Introduction and spread of NDM-producing Enterobacterales and Acinetobacter baumannii into Middle Eastern countries: a molecular-based hypothesis

ABSTRACT

Introduction

The goal of this review is to provide a plausible explanation for the dissemination of NDM-producing Enterobacterales (NDME) and Acinetobacter baumannii (NDMAb) across the ME.

Areas covered

We described and analyzed (1) the initial reports of NDME and NDMAb in ME countries; (2) the most contemporary data regarding the epidemiology of NDME and NDMAb in ME countries; and (3) the molecular features of NDME and NDMAb in ME countries.

Expert opinion

NDMAb first appeared in the Eastern Mediterranean and the Gulf States in 2009–2010. Although no connection to the Indian subcontinent could be traced, evidence for transmission within the region was found. The spread of NDMAb was mainly by clonal transmission, and it remained limited to less than 10% of the total CRAb population.

NDME most likely had evolved from NDMAb and appeared later in the ME. Subsequently, the spread of NDME was mainly via the transmission of the bla_NDM gene into several Klebsiella pneumoniae and Escherichia coli successful clones that had served before as recipient to various bla_ESBLgenes. The most recent epidemiological situation varied widely, from 20.7% of carbapenem-resistant Enterobacterales (CRE) in Saudi Arabia to 80.5% in Egypt.

KEYWORDS:

• NDM
• carbapenemase
• insertion sequence
• plasmid
• middle east
• transmission

Article highlights

• Unlike KPC, the epidemiological trail beyond the dissemination of the NDM-producing Enterobacterales (NDME) and Acinetobacter baumannii (NDMAb) into Middle Eastern (ME) countries is not well understood.

• NDMAb first appeared in the Eastern Mediterranean and the Gulf States in 2009–2010. The spread of NDMAb was mainly by clonal transmission, and it remained limited to less than 10% of the total CRAb population.

• NDME most likely had evolved from NDMAb and appeared later in the ME. Subsequently, the spread of NDME was mainly via the transmission of the bla_NDM gene into several Klebsiella pneumoniae and Escherichia coli successful clones.

• Contemporary rates of NDME varies from 20.7% of carbapenem-resistant Enterobacterales (CRE) in Saudi Arabia to 80.5% in Egypt.

Acknowledgments

The authors would like to thank Dr. Nardeen Khoury, for her assistance in the data search.

Declaration of interests

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.

Additional information

Funding

This study was not funded.