AUTHOR=Hadi Hamad A. , Al-Hail Hissa , Aboidris Leena Elsheikh , Al-Orphaly Mahmood , Ahmed Mazen A. Sid , Samuel Bincy Gladson , Mohamed Hana Adam , Sultan Ali A. , Skariah Sini 

TITLE=Prevalence and genetic characterization of clinically relevant extended-spectrum β-lactamase-producing Enterobacterales in the Gulf Cooperation Council countries

JOURNAL=Frontiers in Antibiotics

VOLUME=2

YEAR=2023

URL=https://www.frontiersin.org/journals/antibiotics/articles/10.3389/frabi.2023.1177954

DOI=10.3389/frabi.2023.1177954

ISSN=2813-2467

ABSTRACT=<sec><title>Introduction</title><p>Among Gram-negative bacteria (GNB), <italic>Enterobacterales</italic> (<italic>Enterobacterales</italic>), such as <italic>Escherichia coli</italic> (<italic>E. coli</italic>) and <italic>Klebsiella pneumoniae</italic> (<italic>K. pneumoniae</italic>), are the most clinically relevant pathogens in healthcare settings. Infections secondary to these pathogens are widely common but multidrug resistance (MDR) in <italic>Enterobacterales</italic> has become a significant challenge with increased morbidity, mortality, and cost of management. The escalating global prevalence of MDR in <italic>Enterobacterales</italic> has led to limited treatment options, raising an urgent need for novel antimicrobial therapy(s) and detailed studies exploring underlying resistance mechanisms. In <italic>Enterobacterales</italic>, the prime antimicrobial resistance mechanism against β-lactam antibiotics is mainly the production of β-lactamases, particularly extended-spectrum β-lactamases (ESBLs). Although the Gulf region is witnessing major challenges from infections secondary to MDR GNB, the extent of the problem has not been fully evaluated. Therefore, this review aims to address the prevalence and genetic characterization of ESBL-producing <italic>Enterobacterales</italic> in the Gulf Cooperation Council (GCC) countries.</p></sec><sec><title>Methods</title><p>PubMed® (National Library of Medicine, Bethesda, MD, USA) search was conducted, which looked for academic articles discussing the epidemiology of MDR <italic>Enterobacterales</italic> in the GCC countries, published in the last 5 years.</p></sec><sec><title>Results and conclusions</title><p>In GCC countries there is a high prevalence rate of MDR <italic>Enterobacterales</italic>, particularly ESBLs. Prevalence rates of ESBL-producing <italic>Enterobacterales</italic> among the <italic>Enterobacterales</italic> in general clinical samples in the GCC region is 21.6%–29.3%, with a slightly higher prevalence rate in intensive care unit patients (17.3–31.3%) and in patients with urinary tract infections (25.2%–31.7%). ESBL carriers have also been noted in the general community. ESBL-producing <italic>Enterobacterales</italic> from the GCC region show high levels of resistance to ampicillin, aztreonam, third-/fourth-generation cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole. Intermediate resistance rates are observed against nitrofurantoin, piperacillin/tazobactam, and gentamicin, with increasing resistance observed against tigecycline. The isolates demonstrate low-level resistance to carbapenems, fosfomycin, colistin, and amikacin. <italic>Enterobacterales</italic> isolates that are concomitant ESBL producers and are carbapenem resistant have been increasingly reported and demonstrate alarmingly increased antibiotic resistance patterns compared with ESBL <italic>Enterobacterales</italic>. The most prevalent genes for ESBL resistance in the <italic>Enterobacterales</italic> isolates in the GCC region are: <italic>bla</italic><sub>CTX-M</sub> (subtype group 1) followed by/co-dominated by <italic>bla</italic><sub>TEM</sub> and <italic>bla</italic><sub>SHV</sub>, whereas the most common carbapenem-resistant genes are <italic>bla</italic><sub>OXA-48</sub> and <italic>bla</italic><sub>NDM-1</sub>.</p></sec>