Resistance to novel antimicrobial agents among NDM-and OXA-48-producing Carbapenem-resistant Enterobacterales in Lebanon

Abstract

Rapid detection of carbapenemases and antimicrobial susceptibility testing (AMST) against carbapenem-resistant (CR) Enterobacterales (CRE) are key elements in controlling their nosocomial spread and useful to guide treatment of patients infected with such morbid pathogens. The absence of comprehensive data in Lebanon prompted this study. This study aimed at revealing the carbapenemase types among CR isolates recovered from patients representing 100 Escherichia coli (CREc) and 40 Klebsiella pneumoniae (CRKp). Their antimicrobial resistance (AMR) profiles against routine and novel antimicrobial agents were also determined. Identification of isolates was done by MALDI-TOF, and the types of carbapenemases were determined by the rapid NG-Test CARBA. Antimicrobial resistance (AMR) profiles were revealed against the routine antibiotics, including ceftazidime-avibactam, and novel antimicrobial agents that still have not been introduced in this country, namely, imipenem-relebactam, meropenem-vaborbactam, and cefiderocol using disk diffusion and standard Etest methods. Among both CREc and CRKp, the detected carbapenemases were only NDM and OXA-48, whereby the majority were NDM. The activity of novel antimicrobial agents was higher against CREc than CRKp isolates, and against OXA-48- producing strains than NDM-producing strains in both species. This first comprehensive in vitro study from Lebanon revealed high resistance (28%-100%, and 0%-100% among NDM and OXA-48 producers, respectively) of yet-to-be- introduced novel antimicrobial agents in this country. This highlights the necessity of scrutinizing the proper use of antimicrobial agents, stewardship programs, and infection control aspects to curb the morbid impact of these pathogens.