Epidemiology of carbapenemase-producing Enterobacterales in the Middle East: a systematic review

ABSTRACT

Introduction

The Middle East is actually recognized as endemic for carbapenemases-producing Enterobacterales (CPE) including at least OXA-48-like and NDM-like.

Areas covered

We performed a search of PubMed and Scopus using relevant keywords. We included peer-reviewed articles published only in English reporting any data on carbapenemase-producing bacteria from Middle East countries. The last literature search was performed on 26 October 2019. All studies describing carbapenemase-producing Enterobacterales isolated from humans, animals or environmental samples from the Middle East were included.

Expert opinion

The Middle-East is considered an endemic region for CPE strains and the extensive international exchange could facilitate the spread of CPE from these countries to other parts of the Globe in which the prevalence of the CPE is low. The expansion of the Middle East conflict has been associated with the rapid collapse of the existing health care system of the concerned countries. Considering that Millions of refugees have fled their country, they could introduce these CPE strains in countries with low endemicity. In conclusion, the health care system actors should take in a count the endemicity of CPE in these countries and develop local surveillance programs to limit the spread of these MDR bacteria.

KEYWORDS:

• Middle East
• carbapenemases-producing Enterobacterales
• epidemiology
• review

Article highlights

• Dissemination of OXA-48-like and NDM-like carbapenemases in all Middle East countries.

• Klebsiella pneumoniae being the most identified species representing about 75% of all reported strains.

• Dissemination of Enterobacterales strains producing different types of carbapenemases in different ecological niches.

• No clonal dissemination has been observed with different STs have been recoded for E. coli and K. pneumoniae strains.

• The dissemination of OXA-48-like carbapenemase is probably linked to IncL/M plasmids, unlike other carbapenemases that are linked to many different Inc groups.

Acknowledgments

We would think « Direction Générale de la Recherche Scientifique et du développement technologique (DGRSDT) » of Algerian Ministry of Higher Education and Scientific Research.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.