title: Emergence and spread of NDM-1 producer Enterobacteriaceae with contribution of IncX3 plasmids in the United Arab Emirates.
abstract: Among 28 clinically relevant, carbapenem non-susceptible Enterobacteriaceae isolates collected in 2009-2011 in the United Arab Emirates three Klebsiella pneumoniae, two Escherichia coli, one Enterobacter cloacae and one Citrobacter freundi were identified to produce NDM-1 carbapenemase. Unexpectedly, with the exception of a K. pneumoniae strain, sequence type ST11, originally acquired in India and subsequently spread nosocomially in the UAE, the majority of the strains could not be directly linked to foreign travel. All isolates harboured the blaNDM-1 gene on plasmids of IncA/C, IncHI1b and IncX3 types, or were untypable. IncX3 type plasmids with a mass of 50 kb and with the same or highly similar restriction patterns, with regions flanking the blaNDM-1 gene identical to the IncX3 NDM plasmids described from China were present in three different species, Enterobacter cloacae, Escherichia coli and C. freundii. Our findings strongly support the assumptions that, beyond the Indian subcontinent, the Middle East is an important reservoir of NDM-producing organisms. Furthermore, we also provide evidence that IncX3 plasmids, recently implicated in the spread of blaNDM-1 in China, have been widely distributed and are important vehicles of the inter-species spread of the NDM-1 gene.
authors.affiliation: Microbiology and Immunology, Faculty of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates.
authors.forename: Agnes
authors.initials: A
authors.lastname: Sonnevend
authors.affiliation: Microbiology and Immunology, Faculty of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates.
authors.forename: Amna
authors.initials: A
authors.lastname: Al Baloushi
authors.affiliation: Microbiology and Immunology, Faculty of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates.
authors.forename: Akela
authors.initials: A
authors.lastname: Ghazawi
authors.affiliation: Tawam Hospital, Al Ain, United Arab Emirates.
authors.forename: Rayhan
authors.initials: R
authors.lastname: Hashmey
authors.affiliation: Mafraq Hospital, Abu Dhabi, United Arab Emirates.
authors.forename: Safinaz
authors.initials: S
authors.lastname: Girgis
authors.affiliation: Tawam Hospital, Al Ain, United Arab Emirates.
authors.forename: Mohammed Baraa
authors.initials: MB
authors.lastname: Hamadeh
authors.affiliation: Microbiology and Immunology, Faculty of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Haj
authors.affiliation: Microbiology and Immunology, Faculty of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates.
authors.forename: Tibor
authors.initials: T
authors.lastname: Pál
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000382:microbiology*; D004305:Dose-Response Relationship, Drug; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology / Q000378:metabolism*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology*; D015964:Gene Expression Regulation, Bacterial; D015971:Gene Expression Regulation, Enzymologic; D005838:Genotype; D006801:Humans; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D010957:Plasmids / Q000235:genetics*; D014479:United Arab Emirates / Q000453:epidemiology; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1