GENETIC SUPPORT OF CARBAPENEMASES IN DOUBLE CARBAPENEMASE PRODUCER KLEBSIELLA PNEUMONIAE ISOLATED IN THE ARABIAN PENINSULA

Enterobacteriaceae co-producing NDM- and OXA-48-type carbapenemases were encountered in higher frequency in the United Arab Emirates (UAE) than in the neighboring countries in our earlier study. The aim of this investigation was to characterize the seven double carbapenemase producer Klebsiella pneumoniae found in the region to assess factors contributing to their emergence. Three K. pneumoniae ST14 isolated in the UAE harboring bla(NDM-1) on IncHI1b and bla(OXA-232) on IncCo1E plasmids were clonally related. Furthermore, two K. pneumoniae from the UAE, ABC106 and ABC137 belonged to ST307 and ST1318, respectively. ABC106 carried bla(NDM-1) on IncHI1b, and bla(OXA-162) on IncL/M plasmids, whereas ABC137 possessed bla(NDM-1) on IncX3 and bla(OXA-48) on IncL/M plasmids. The double carbapenemase-producing K. pneumoniae from Oman (OMABC109) and Saudi Arabia (SA54) belonged to ST11 and ST152, respectively. OMABC109 harbored bla(NDM-1) on an IncHI1b plasmid highly similar to the NDM-plasmid of ABC106 and carried a chromosomally coded bla(OXA-181) located on Tn2013. SA54 possessed a bla(NDM-1) on an IncFIb/FII plasmid and a bla(OXA-48) on an IncL/M plasmid. Based on these findings, clonal spread and horizontal transfer of carbapenemase genes located on transposons or self-transmissible plasmids contributed equally to the emergence of double carbapenemase-producing Enterobacteriaceae in the region.