Prevalence and Molecular Mechanisms of Carbapenem Resistance among Gram-Negative Bacilli in Three Hospitals of Northern Lebanon

Mariam Rima; Saoussen Oueslati; Laura Dabos; Dina Daaboul; Hassan Mallat; Elie Bou Raad; Marcel Achkar; Osman Mawlawi; Sandrine Bernabeu; Rémy A Bonnin; Delphine Girlich; Marwan Osman; Monzer Hamze; Thierry Naas

doi:10.3390/antibiotics11101295

Prevalence and Molecular Mechanisms of Carbapenem Resistance among Gram-Negative Bacilli in Three Hospitals of Northern Lebanon

Antibiotics (Basel). 2022 Sep 22;11(10):1295. doi: 10.3390/antibiotics11101295.

Authors

Mariam Rima^{1

2}, Saoussen Oueslati^{1

3}, Laura Dabos¹, Dina Daaboul^{1

2}, Hassan Mallat², Elie Bou Raad⁴, Marcel Achkar⁵, Osman Mawlawi⁶, Sandrine Bernabeu^{1

3}, Rémy A Bonnin^{1

7}, Delphine Girlich¹, Marwan Osman^{8

9}, Monzer Hamze², Thierry Naas^{1

3

7}

Affiliations

¹ Team ReSIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, 94270 Le Kremlin-Bicêtre, France.
² Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon.
³ Bacteriology-Hygiene Unit, Bicêtre Hospital, APHP Paris-Saclay, 94270 Le Kremlin-Bicêtre, France.
⁴ Clinical Laboratory, El Youssef Hospital Center, Halba 1302, Lebanon.
⁵ Clinical Laboratory, Nini Hospital, Tripoli 1300, Lebanon.
⁶ Clinical Laboratory, Tripoli Governmental Hospital, Tripoli 1300, Lebanon.
⁷ French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacterales, 94270 Le Kremlin-Bicêtre, France.
⁸ Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY 14853, USA.
⁹ Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.

Abstract

Carbapenem resistance (CR) is an emerging health issue. Epidemiological surveys on carbapenem-resistant Gram-negative bacilli (CR-GNB) in Lebanon remain scarce. In this study, we determined the prevalence of CR-GNB isolated between 2015 to 2019 in three hospitals in northern Lebanon: 311 CR-Enterobacterales (out of 11210; 2.8%), 155 CR-Pseudomonas (out of 1034; 15%) and 106 CR- Acinetobacter (out of 184; 57.6%) were identified. CR mechanisms were determined for 146 randomly chosen isolates: the Carba NP test revealed an enzymatic resistance to carbapenems in 109 isolates (out of 146, 74.7%). Produced carbapenemases were evaluated by the NG-Test Carba5, NG-Test OXA-23 immunochromatographic assays and PCR. Carbapenemase-producing (CP) Enterobacterales expressed bla_OXA-48-like, bla_NDM-like and bla_VIM-like genes and CP-Pseudomonas expressed bla_IMP-like and bla_VIM-like genes, whereas CP-Acinetobacter expressed bla_OXA-23-like genes. The NG-Test Carba5 results were confirmed by PCR sequencing and revealed several variants, such as NDM-19, VIM-62 and OXA-162, never described so far in Lebanon. Isolates with discordant results were sequenced by WGS and highlighted novel variants of the natural oxacillinases of Pseudomonas aeruginosa: bla_OXA-50-like genes. Their role in carbapenem resistance should be further studied. Overall, our findings highlight an alarming situation and encourage health care centers to establish performant registration systems that could help in limiting resistance spread.

Keywords: Gram-negative bacilli; antimicrobial resistance; carbapenem; carbapenemase.

Abstract

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