Phenotypic and molecular characterization of multidrug-resistant Enterobacterales isolated from clinical samples in Palestine: a focus on extended-spectrum β-lactamase- and carbapenemase-producing isolates

• Published in: BMC infectious diseases 2024-08, Vol.24 (1), p.812-12, Article 812
• Main Authors: Ibaideya, Mamoun At, Taha, Adham Abu, Qadi, Mohammad
• Format: Article
• Language: English
• Subjects: Acids; Adolescent; Adult; Aged; Anti-Bacterial Agents - pharmacology; Antibiotics; Antimicrobial agents; Antimicrobial Resistance; Bacteria; Bacterial Proteins - genetics; Bacterial Proteins - metabolism; beta-Lactamases - genetics; Carbapenem-Resistant; Carbapenem-Resistant Enterobacteriaceae - drug effects; Carbapenem-Resistant Enterobacteriaceae - genetics; Carbapenem-Resistant Enterobacteriaceae - isolation & purification; Carbapenemase; Carbapenems; Carbapenems - pharmacology; Child; Child, Preschool; Colistin; Colistin-resistant; Cross-Sectional Studies; Drug resistance; Drug Resistance, Multiple, Bacterial - genetics; E coli; Enterobacter cloacae; Enterobacterales; Enterobacteriaceae - drug effects; Enterobacteriaceae - enzymology; Enterobacteriaceae - genetics; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Enzymes; Extended-spectrum β-lactamase; Female; Fluoroquinolones; Fosfomycin; Genes; High resistance; Hospitals; Humans; Inactivation; Indicator organisms; Klebsiella; Male; Microbial Sensitivity Tests; Microbiology; Middle Aged; Middle East - epidemiology; Morbidity; Multidrug resistance; Nitrofurantoin; Phenotype; Phenotypes; Real time; Silent (cryptic) antimicrobial resistance genes; Sulfamethoxazole; Transmissible infections; Trimethoprim; Young Adult; β Lactamase
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-024-09726-x

Infections resulting from multidrug-resistant Enterobacterales (MDR-E) pose a growing global threat, presenting challenges in treatment and contributing significantly to morbidity and mortality rates. The main objective of this study was to characterize phenotypically and genetically extended-spectrum β-lactamase- and carbapenemase- producing Enterobacterales (ESBLE and CPE respectively) isolated from clinical samples in the West Bank, Palestine. A cross sectional study was conducted in October 2023 on clinical bacterial isolates collected from five governmental hospitals in the West Bank, Palestine. The isolates obtained from the microbiology laboratories of the participating hospitals, underwent identification and antibiotic susceptibility testing (AST) using the VITEK 2 Compact system. ESBL production was determined by the Vitek2 Compact system. A modified carbapenem inactivation method (mCIM) was employed to identify carbapenemase-producing Enterobacterales (CPE). Resistance genes were detected by real-time PCR. Out of the total 1380 collected isolates, we randomly selected 600 isolates for analysis. Our analysis indicated that 287 (47.83%) were extended-spectrum beta-lactamase producers (ESBLE), and 102 (17%) as carbapenem-resistant Enterobacterales (CRE) isolates. A total of 424 isolates (70.67%) were identified as multidrug-resistant Enterobacterales (MDRE). The most prevalent ESBL species were K. pneumoniae (n = 124; 43.2%), E. coli (n = 119; 41.5%) and E. cloacae (n = 31; 10.8%). Among the CRE isolates, 85 (83.33%) were carbapenemase-producing Enterobacterales (CPE). The most frequent CRE species were K. pneumoniae (n = 63; 61.7%), E. coli (n = 25; 24.5%) and E. cloacae (n = 13; 12.8%). Additionally, 47 (7.83%) isolates exhibited resistance to colistin (CT), with 38 (37.62%) being CT-resistant CRE and 9 (3.14%) being CT-resistant ESBLE while sensitive to carbapenems. We noticed that 11 isolates (6 Klebsiella pneumoniae and 5 Enterobacter cloacae complex) demonstrated sensitivity to carbapenems by phenotype but carried silent CPE genes (1 blaOXA48, and 6 blaNDM, 4 blaOXA48, blaNDM). ESBL-producing Enterobacterales strains exhibited varied resistance patterns across different antibiotic classes. E. coli isolates showed notable 48% resistance to trimethoprim/sulfamethoxazole. K. pneumoniae isolates displayed a significant resistance to trimethoprim/sulfamethoxazole, nitrofurantoin, and fosfomycin (54%, 90%, and 70% respectively). E. cloacae isolates