Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan.

Carbapenem resistance has become major concern in healthcare settings globally; therefore, its monitoring is crucial for intervention efforts to halt resistance spread. During May 2019-April 2022, 2170 clinical strains were characterized for antimicrobial susceptibility, resistance genes, replicon and sequence types. Overall, 42.1% isolates were carbapenem-resistant, and significantly associated with Klebsiella pneumoniae ( K. pneumoniae ) ( p = 0.008) and Proteus species ( p = 0.043). Carbapenemases were detected in 82.2% of isolates, with bla NDM-1 (41.1%) associated with the ICU ( p < 0.001), cardiology ( p = 0.042), pediatric medicine ( p = 0.013) and wound samples ( p = 0.041); bla OXA-48 (32.6%) was associated with the ICU ( p < 0.001), cardiology ( p = 0.008), pediatric medicine ( p < 0.001), general surgery ( p = 0.001), general medicine ( p = 0.005) and nephrology ( p = 0.020); bla KPC-2 (5.5%) was associated with general surgery ( p = 0.029); bla NDM-1 / bla OXA-48 (11.4%) was associated with general surgery ( p < 0.001), and wound ( p = 0.002), urine ( p = 0.003) and blood ( p = 0.012) samples; bla OXA-48 / bla VIM (3.1%) was associated with nephrology ( p < 0.001) and urine samples ( p < 0.001). Other detected carbapenemases were bla VIM (3.0%), bla IMP (2.7%), bla OXA-48 / bla IMP (0.1%) and bla VIM / bla IMP (0.3%). Sequence type (ST)147 (39.7%) represented the most common sequence type identified among K. pneumoniae , along with ST11 (23.0%), ST14 (15.4%), ST258 (10.9%) and ST340 (9.6%) while ST405 comprised 34.5% of Escherichia coli ( E. coli ) isolates followed by ST131 (21.2%), ST101 (19.7%), ST10 (16.0%) and ST69 (7.4%). Plasmid replicon types IncFII, IncA/C, IncN, IncL/M, IncFIIA and IncFIIK were observed. This is first report describing the carbapenem-resistance burden and emergence of bla KPC-2 -ST147, bla NDM-1 -ST340 and bla NDM-1 -ST14 in K. pneumoniae isolates and bla NDM-1 -ST69 and bla NDM-1 / bla OXA-48 -ST69 in E. coli isolates coharboring extended-spectrum beta-lactamases (ESBLs) from Pakistan.