Introduction and spread of NDM-producing Enterobacterales and Acinetobacter baumannii into Middle Eastern countries:...

Area of Science:

• Microbiology
• Infectious Diseases
• Genetics

Background:

• The Middle East (ME) faces a significant challenge with the emergence and spread of carbapenem-resistant bacteria.
• New Delhi Metallo-beta-lactamase (NDM) is a critical enzyme conferring resistance to carbapenems, a last-resort antibiotic class.
• Understanding the dissemination patterns of NDM-producing Enterobacterales (NDME) and Acinetobacter baumannii (NDMAb) is crucial for public health.

Purpose of the Study:

• To provide a plausible explanation for the dissemination of NDME and NDMAb across the ME.
• To analyze the initial reports, contemporary epidemiology, and molecular features of these resistant organisms in the region.

Main Methods:

• Review and analysis of published data on NDME and NDMAb in ME countries.
• Examination of epidemiological trends and molecular characteristics, including gene transmission and clonal spread.
• Comparison of resistance data across different ME countries.

Main Results:

• NDMAb emerged in the ME around 2009-2010, spreading via clonal transmission with limited impact on the overall carbapenem-resistant Acinetobacter baumannii (CRAB) population.
• NDME appeared later, likely evolving from NDMAb, with the blaNDM gene transmitting into successful Klebsiella pneumoniae and Escherichia coli clones.
• Epidemiological data show wide variations in NDME prevalence, ranging from 20.7% in Saudi Arabia to 80.5% in Egypt.

Conclusions:

• Clonal transmission and horizontal gene transfer of the blaNDM gene are key drivers for the spread of NDMAb and NDME in the ME.
• The distinct evolutionary and dissemination pathways of NDMAb and NDME highlight the need for targeted surveillance and control strategies.
• Regional variations in prevalence underscore the dynamic nature of antimicrobial resistance in the Middle East.