Prevalence of carbapenem resistance encoding genes and corresponding MIC90 in enterobacteriaceae at a tertiary medical care center in Lebanon

Kissoyan, Kohar Annie B.; Araj, George F.; Matar, Ghassan M.

doi:10.3823/785

Cited by 2 publications

(3 citation statements)

References 26 publications

(20 reference statements)

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“…The prevalence of blaOXA-48, blaNDM-1, blaTEM-1 and blaCTX-M-15 among the E. coli isolates were 36%, 12%, 20% and 80%, respectively, while among K. pneumoniae isolates they were 37%, 28%, 28% and 72%, respectively. The presence of more than one carbapenem resistance encoding gene and/ or ESBL encoding gene did not have an effect on the MIC 90 value in K. pneumoniae isolates, while in E. coli they resulted in higher MIC 90 values [14].…”

Section: Discussionmentioning

confidence: 77%

“…Studies at our medical center since 2008 have been addressing molecular characterizations, resistance mechanisms, genes involved, and other aspects of CR Ec and Kp isolates [9,10,[12][13][14]. The first CRE detected in Lebanon was a K. pneumoniae recovered from a 7year-old female child, which was characterized by PCR experiments using primers for multiple β-lactamase and carbapenemase genes: TEM, SHV, CTX-M, GES, KPC, IMI, OXA-1 ⁄ 2 ⁄ OXA-10 ⁄ 18, OXA-23 ⁄ 58, IMP, VIM, SPM, GIM and SIM.…”

Section: Discussionmentioning

confidence: 99%

“…In Lebanon, similar problems and challenges have been encountered since CRE pathogens were introduced in this country several years ago [9,10]. As a result, several studies have been conducted to describe the phenotypic and molecular features of CR E. coli and K. pneumoniae in this country [5,[11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial agents active against carbapenem-resistant Escherichia coli and Klebsiella pneumoniae isolates in Lebanon

Araj

Avedissian

Itani

et al. 2018

J Infect Dev Ctries

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Introduction: It is not yet clear which antimicrobial agents should be used to treat the ominously increasing infections with carbapenem-resistant (CR) bacteria. We therefore investigated the activity of different antimicrobial agents against CR Escherichia coli and Klebsiella pneumoniae in Lebanon. Methodology: This retrospective study assessed the minimum inhibitory concentrations (MICs) of three carbapenems (by Etest), as well as the in vitro activity of eight other antimicrobials (by disk diffusion) against CR E. coli (n = 300) and K. pneumoniae (n = 232) isolates recovered at a major University Medical Center in Lebanon. Results: Higher percentages of isolates showing carbapenem MICs of ≤ 8 µg/mL were noted among the CR E. coli compared to the CR K. pneumoniae for ertapenem (48% vs 27%), imipenem (74 % vs 58%) and meropenem (82% vs 63%). Among the eight other antimicrobials, activity was generally higher when the MICs for the three carbapenems were ≤ 8 µg/mL. Regardless of the MIC level of the three carbapenems, very low susceptibility rates (≤ 33%) were noted for ciprofloxacin, trimethoprim-sulfamethoxazole and aztreonam against both E. coli and K. pneumoniae isolates. With Amikacin, higher susceptibility rates were seen against E. coli isolates (81%-97%) than against K. pneumoniae isolates (55%-86%), also reflecting higher activity than gentamicin (44%-54%). The best activity (66%-100%) was observed for tigecycline, colistin and fosfomycin against both CR species. Conclusions: Based on the in vitro findings in this study, the combination of a carbapenem showing an MIC of ≤ 8 µg/mL together with an active colistin, tigecycline, or fosfomycin, would offer a promising treatment option for patients infected with CR E. coli or K. pneumoniae.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Antimicrobial agents active against carbapenem-resistant Escherichia coli and Klebsiella pneumoniae isolates in Lebanon

Araj

Avedissian

Itani

et al. 2018

J Infect Dev Ctries

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The 2018 Lebanese Society of Infectious Diseases and Clinical Microbiology Guidelines for the use of antimicrobial therapy in complicated intra-abdominal infections in the era of antimicrobial resistance

et al. 2019

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Background The Lebanese Society of Infectious Diseases and Clinical Microbiology (LSIDCM) is involved in antimicrobial stewardship. In an attempt at guiding clinicians across Lebanon in regards to the proper use of antimicrobial agents, members of this society are in the process of preparing national guidelines for common infectious diseases, among which are the guidelines for empiric and targeted antimicrobial therapy of complicated intra-abdominal infections (cIAI). The aims of these guidelines are optimizing patient care based on evidence-based literature and local antimicrobial susceptibility data, together with limiting the inappropriate use of antimicrobials thus decreasing the emergence of antimicrobial resistance (AMR) and curtailing on other adverse outcomes. Methods Recommendations in these guidelines are adapted from other international guidelines but modeled based on locally derived susceptibility data and on the availability of pharmaceutical and other resources. Results These guidelines propose antimicrobial therapy of cIAI in adults based on risk factors, site of acquisition of infection, and clinical severity of illness. We recommend using antibiotic therapy targeting third-generation cephalosporin (3GC)-resistant gram negative organisms, with carbapenem sparing as much as possible, for community-acquired infections when the following risk factors exist: prior (within 90 days) exposure to antibiotics, immunocompromised state, recent history of hospitalization or of surgery and invasive procedure all within the preceding 90 days. We also recommend antimicrobial de-escalation strategy after culture results. Prompt and adequate antimicrobial therapy for cIAI reduces morbidity and mortality; however, the duration of therapy should be limited to no more than 4 days when adequate source control is achieved and the patient is clinically stable. The management of acute pancreatitis is conservative, with a role for antibiotic therapy only in specific situations and after microbiological diagnosis. The use of broad-spectrum antimicrobial agents including systemic antifungals and newly approved antibiotics is preferably restricted to infectious diseases specialists. Conclusion These guidelines represent a major step towards initiating a Lebanese national antimicrobial stewardship program. The LSIDCM emphasizes on development of a national AMR surveillance network, in addition to a national antibiogram for cIAI stratified based on the setting (community, hospital, unit-based) that should be frequently updated.

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Prevalence of carbapenem resistance encoding genes and corresponding MIC90 in enterobacteriaceae at a tertiary medical care center in Lebanon

Abstract: Background: The aim of this study was to correlate genes involved in carbapenem resistance to MIC levels among clinical ESBL and non-ESBL producing carbapenem resistant Enterobacteriaceae (CRE) isolates of Escherichia coli and Klebsiella pneumoniae.

Cited by 2 publications

References 26 publications

Antimicrobial agents active against carbapenem-resistant Escherichia coli and Klebsiella pneumoniae isolates in Lebanon

Antimicrobial agents active against carbapenem-resistant Escherichia coli and Klebsiella pneumoniae isolates in Lebanon

The 2018 Lebanese Society of Infectious Diseases and Clinical Microbiology Guidelines for the use of antimicrobial therapy in complicated intra-abdominal infections in the era of antimicrobial resistance

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