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
Affiliations
Mariam Rima
Team ReSIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, 94270 Le Kremlin-Bicêtre, France
Saoussen Oueslati
Team ReSIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, 94270 Le Kremlin-Bicêtre, France
Laura Dabos
Team ReSIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, 94270 Le Kremlin-Bicêtre, France
Dina Daaboul
Team ReSIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, 94270 Le Kremlin-Bicêtre, France
Hassan Mallat
Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon
Elie Bou Raad
Clinical Laboratory, El Youssef Hospital Center, Halba 1302, Lebanon
Team ReSIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, 94270 Le Kremlin-Bicêtre, France
Rémy A. Bonnin
Team ReSIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, 94270 Le Kremlin-Bicêtre, France
Delphine Girlich
Team ReSIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, 94270 Le Kremlin-Bicêtre, France
Marwan Osman
Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY 14853, USA
Monzer Hamze
Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon
Thierry Naas
Team ReSIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, 94270 Le Kremlin-Bicêtre, France
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 blaOXA-48-like, blaNDM-like and blaVIM-like genes and CP-Pseudomonas expressed blaIMP-like and blaVIM-like genes, whereas CP-Acinetobacter expressed blaOXA-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: blaOXA-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.
