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<p>Antimicrobial resistance among Gram-negative bacteria is a growing clinical challenge. This study aimed to assess bacterial distribution, antimicrobial susceptibility, and carbapenemase gene prevalence in clinical isolates.&#xa0;A total of 154 patients (mean age: 57.51 ± 18.75&#xa0;years) were included. Specimens were primarily sputum (42.2%), blood (22.7%), and urine (18.8%). Bacterial isolates included <i>K pneumoniae</i> (43.8%), <i>A. baumannii</i> (24%), and <i>P. aeruginosa</i> (13.5%). Antimicrobial susceptibility testing (AST) was conducted to evaluate resistance patterns. MDR was detected, with alarming resistance to carbapenems, β-lactams, and fluoroquinolones. <i>A. baumannii</i> and <i>P. aeruginosa</i> exhibited near-total resistance to Imipenem (IPM), Meropenem (MRP), and Ertapenem (ETP), indicating extensive drug resistance (XDR). <i>K. pneumoniae</i> demonstrated exceptionally high resistance to carbapenems (IPM: 90.5%, MRP: 92.9%) and β-lactam antibacterial drugs (&gt; 90%). Fluoroquinolone resistance exceeded 90% for Ciprofloxacin and Levofloxacin in <i>A. baumannii</i>, <i>P. aeruginosa</i>, and <i>K. pneumoniae</i>. Aminoglycosides, particularly Gentamicin, showed moderate resistance (<i>A. baumannii</i>: 87%, <i>P. aeruginosa</i>: 69.2%). Tigecycline remained one of the few viable treatment options against <i>K. pneumoniae</i>. Biofilm formation was significant, with 63.6% of isolates producing biofilm, particularly <i>P. aeruginosa</i> (80.9%), <i>K. pneumoniae</i> (67.2%), and <i>A. baumannii</i> (48.6%), increasing their pathogenic potential. Carbapenemase production was detected in 42.9% of isolates. The most prevalent genes were <i>blaOXA- 48</i> (15.6%), <i>blaNDM</i> (8.4%), and <i>blaVIM</i> (7.1%), with co-expression in 9.7% of isolates. <i>K. pneumoniae</i> exhibited the highest risk for carbapenemase production (OR: 4.23, <i>p</i> &lt; 0.001), whereas <i>A. baumannii</i> had a significantly lower risk (OR: 0.20, <i>p</i> = 0.005). Screening swabs showed more <i>OXA- 48</i> (42.1%), while clinical isolates had more <i>NDM</i> and <i>VIM</i>. Alternative resistance mechanisms were suggested in 57.3% of clinical cases. The overwhelming prevalence of MDR and Carbapenem resistance among Gram-negative bacteria, particularly <i>K. pneumoniae</i> and <i>A. baumannii</i>, emphasizes an urgent need for strict antimicrobial stewardship, advanced infection control strategies, and novel therapeutic interventions to combat resistance spread.</p>

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Multidrug-resistant gram-negative bacteria in ICU patients of a tertiary care hospital in Saudi Arabia: distribution of carbapenemase genes in clinical and rectal swab samples

  • 期刊论文

  • 发表日期：

    2025年4月24日

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  • Amal Daher Alshammari,
  • Alharbi Mohammed Salem,
  • Sumayyah Mohammad Almarshedy,
  • Ehab Rakha,
  • Mohd Saleem

摘要

Antimicrobial resistance among Gram-negative bacteria is a growing clinical challenge. This study aimed to assess bacterial distribution, antimicrobial susceptibility, and carbapenemase gene prevalence in clinical isolates. A total of 154 patients (mean age: 57.51 ± 18.75 years) were included. Specimens were primarily sputum (42.2%), blood (22.7%), and urine (18.8%). Bacterial isolates included K pneumoniae (43.8%), A. baumannii (24%), and P. aeruginosa (13.5%). Antimicrobial susceptibility testing (AST) was conducted to evaluate resistance patterns. MDR was detected, with alarming resistance to carbapenems, β-lactams, and fluoroquinolones. A. baumannii and P. aeruginosa exhibited near-total resistance to Imipenem (IPM), Meropenem (MRP), and Ertapenem (ETP), indicating extensive drug resistance (XDR). K. pneumoniae demonstrated exceptionally high resistance to carbapenems (IPM: 90.5%, MRP: 92.9%) and β-lactam antibacterial drugs (> 90%). Fluoroquinolone resistance exceeded 90% for Ciprofloxacin and Levofloxacin in A. baumannii, P. aeruginosa, and K. pneumoniae. Aminoglycosides, particularly Gentamicin, showed moderate resistance (A. baumannii: 87%, P. aeruginosa: 69.2%). Tigecycline remained one of the few viable treatment options against K. pneumoniae. Biofilm formation was significant, with 63.6% of isolates producing biofilm, particularly P. aeruginosa (80.9%), K. pneumoniae (67.2%), and A. baumannii (48.6%), increasing their pathogenic potential. Carbapenemase production was detected in 42.9% of isolates. The most prevalent genes were blaOXA- 48 (15.6%), blaNDM (8.4%), and blaVIM (7.1%), with co-expression in 9.7% of isolates. K. pneumoniae exhibited the highest risk for carbapenemase production (OR: 4.23, p < 0.001), whereas A. baumannii had a significantly lower risk (OR: 0.20, p = 0.005). Screening swabs showed more OXA- 48 (42.1%), while clinical isolates had more NDM and VIM. Alternative resistance mechanisms were suggested in 57.3% of clinical cases. The overwhelming prevalence of MDR and Carbapenem resistance among Gram-negative bacteria, particularly K. pneumoniae and A. baumannii, emphasizes an urgent need for strict antimicrobial stewardship, advanced infection control strategies, and novel therapeutic interventions to combat resistance spread.