Enterobacterial infection in Saudi Arabia: First record of Klebsiella pneumoniae with triple carbapenemase genes resistance

Introduction: Carbapenemase producing Enterobacteriaceae are emerging as important pathogens worldwide with serious effects on patients' outcome. The study aimed to investigate the emergence of carbapenemases associated with enterobacterial infection in Western region of Saudi Arabia. Methodology: Clinical isolates from suspected patients with enterobacterial infection were investigated over a one-year period from four tertiary care hospitals of Makkah, Saudi Arabia. All isolates were identified using Vitek-2 system and then screened for potential carbapenemase production using disk diffusion test. Suspected isolates with reduced susceptibility to carbapenems were further investigated for bla(NDM-1), bla(KPC) and bla(OXA-48) resistant genes. Results: Out of 120 confirmed Enterobacteriaceae isolates, Klebsiella pneumoniae and Escherichia coli comprised the largest proportion (35% and 34.2%, respectively) of encountered infections. Twenty-six (21.7%) isolates showed resistance to carbapenems, the majority of which (21/26) were K. pneumoniae. Remarkably, 17 isolates carried triple resistant genes KPC/NDM-1/OXA-48 while the other 4 carried double resistant genes (KPC/OXA-48) or (NDM-1/OXA-48). The current study revealed that the mentioned triple resistance genes have the higher incidence with significant association risk among males (COR 4.5; CI: 1.9-17.3; P = 0.018), non-Saudi nationalities (COR 4.9; CI: 1.5-19.3; P = 0.003), ICU-obtained specimens (COR 3.6; CI: 1.5-8.4; P= 0.002) and blood specimens (COR 2.8; CI: 1.1-6.9; P = 0.02). Conclusion: Multidrug-resistant Enterobacteriaceae isolates in particular K. pneumoniae co-harboring KPC, NDM-1 and OXA-48 genes are emerging in Western region, Saudi Arabia. This is the first record of triple carbapenemase genes co-producing K. pneumoniae associated with enterobacterial infection.