Updates on the Status of Carbapenem-Resistant Enterobacterales in Lebanon

Carbapenem-resistant Enterobacterales (CRE) pathogens have been increasingly isolated and reported in Lebanon. Several studies have been published over the last two decades about the CRE situation in the country. However, compared to the worldwide data, those studies are scarce and mostly restricted to single center studies. In this review, we aim to present a comprehensive and reliable report illustrating the current situation regarding CRE in Lebanon. Variable studies have shown an increasing pattern of carbapenem resistance in Enterobacterales since the first reports of CRE isolates in 2007 and 2008. Escherichia coli and Klebsiella pneumoniae were the most detected ones. The OXA-48 class D carbapenemases were the most prevalent carbapenemases among CRE isolates. Moreover, the emergence of other carbapenemases like the NDM class B carbapenemase has been noticed. Strict infection control measures in hospitals, including the identification of CRE carriers, are needed in Lebanese hospitals since carriage is a potential risk for the spread of CRE in healthcare settings. The dissemination of CRE in the community is noticed and attributed to multiple causes, such as the refugee crisis, water contamination, and antimicrobial misuse. In conclusion, strict infection control measures in healthcare settings, in addition to accurate antimicrobial stewardship program implementation, are urgently needed.

Automated summary

Carbapenem-resistant Enterobacterales (CRE) pathogens have been increasingly isolated and reported in Lebanon. However, compared to the worldwide data, research on CRE in the country is scarce and mostly limited to single center studies. This review aims to provide a comprehensive and reliable report on the current situation of CRE in Lebanon. Studies have shown a rising trend of carbapenem resistance in Enterobacterales since the first reports of CRE isolates in 2007 and 2008, with Escherichia coli and Klebsiella pneumoniae being the most frequently detected species. OXA-48 class D carbapenemases were the most prevalent among CRE isolates, but the emergence of other carbapenemases like NDM class B carbapenemase has also been observed. Strict infection control measures, including the identification of CRE carriers, are needed in Lebanese hospitals to prevent the spread of CRE. The dissemination of CRE in the community is attributed to various causes such as the refugee crisis, water contamination, and misuse of antimicrobials. In conclusion, strict infection control measures and antimicrobial stewardship programs are urgently needed in Lebanese healthcare settings.