Related Experiment Video

Updated: Jul 9, 2026

Isolation and Identification of Waterborne Antibiotic-Resistant Bacteria and Molecular Characterization of their Antibiotic Resistance Genes

Isolation and Identification of Waterborne Antibiotic-Resistant Bacteria and Molecular Characterization of their Antibiotic Resistance Genes

Published on: March 3, 2023

Distinct molecular epidemiology and outcomes of carbapenem-resistant gram-negative infections in Lebanon: insights

Jean-Francois Jabbour¹, Hind Kadri¹, Elio Jabra²

¹Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Riad El Solh 1107 2020, PO -Box 11-0236, Beirut, Lebanon.

BMC Infectious Diseases

|July 7, 2026

Abstract

Background:

This study provides the first prospective, genomically validated dataset integrated into the global MultiDrug-Resistant Organism (MDRO) Network from the Middle East and North Africa region. To address the substantial gap in antimicrobial resistance (AMR) data, the American University of Beirut Medical Center (AUBMC) investigated carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA).

Methods:

Consecutive, hospitalized patients whose clinical cultures were positive for CRE, CRAB, or CRPA were prospectively enrolled between June 2018 and November 2019. Data on demographics, hospitalization, outcomes, and antimicrobial susceptibility were collected. Whole-genome sequencing (WGS) characterized the isolates. The primary outcome was the Desirability of Outcome Ranking (DOOR).

Results:

Ninety-four patients were included: 35 with CRE, 19 with CRAB, and 40 with CRPA. Overall, 30% of patients survived without adverse events, whereas 33% experienced two or more adverse events. Patients with CRAB had the poorest prognosis, with only 5% surviving without complications, and a significantly different DOOR distribution versus CRE or CRPA (p = 0.023). Adjusted DOOR probabilities confirmed the poorer outcomes associated with CRAB: when compared with CRE or CRPA, a randomly selected CRAB patient had only a 37.7% (95% CI, 24.9-52.6%) and 38.8% (95% CI, 26.5-52.7%) probability of achieving a more desirable outcome, respectively. WGS identified bla_NDM-5 (24%) and bla_OXA-48 (24%) as the most common genes in CRE, bla_OXA-23 in all CRAB strains, and bla_VIM-2 in 88% of CRPA strains. The dominant clones were CG383 K. pneumoniae (CRE), CG2 (CRAB), and CG111 (CRPA).

Conclusions:

MDRO infections in Lebanon have distinct molecular patterns compared to the US, Chinese, South American, and Australian cohorts, as well as poor outcomes, especially with CRAB. Ongoing surveillance, strengthening regional collaboration, and future clinical trials are essential to guide diagnostic and therapeutic strategies in settings with increasing AMR.

Trial Registry:

ClinicalTrials.gov.

Trial Registration Number:

NCT03646227.

Date Of Registration:

15-08-2018.

Keywords:

Antimicrobial resistance Carbapenemase genes Genomic epidemiology Infection outcomes Molecular surveillance Multidrug-resistant pathogens

Related Concept Videos

Clinical Significance of Antibiotic Resistance

Clinical Significance of Antibiotic Resistance

Methicillin-resistant Staphylococcus aureus (MRSA) presents a critical public health threat, arising from its capacity to resist β-lactam antibiotics due to acquisition of the mecA gene within the staphylococcal cassette chromosome mec (SCCmec). This gene encodes penicillin-binding protein 2a (PBP2a), which impairs binding efficacy of methicillin and other β-lactams. MRSA has evolved into distinct clonal lineages impacting humans and animals alike, reinforcing its significance within the One...

Mechanism of Antibiotic Resistance in MRSA

Mechanism of Antibiotic Resistance in MRSA

Antibiotic resistance in bacteria arises when microorganisms evolve the ability to withstand drugs designed to kill them or inhibit their growth, rendering once-effective treatments useless. This phenomenon, driven by genetic change and selection under antibiotic exposure, poses a profound threat to modern medicine. Mechanisms include drug-inactivating enzymes (e.g., β-lactamases), efflux pumps that eject antibiotics, mutations altering antibiotic targets, decreased drug uptake, and acquisition...

Development of Antibiotic Resistance

Development of Antibiotic Resistance

Antibiotic resistance is a major public health concern that arises when bacteria evolve mechanisms to withstand the effects of antibiotic treatments. This resistance can be intrinsic, acquired through genetic mutations, or transferred between bacteria via horizontal gene transfer. The development of antibiotic resistance poses significant challenges in treating bacterial infections and necessitates ongoing research to develop new therapeutic strategies.Intrinsic resistance occurs when bacterial...

Modern Molecular Taxonomy

Modern Molecular Taxonomy

Advancements in molecular biology have revolutionized the identification and characterization of bacteria, with multiple methods leveraging DNA sequencing for enhanced precision. As sequencing technologies improve and costs decline, these approaches are increasingly used in clinical, environmental, and evolutionary studies.Multilocus Sequence Typing (MLST) examines several housekeeping genes, essential chromosomal genes encoding cellular functions, to distinguish strains. Approximately...

Antimicrobial Effectiveness

Antimicrobial Effectiveness

The effectiveness of antimicrobial agents depends on various factors influencing their ability to eliminate microbial populations. Larger microbial populations require more time for complete eradication, emphasizing the importance of population size analysis when evaluating antimicrobial efficacy.Microbial resistance to antimicrobial agents varies significantly. Highly resilient microorganisms include endospores, gram-negative bacteria, and non-enveloped viruses, while prions are exceptionally...

Rapid Identification of Pathogens

Rapid Identification of Pathogens

MALDI-TOF MS has transformed clinical microbiology by offering a rapid and reliable method for pathogen identification. The traditional approach to microbial identification typically involves time-consuming culture techniques and biochemical tests, which can delay the initiation of appropriate antimicrobial therapy. MALDI-TOF MS avoids these delays by using characteristic ribosomal protein mass patterns of microbial cells, enabling accurate species-level identification within minutes.Principle...

Articles linked to this work by shared authors, journal, and citation graph.

Anticancer natural products from the Middle East and North Africa: biodiversity, mechanisms, and translational challenges.

Frontiers in oncology·2026

Molecular characterization of pESI-like megaplasmids in Salmonella Infantis from poultry in Lebanon.

Microbiology spectrum·2026

A Fitness Burden Drives the Reversion of in vitro Acquired Doxycycline Resistance in V. cholerae O1.

Infection and drug resistance·2026

Genomic Insights into blaNDM-5-Producing Escherichia coli ST648 Isolates from Human and Wildlife Sources in Lebanon.

Microorganisms·2025

Draft genome sequences of New Delhi metallo-beta-lactamase-producing Klebsiella pneumoniae strains isolated from water and wastewater sources.

Microbiology resource announcements·2025

Nationwide surveillance of carbapenem-resistant Gram-negative pathogens in the Lebanese environment.

Applied and environmental microbiology·2025

See all related articles