title: The emergence of OXA-48- and NDM-1-positive Klebsiella pneumoniae in Riyadh, Saudi Arabia.
abstract: OBJECTIVE
  To investigate the emergence of NDM-, OXA-48-, and VIM-producing Klebsiella pneumoniae in Saudi Arabia.
  
  
  METHODS
  From June to December 2011, we obtained K. pneumoniae isolates with reduced sensitivity to carbapenem identified in Riyadh, Saudi Arabia. Only non-duplicate clinical and surveillance isolates obtained from inpatients were included. PCR amplification was carried out for the detection of extended-spectrum beta-lactamase genes (blaCTX-M, blaTEM, blaSHV) and carbapenemase genes (blaKPC, blaVIM, blaIMP, blaNDM, and blaOXA-48). Susceptibility to imipenem, meropenem, amikacin, gentamicin, trimethoprim-sulfamethoxazole, and colistin was determined.
  
  
  RESULTS
  Of the 60K. pneumoniae isolates studied, 45 were from patients in the intensive care unit. Forty-seven isolates harbored blaOXA-48, 12 were positive for blaNDM, and one for blaVIM. No isolate harbored a combination of these resistance genes. No isolate harbored blaKPC or blaIMP. All 37 blaCTX-M-positive isolates belonged to CTX-M group 1, and 29 were positive for a combination of blaCTX-M and blaOXA-48. blaTEM and blaSHV genes were found in 17 and 39 isolates, respectively. All isolates were imipenem- and meropenem-resistant, with a high rate of co-resistance to the other antibiotics. Three blaOXA-48-positive isolates with colistin resistance were detected.
  
  
  CONCLUSIONS
  Multidrug-resistant K. pneumoniae isolates harboring blaOXA-48, blaNDM, and colistin resistance are emerging in Saudi Arabia.
authors.affiliation: College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; Department of Pathology and Pharmacology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. Electronic address: amshibl@ksu.edu.sa.
authors.forename: Atef
authors.initials: A
authors.lastname: Shibl
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al-Agamy
authors.forename: Ziad
authors.initials: Z
authors.lastname: Memish
authors.forename: Abiola
authors.initials: A
authors.lastname: Senok
authors.forename: Shamshad Abdul
authors.initials: SA
authors.lastname: Khader
authors.forename: Abdullah
authors.initials: A
authors.lastname: Assiri
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D012529:Saudi Arabia / Q000453:epidemiology; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1; C108449:oxacillinase
keywords: Carbapenem-hydrolyzing class D; Carbapenemases; Klebsiella pneumoniae; Metallo-beta-lactamases; NDM-1; OXA-48; Saudi Arabia