PMID- 34477546
OWN - NLM
STAT- MEDLINE
DCOM- 20210916
LR  - 20210916
IS  - 1473-5644 (Electronic)
IS  - 0022-2615 (Linking)
VI  - 70
IP  - 9
DP  - 2021 Sep
TI  - Molecular characterization of rectal isolates of carbapenemase-negative 
      carbapenem-resistant enterobacterales obtained from ICU patients in Kuwait by 
      whole-genome sequencing.
LID - 10.1099/jmm.0.001409 [doi]
AB  - Introduction. Carbapenem-resistant enterobacterales (CRE) are listed among the 
      most urgent antibiotic resistance threats.Hypothesis. Previous studies on the 
      mechanisms of CRE in Kuwait have focused on carbapenemases. There have been no 
      studies on non-carbapenemase-producing CRE in Kuwait.Aim/Gap Statement. The aim 
      of this study was to investigate the genetic characteristics of 
      non-carbapenemase-producing carbapenem-resistant enterobacterales (NCPE) isolates 
      using whole-genome sequencing (WGS).Methodology. Fourteen confirmed NCPE isolates 
      that were negative for genes encoding carbapenemase production by polymerase 
      chain reaction (PCR) assays using rectal swabs from intensive care unit patients 
      were characterized using phenotypic, PCR and WGS methods. Susceptibility testing 
      was performed via Etest and clonality via multi-locus sequence typing 
      (MLST).Results. All of the isolates were resistant to ertapenem; 78.6 % were 
      resistant to imipenem, meropenem and trimethoprim-sulfamethoxazole. Resistance to 
      the other antibiotics was variable, ranging from 28.5 (colistin) through 50 
      (tigecycline) and 64.3 (amikacin) up to 85.7 % against both 
      amoxicillin-clavulanic acid and ciprofloxacin. WGS detected several resistance 
      genes mediating the production of beta-lactamases, genes encoding an outer-membrane 
      porin permeability mutation resulting in reduced susceptibility to beta-lactams, 
      including carbapenems, and genes for multidrug-resistant (MDR) efflux pumps. The 
      isolates also possessed global activator protein MarA, which mediated reduced 
      permeability to beta-lactams. The existence of beta-lactamase genes, overexpression of 
      MDR efflux pumps and reduced permeability mediated by the porin genes were 
      responsible for carbapenem resistance.Conclusions. This finding reflects the 
      superior detection capabilities offered by WGS analysis, which can be used to 
      complement traditional methods and overcome their limited resolution in clinical 
      settings.
FAU - Al Fadhli, Amani
AU  - Al Fadhli A
AD  - Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, 
      Kuwait.
FAU - Jamal, Wafaa
AU  - Jamal W
AD  - Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, 
      Kuwait.
FAU - Rotimi, Vincent O
AU  - Rotimi VO
AD  - Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, 
      Kuwait.
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Med Microbiol
JT  - Journal of medical microbiology
JID - 0224131
SB  - IM
MH  - *Carbapenem-Resistant Enterobacteriaceae/genetics/isolation & purification
MH  - Drug Resistance, Bacterial/*genetics
MH  - Enterobacteriaceae Infections/*microbiology
MH  - Gastrointestinal Tract/*microbiology
MH  - Humans
MH  - Kuwait/epidemiology
MH  - Whole Genome Sequencing/*methods
OTO - NOTNLM
OT  - CRE
OT  - ICU
OT  - WGS
EDAT- 2021/09/04 06:00
MHDA- 2021/09/18 06:00
CRDT- 2021/09/03 12:18
PHST- 2021/09/03 12:18 [entrez]
PHST- 2021/09/04 06:00 [pubmed]
PHST- 2021/09/18 06:00 [medline]
AID - 10.1099/jmm.0.001409 [doi]
PST - ppublish
SO  - J Med Microbiol. 2021 Sep;70(9). doi: 10.1099/jmm.0.001409.