Prevalence and molecular determinants of carbapenemase-producing Klebsiella pneumoniae isolated from Jazan, Saudi Arabia

Abstract

Introduction: The World Health Organization (WHO) designated Carbapenem-resistant Enterobacterales (CRE), formerly Enterobacteriaceae, among the global priority list of antibiotic-resistant bacteria. The rate of CRE in Arabian countries, including Saudi Arabia has increased. Here, we report the prevalence of carbapenemase-producing Klebsiella pneumoniae (CPKP) in the Jazan region, a southern coastal province of Saudi Arabia. Methodology: Eighty-six non-repetitive clinical isolates of K. pneumoniae that showed resistance to at least one of the carbapenem drugs were collected from three tertiary hospitals in the Jazan region from March 2020 to April 2021. The identification and antimicrobial susceptibility testing (AST) of isolates were performed using various automated systems. Molecular detection of carbapenemase genes was conducted using a multiplex PCR. Results: Out of the 86 tested CRKP isolates, 64 (74.4%) were carbapenemase-producing isolates. The blaOXA-48 gene was the most predominant carbapenemase gene, detected in 65.1% (n = 56) of isolates. The blaNDM gene was detected in only 9.3% (n = 8) of isolates; three were found to be co-harbored with blaVIM. Interestingly, one isolate of CRKP was found to have carbapenemase genes (blaNDM, blaVIM and blaKPC), which was associated with COVID-19 patient. Conclusions: The incidence of carbapenemase-producing K. pneumoniae in Jazan hospitals seemed to be high, confirming the continued prevalence of carbapenem resistance in Saudi Hospitals. We report K. pneumoniae strain with triple carbapenemase genes in southern Saudi Arabia. The emergence of such an isolate could threaten patients and healthcare workers and requires great attention to rapid interventions to avoid further dissemination, particularly during the COVID-19 pandemic.

Antibiotic Resistance Trends Among Enterobacteriaceae in Saudi Arabia: A Systematic Review

“…Enterobacteriaceae that harbored carbapenemase enzyme was detected in some studies [20,27,29,33,35,37,39]. On the other hand, the AmpC enzyme was identified among Enterobacteriaceae in only one study [28].…”

“…It was detected that the bacterial strains were highly resistant to meropenem and imipenem [20], ciprofloxacin, tobramycin [22], ampicillin, amoxicillin-clavulanic acid, and cephalothin, cefuroxime [23] before 2013. On the other hand, in the last decade, the bacterial pathogens exhibited resistance to other antibiotics classes such as ceftazidime [24,25,29,33,35], trimethoprim/sulfa [24,25,33,35], norfloxacin [24], aminoglycosides [26,29,35], ceftriaxone [29], cefepime [29], tigecycline [30,35,[37][38][39], aztreonam [33], ofloxacin [33], levofloxacin [35], piperacillin-tazobactam [35,39], amikacin [35], fosfomycin [35]. The shift in resistance patterns in the last decade, with bacterial strains showing resistance to newer antibiotic classes, indicates a dynamic adaptation of bacteria to the antibiotic landscape, which suggests a need for updated treatment guidelines and an awareness of emerging resistance to newer antimicrobial agents.…”

“…In a study published in 2013, the resistance rate to both imipenem and meropenem was recorded at 15.5%. However, as time progressed, this resistance rate gradually climbed to a staggering 100% [20,33,[35][36][37][38][39].…”