title: Countrywide spread of OXA-48 carbapenemase in Lebanon: surveillance and genetic characterization of carbapenem-non-susceptible Enterobacteriaceae in 10 hospitals over a one-year period.
abstract: OBJECTIVE
  To detect, characterize, and assess the genetic clonality of carbapenem-non-susceptible Enterobacteriaceae in 10 Lebanese hospitals in 2012.
  
  
  METHODS
  Selected Enterobacteriaceae isolates with reduced susceptibility to carbapenems were subject to phenotypic study including antibiotic susceptibility, cloxacillin effect, modified Hodge test, and activity of efflux pump inhibitor. Carbapenemase genes were detected using PCR; clonal relatedness was studied by pulsed field gel electrophoresis.
  
  
  RESULTS
  Out of 8717 Enterobacteriaceae isolated in 2012, 102 (1.2%) showed reduced susceptibility to carbapenems. Thirty-one (70%) of the 44 studied clinical isolates harbored blaOXA-48, including 15 Klebsiella pneumoniae, eight Escherichia coli, four Serratia marcescens, three Enterobacter cloacae, and one Morganella morganii. The majority of OXA-48 producers co-secreted an extended-spectrum beta-lactamase, while one had an acquired AmpC of the ACC type. In the non-OXA-48 producers, carbapenem resistance was attributed to the production of acquired AmpC cephalosporinases of MOX or CIT type, outer membrane impermeability, and/or efflux pump overproduction. DNA fingerprints revealed that OXA-48 producers were different, except for clonal relatedness among four K. pneumoniae, two E. coli, two E. cloacae, and three S. marcescens.
  
  
  CONCLUSIONS
  Nosocomial carbapenem-non-susceptible Enterobacteriaceae are moderately spread in Lebanon and the predominant mechanism is OXA-48 production.
authors.affiliation: Microbiology Laboratory, School of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Rodolphe Mérieux Laboratory, Beirut, Lebanon. Electronic address: dalal.hammoudi@net.usj.edu.lb.
authors.forename: D
authors.initials: D
authors.lastname: Hammoudi
authors.affiliation: Microbiology Laboratory, School of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Rodolphe Mérieux Laboratory, Beirut, Lebanon; Department of Natural Science and Public Health, College of Sustainability Sciences and Humanities, Zayed University, Dubai, United Arab Emirates.
authors.forename: C
authors.initials: C
authors.lastname: Ayoub Moubareck
authors.affiliation: EA4065, Sorbonne Paris Cité, Université Paris Descartes, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Aires
authors.affiliation: Microbiology Laboratory, School of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Rodolphe Mérieux Laboratory, Beirut, Lebanon; Clinique du Levant, Beirut, Lebanon.
authors.forename: A
authors.initials: A
authors.lastname: Adaime
authors.affiliation: Bellevue Medical Center, Beirut, Lebanon.
authors.forename: A
authors.initials: A
authors.lastname: Barakat
authors.affiliation: Secours Populaire Libanais, Nabatieh, South Lebanon.
authors.forename: N
authors.initials: N
authors.lastname: Fayad
authors.affiliation: Saint George Hospital and University of Balamand, Beirut, Lebanon.
authors.forename: N
authors.initials: N
authors.lastname: Hakime
authors.affiliation: Labib Medical Center, Saida, South Lebanon.
authors.forename: M
authors.initials: M
authors.lastname: Houmani
authors.affiliation: Microbiology Laboratory, School of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Rodolphe Mérieux Laboratory, Beirut, Lebanon; Arz Hospital, Beirut, Lebanon.
authors.forename: T
authors.initials: T
authors.lastname: Itani
authors.affiliation: Chtoura Hospital, Bekaa, Lebanon.
authors.forename: Z
authors.initials: Z
authors.lastname: Najjar
authors.affiliation: Farhat Hospital, Bekaa, Lebanon.
authors.forename: M
authors.initials: M
authors.lastname: Suleiman
authors.affiliation: Monla Hospital, Tripoli, North Lebanon.
authors.forename: R
authors.initials: R
authors.lastname: Sarraf
authors.affiliation: Microbiology Laboratory, School of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Rodolphe Mérieux Laboratory, Beirut, Lebanon.
authors.forename: D
authors.initials: D
authors.lastname: Karam Sarkis
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics*; D015780:Carbapenems / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D004926:Escherichia coli / Q000187:drug effects; D006761:Hospitals; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects; D007861:Lebanon; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase
keywords: AmpC; Carbapenem resistance; Enterobacteriaceae; OXA-48