Emergence of a blaNDM-5-carrying extensively drug-resistant Enterobacter cloacae ST1718 in Saudi Arabia: Insights from comprehensive genome analysis
Background: Patients with severe COVID-19 may require intensive care unit (ICU) admission to manage life-threatening complications. However, ICU admission is associated with an increased risk of acquiring nosocomial infections caused by multidrug-resistant (MDR) bacteria, particularly carbapenem-res...
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Elsevier
2025-02-01
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| Series: | Journal of Infection and Public Health |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1876034124003794 |
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| author | Ibrahim A. Al-Zahrani Thamer M. Brek |
| author_facet | Ibrahim A. Al-Zahrani Thamer M. Brek |
| author_sort | Ibrahim A. Al-Zahrani |
| collection | DOAJ |
| description | Background: Patients with severe COVID-19 may require intensive care unit (ICU) admission to manage life-threatening complications. However, ICU admission is associated with an increased risk of acquiring nosocomial infections caused by multidrug-resistant (MDR) bacteria, particularly carbapenem-resistant Enterobacterale (CRE). Enterobacter cloacae complex (ECC), a group of closely related species including Enterobacter cloacae, is a common cause of healthcare-associated infections (HAIs). Methods: The study conducted a comprehensive genomic analysis of an extensively drug-resistant (XDR) E. cloacae strain (ECloa-JZ71) isolated from the blood of a critically ill COVID-19 patient in Jazan, Saudi Arabia. Results: ECloa-JZ71 exhibited resistance to multiple antimicrobial agents, except for amikacin, gentamycin, and fosfomycin. Whole-genome sequencing revealed that ECloa-JZ71 had a rarely reported sequence type, ST1718. Resistance to β-lactam antibiotics was primarily mediated by the genes blaCMH-3, blaTEM-1B, blaLAP-2, and blaNDM-5. The strain was found to harbor IncFIB(pECLA) and IncX3 plasmid replicons, with the latter encoding the blaNDM-5 gene. The IncX3 plasmid was identified as a significant contributor to the dissemination of the blaNDM-5 gene among Enterobacterale species The coexistence of blaNDM-5 and other carbapenem-hydrolyzing enzymes explains the reduced efficacy of β-lactam drugs in ECloa-JZ71. The coexistence of blaNDM-5 and other carbapenem-hydrolyzing enzymes explains the reduced efficacy of β-lactam drugs in ECloa-JZ71. The presence of specific virulence factors along with carbapenem resistance in ECloa-JZ71 may enhance its pathogenesis, complicating treatment and control efforts. Conclusion: The findings highlight the need for monitoring the spread of multidrug-resistant clones, conducting molecular epidemiological studies, and implementing effective infection control measures to prevent the dissemination of antimicrobial resistance in healthcare settings. |
| format | Article |
| id | doaj-art-3de0644955b3469a961168723b187783 |
| institution | Kabale University |
| issn | 1876-0341 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Infection and Public Health |
| spelling | doaj-art-3de0644955b3469a961168723b1877832025-01-21T04:12:58ZengElsevierJournal of Infection and Public Health1876-03412025-02-01182102645Emergence of a blaNDM-5-carrying extensively drug-resistant Enterobacter cloacae ST1718 in Saudi Arabia: Insights from comprehensive genome analysisIbrahim A. Al-Zahrani0Thamer M. Brek1Medical Laboratory Sciences Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; Special Infectious Agents Unit-Biosafety Level-3, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia; Correspondence to: Medical Laboratory Sciences Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O Box-21589, Jeddah 80324, Saudi Arabia.Public health Laboratory, The regional laboratory, Jazan Health Cluster, Jazan, Saudi ArabiaBackground: Patients with severe COVID-19 may require intensive care unit (ICU) admission to manage life-threatening complications. However, ICU admission is associated with an increased risk of acquiring nosocomial infections caused by multidrug-resistant (MDR) bacteria, particularly carbapenem-resistant Enterobacterale (CRE). Enterobacter cloacae complex (ECC), a group of closely related species including Enterobacter cloacae, is a common cause of healthcare-associated infections (HAIs). Methods: The study conducted a comprehensive genomic analysis of an extensively drug-resistant (XDR) E. cloacae strain (ECloa-JZ71) isolated from the blood of a critically ill COVID-19 patient in Jazan, Saudi Arabia. Results: ECloa-JZ71 exhibited resistance to multiple antimicrobial agents, except for amikacin, gentamycin, and fosfomycin. Whole-genome sequencing revealed that ECloa-JZ71 had a rarely reported sequence type, ST1718. Resistance to β-lactam antibiotics was primarily mediated by the genes blaCMH-3, blaTEM-1B, blaLAP-2, and blaNDM-5. The strain was found to harbor IncFIB(pECLA) and IncX3 plasmid replicons, with the latter encoding the blaNDM-5 gene. The IncX3 plasmid was identified as a significant contributor to the dissemination of the blaNDM-5 gene among Enterobacterale species The coexistence of blaNDM-5 and other carbapenem-hydrolyzing enzymes explains the reduced efficacy of β-lactam drugs in ECloa-JZ71. The coexistence of blaNDM-5 and other carbapenem-hydrolyzing enzymes explains the reduced efficacy of β-lactam drugs in ECloa-JZ71. The presence of specific virulence factors along with carbapenem resistance in ECloa-JZ71 may enhance its pathogenesis, complicating treatment and control efforts. Conclusion: The findings highlight the need for monitoring the spread of multidrug-resistant clones, conducting molecular epidemiological studies, and implementing effective infection control measures to prevent the dissemination of antimicrobial resistance in healthcare settings.http://www.sciencedirect.com/science/article/pii/S1876034124003794Carbapenem-resistant E. cloacae (CREC)Enterobacter cloacae complex (ECC)Healthcare-associated infections (HAIs)WGSSaudi Arabia |
| spellingShingle | Ibrahim A. Al-Zahrani Thamer M. Brek Emergence of a blaNDM-5-carrying extensively drug-resistant Enterobacter cloacae ST1718 in Saudi Arabia: Insights from comprehensive genome analysis Journal of Infection and Public Health Carbapenem-resistant E. cloacae (CREC) Enterobacter cloacae complex (ECC) Healthcare-associated infections (HAIs) WGS Saudi Arabia |
| title | Emergence of a blaNDM-5-carrying extensively drug-resistant Enterobacter cloacae ST1718 in Saudi Arabia: Insights from comprehensive genome analysis |
| title_full | Emergence of a blaNDM-5-carrying extensively drug-resistant Enterobacter cloacae ST1718 in Saudi Arabia: Insights from comprehensive genome analysis |
| title_fullStr | Emergence of a blaNDM-5-carrying extensively drug-resistant Enterobacter cloacae ST1718 in Saudi Arabia: Insights from comprehensive genome analysis |
| title_full_unstemmed | Emergence of a blaNDM-5-carrying extensively drug-resistant Enterobacter cloacae ST1718 in Saudi Arabia: Insights from comprehensive genome analysis |
| title_short | Emergence of a blaNDM-5-carrying extensively drug-resistant Enterobacter cloacae ST1718 in Saudi Arabia: Insights from comprehensive genome analysis |
| title_sort | emergence of a blandm 5 carrying extensively drug resistant enterobacter cloacae st1718 in saudi arabia insights from comprehensive genome analysis |
| topic | Carbapenem-resistant E. cloacae (CREC) Enterobacter cloacae complex (ECC) Healthcare-associated infections (HAIs) WGS Saudi Arabia |
| url | http://www.sciencedirect.com/science/article/pii/S1876034124003794 |
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