[Show abstract][Hide abstract] ABSTRACT: Among 28 clinically relevant, carbapenem non-susceptible Enterobacteriaceae isolates collected in 2009-2011 in the United Arab Emirates 3 Klebsiella pneumoniae, 2 Escherichia coli, 1 Enterobacter cloacae and 1 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, E. cloacae, E. coli and C. freundii, respectively. 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 evidences 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.
Full-text · Article · Apr 2013 · Journal of Medical Microbiology
[Show abstract][Hide abstract] ABSTRACT: We compared the antibiotic susceptibility, clonal lineages and the resistance genes of singleton Acinetobacter baumannii strains to those of isolates representing repeatedly encountered molecular types in five Abu Dhabi hospitals. One hundred and ten clinically relevant, non-repeat strains were typed by bla(OXA-51)-like allele sequencing, by PFGE, and selected isolates also by MLST. Resistance was assessed by MIC determinations and by disc diffusion. Genotyping was carried out by PCR, targeting 28 genes. The 80 epidemic strains belonged to worldwide lineages 1, 2 and 7, representing 11 pulsotypes and 9 genotpyes, while the 30 sporadic isolates exhibited high level of genetic variability and, with the exception of a small subgroup, not being associated with any recognized epidemic lineages. All epidemic subtypes carried the ISAba1-linked bla(OXA-23) gene, and harbored significantly more frequently the int, the bla(PER) and the armA genes than their sporadic counterparts. They were all multi-drug resistant including non-susceptibility to carbepenems, and were often extensively drug resistant, a phenomenon rarely seen among sporadic strains. Epidemic strains represented 78.8% of ICU isolates causing more respiratory infections, while sporadic strains were more frequently isolated form wound and soft tissue infections. The study showed that among strains collected at the same time and region, the very heterogeneous, sensitive sporadic strains, with the exception of a few non-susceptible singleton isolates, clearly differed from the highly resistant epidemic ones that belonged to multiple pulso-, and genotypes clustered into three worldwide clonal lineages carrying bla(OXA64), bla(OXA66), and bla(OXA69), respectively.
Full-text · Article · Dec 2012 · Journal of Medical Microbiology
[Show abstract][Hide abstract] ABSTRACT: Meticillin-resistant Staphylococcus aureus (MRSA) strains isolated in Tawam Hospital, a tertiary care hospital in the United Arab Emirates, were examined in order to understand the reasons for a doubling of its incidence between 2003 and 2008 while maintaining the same infection control measures.
All consecutive non-duplicate clinically relevant MRSA isolates recovered between January and December 2003 and between May and October 2008 were studied. The antibiotic susceptibility, pulsed field gel electrophoresis, toxin gene, staphylococcal cassette chromosome mec (SCCmec), spa, agr and multilocus sequence types of the strains were tested.
In 2003, typical healthcare-associated (HA-MRSA) genotypes (ST239-MRSA-III, ST22-MRSA-IV and ST5-MRSA-II) represented the majority (61.5%) of the isolates. By 2008 this pattern had changed and clonal types considered as community-associated (CA) MRSA comprised 73.1% of the strains with ST80-MRSA-IV, ST5-MRSA-IV and ST1-MRSA with non-typable SCCmec types being the most frequent. However, further epidemiological investigations showed that only one-third of the CA-MRSA infections were actually acquired in the community, indicating that CA-MRSA clones have entered and spread within the hospital.
The emergence of CA-MRSA clones with subsequent entry to and spread within the hospital has contributed to the increasing incidence of MRSA observed in Tawam Hospital and probably also in other hospitals in the UAE.
No preview · Article · Feb 2012 · Journal of clinical pathology