avibactam versus Colistin for the Treatment of Infections Due to Carbapenem-Resistant Enterobacterales: A Multicenter Cohort Study

Almangour¹,

Ghonem²,

Aljabri³

et al. 2022

IDR

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Background The aim of this study was to compare the safety and effectiveness of ceftazidime-avibactam (CAZ-AVI) to colistin-based regimen in the treatment of infections caused by carbapenem-resistant Enterobacterales (CRE). Methods This was a retrospective, multicenter, observational cohort study of inpatients who received either CAZ-AVI or intravenous colistin for treatment of infections due to CRE. The study was conducted in 5 tertiary care hospitals in Saudi Arabia. Main study outcomes included in-hospital mortality, clinical cure at end of treatment, and acute kidney injury (AKI). Univariate analysis and multivariate logistic regression model were conducted to assess the independent impact of CAZ-AVI on the clinical outcome. Results A total of 230 patients were included in this study: 149 patients received CAZ-AVI and 81 patients received colistin-based regimen. Clinical cure (71% vs 52%; P = 0.004; OR, 2.29; 95% CI, 1.31–4.01) was significantly more common in patients who received CAZ-AVI. After adjusting the difference between the two groups, treatment with CAZ-AVI is independently associated with clinical cure (adjusted OR, 2.75; 95% CI, 1.28–5.91). In-hospital mortality (35% vs 44%; P = 0.156; OR, 0.67; 95% CI, 0.39–1.16) was lower in patients who received CAZ-AVI but the difference was not significant. AKI (15% vs 33%; P = 0.002; OR, 0.37; 95% CI, 0.19–0.69) was significantly less common in patients who received CAZ-AVI. Conclusion CAZ-AVI is associated with higher rate of clinical cure and lower rate of AKI compared to colistin. Our findings support the preferential use of CAZ-AVI over colistin-based regimen for treating these infections.

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“…Lack of reporting is probably the reason. Klebsiella pneumoniae is the most reported CRE species in Saudi Arabia with a prevalence of 88% followed by E. coli at 11% [5,19,20]. NDM and OXA-48 enzymes are the major carbapenemases causing resistance in Enterobacteriaceae reported from the Gulf region and Saudi Arabia [20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Carbapenem-Resistant Enterobacteriaceae: A Retrospective Review of Presentation, Treatment, and Clinical Outcomes in a Tertiary Care Referral Hospital

Khamis¹,

AlMusa²,

Hashhoush³

et al. 2022

Cureus

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Background: Carbapenem-resistant Enterobacteriaceae (CRE) is an emerging infectious threat with an increasing incidence locally and worldwide. It carries a high morbidity and mortality; focusing on this topic should be a priority in clinical research as local data are not widely available. The objective of this study is to describe the presentation, risk factors, treatment pattern and clinical outcomes associated with CRE infections.Methods: We conducted a cross-sectional retrospective study in a single center tertiary referral hospital. We included adult patients above 18 years of age with infection due to CRE between January 1, 2018, to December 30, 2019.Results: During this period, 76 cases were studied. The mean age of the cases was 54 years. The majority were immunosuppressed and admitted to the intensive care unit. The most frequent risk factors associated with CRE infection among study subjects included prior antibiotics in the preceding three months and prior hospital admission in the last one year. Klebsiella pneumoniae (77%) represented the most isolated organism. All-cause intensive care unit and in-hospital mortality were significantly higher among patients with pneumonia and bacteremia.Conclusions: CRE infections are associated with higher morbidity and mortality specifically in patients who presented with pneumonia and bacteremia. High resistance rate and limited treatment options have made a great variability in the clinical practice. Appropriate definitive treatment of CRE infections, strict infection control measures, and antimicrobial stewardship program activation are essential.

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

Cited by 22 publications

References 64 publications

Diversity of carbapenem-resistant Klebsiella pneumoniae ST14 and emergence of a subgroup with KL64 capsular locus in the Arabian Peninsula

Diversity of carbapenem-resistant Klebsiella pneumoniae ST14 and emergence of a subgroup with KL64 capsular locus in the Arabian Peninsula

Ceftazidime-Avibactam versus Colistin for the Treatment of Infections Due to Carbapenem-Resistant Enterobacterales: A Multicenter Cohort Study

Carbapenem-Resistant Enterobacteriaceae: A Retrospective Review of Presentation, Treatment, and Clinical Outcomes in a Tertiary Care Referral Hospital

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