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Title: Carbapenem resistance determinants and their transmissibility among clinically isolated Enterobacterales in Lebanon
Authors: Moussa, Jennifer
Nassour, Elie
Tahan, Elio
Chaar, Mira El 
Jisr, Tamima
Tokajian, Sima
Affiliations: Department of Medical Laboratory Sciences 
Keywords: Carbapenem
K. pneumoniae
E. coli
Issue Date: 2023-12-01
Publisher: Elsevier
Part of: Journal of Infection and Public Health
Volume: 16
Issue: 12
Start page: 1947
End page: 1953
The occurrence of carbapenem-resistant bacterial infections has increased significantly over the years with Gram-negative bacteria exhibiting the broadest resistance range. In this study we aimed to investigate the genomic characteristics of clinical carbapenem-resistant Enterobacterales (CRE).

Seventeen representative multi-drug resistant (MDR) isolates from a hospital setting showing high level of resistance to carbapenems (ertapenem, meropenem and imipenem) were chosen for further characterization through whole-genome sequencing. Resistance mechanisms and transferability of plasmids carrying carbapenemase-encoding genes were also determined in silico and through conjugative mating assays.

We detected 18 different β-lactamases, including four carbapenemases ( bla NDM-1 , bla NDM-5 , bla NDM-7 , bla OXA-48 ) on plasmids with different Inc groups. The combined results from PBRT and in silico replicon typing revealed 20 different replicons linked to plasmids ranging in size between 80-200 kb. The most prevalent Inc groups were IncFIB(K) and IncM. OXA-48, detected on 76-kb IncM1 conjugable plasmid, was the most common carbapenemase. We also detected other conjugative plasmids with different carbapenemases confirming the role of horizontal gene transfer in the dissemination of antimicrobial resistance genes

Our findings verified the continuing spread of carbapenemases in Enterobacterales and revealed the type of mobile elements circulating in a hospital setting and contributing to spread of resistance determinants. The occurrence and transmission of plasmids carrying carbapenemase-encoding genes call for strengthening active surveillance and prevention efforts to control antimicrobial resistance dissemination in healthcare settings.
Open URL: Link to full text
Type: Journal Article
Appears in Collections:Department of Medical Laboratory Sciences

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