{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:26:38Z","timestamp":1790022398098,"version":"4.0.1"},"reference-count":51,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Deanship of Scientific Research at Imam Mohammad Ibn Saud Islamic University","award":["IMSIU-DDRSP2601"],"award-info":[{"award-number":["IMSIU-DDRSP2601"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Carbapenem-resistant Enterobacteriaceae (CRE) are critical priority pathogens due to their resistance to carbapenems, the last-resort antibiotics, and their rapid spread in healthcare facilities. The study investigates the epidemiological and molecular characteristics of CRE isolates in the Jazan region, Saudi Arabia. Clinical specimens were collected from patients admitted to Jazan General Hospital between December 2023 and May 2024. Identification of the isolates was done by the VITEK 2 system, and their susceptibility to antibiotics was determined on the MicroScan WalkAway platform according to the EUCAST guidelines. The E-test was used to confirm the CRE isolates. Molecular detection of carbapenemase genes (\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>IMP<\/jats:sub>\n                    ,\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>VIM<\/jats:sub>\n                    ,\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM<\/jats:sub>\n                    ,\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>KPC<\/jats:sub>\n                    and\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-48<\/jats:sub>\n                    ) was conducted using the GeneXpert Carba-R assay using the GeneXpert\u00ae. A total of 426 Enterobacterial clinical isolates were collected from patients; among them, 53 (12.4%) were phenotypically found to be CRE; among such isolates, 14 (26.4%) were found to be carbapenemase-positive Enterobacteriaceae (CPE), and 39 (73.6%) were carbapenemase-negative Enterobacteriaceae (CNE). Among the CPE strains,\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    was the predominant organism (42.9%), followed by\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    (28.6%),\n                    <jats:italic>Enterobacter cloacae<\/jats:italic>\n                    (21.4%), and\n                    <jats:italic>Serratia marcescens<\/jats:italic>\n                    (7.1%). Molecular analysis revealed a high prevalence of the\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM<\/jats:sub>\n                    gene (71.4%), with\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-48<\/jats:sub>\n                    detected in 42.9% of isolates. The\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>VIM<\/jats:sub>\n                    was identified in only 7.1%, while neither the\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>KPC<\/jats:sub>\n                    nor\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>IMP<\/jats:sub>\n                    is detected. For the CNE strains,\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    was most common (62%), of which 15% produced extended-spectrum \u03b2-lactamase (ESBL). The isolates were all highly resistant to penicillin and \u03b2-lactam\/\u03b2-lactamase inhibitors, moderately susceptible to fluoroquinolone (33%) and aminoglycosides (49%), and most susceptible to tigecycline (79%). The\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM<\/jats:sub>\n                    was mainly found among ICU patients, while\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-48<\/jats:sub>\n                    was most frequently identified among pediatric patients. The ICU admission with invasive devices, and prior broad-spectrum antibiotic exposure emerged as the main risk factors for the evolution of CPE. Multiple comorbidities; particularly malignancy, diabetes, and surgery; further increased vulnerability to CPE infections. Jazan city has a lower prevalence of CPE, while non-carbapenemase resistance is most predominant, reflecting regional epidemiological heterogeneity, which is important for regional stewardship and control.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-49160-4","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T17:57:10Z","timestamp":1777053430000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Detection of New Delhi metallo-\u03b2-lactamase (blaNDM) and oxacillinase (blaOXA-48) genes among carbapenem-resistant Enterobacteriaceae (CRE) in Jazan Region, Saudi Arabia"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5461-5719","authenticated-orcid":false,"given":"Soheir A. A.","family":"Hagras","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5410-7936","authenticated-orcid":false,"given":"Gharieb S.","family":"El-Sayyad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwa Yousry A.","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani A.","family":"Ozbak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahitab M.","family":"Wahby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Ahmed","family":"Eltigani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neamat Hanem M. I.","family":"Dorra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samar","family":"Elshahidy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa A.","family":"Abdel-Maksoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salman","family":"Alrokayan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan A.","family":"Rudayni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasser Q.","family":"Majrabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"49160_CR1","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1097\/CCM.0000000000004371","volume":"48","author":"SS Kadri","year":"2020","unstructured":"Kadri, S. S. Key takeaways from the US CDC\u2019s 2019 antibiotic resistance threats report for frontline providers. Crit. Care Med. 48, 939\u2013945 (2020).","journal-title":"Crit. Care Med."},{"key":"49160_CR2","doi-asserted-by":"publisher","DOI":"10.1136\/ebnurs-2022-103540","author":"R Ranjbar","year":"2023","unstructured":"Ranjbar, R. & Alam, M. Antimicrobial resistance collaborators (2022). Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Evid. Based Nurs. https:\/\/doi.org\/10.1136\/ebnurs-2022-103540 (2023).","journal-title":"Evid. Based Nurs."},{"key":"49160_CR3","doi-asserted-by":"publisher","first-page":"2086","DOI":"10.3390\/microorganisms11082086","volume":"11","author":"AK Thabit","year":"2023","unstructured":"Thabit, A. K., Alabbasi, A. Y., Alnezary, F. S. & Almasoudi, I. A. An overview of antimicrobial resistance in Saudi Arabia (2013\u20132023) and the need for national surveillance. Microorganisms 11, 2086 (2023).","journal-title":"Microorganisms"},{"key":"49160_CR4","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1093\/cid\/ciae403","volume":"45","author":"PD Tamma","year":"2024","unstructured":"Tamma, P. D. et al. Infectious diseases society of America 2024 guidance on the treatment of antimicrobial-resistant gram-negative infections. Clin. Infect. Dis. 45, 403. https:\/\/doi.org\/10.1093\/cid\/ciae403 (2024).","journal-title":"Clin. Infect. Dis."},{"key":"49160_CR5","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1186\/s12866-017-1012-8","volume":"17","author":"AU Khan","year":"2017","unstructured":"Khan, A. U., Maryam, L. & Zarrilli, R. Structure, genetics and worldwide spread of New Delhi metallo-\u03b2-lactamase (NDM): A threat to public health. BMC Microbiol. 17, 101 (2017).","journal-title":"BMC Microbiol."},{"key":"49160_CR6","doi-asserted-by":"publisher","first-page":"1370","DOI":"10.1093\/cid\/ciab415","volume":"73","author":"GM Wilson","year":"2021","unstructured":"Wilson, G. M. et al. Risk factors associated with carbapenemase-producing carbapenem-resistant Enterobacteriaceae positive cultures in a cohort of US veterans. Clin. Infect. Dis. 73, 1370\u20131378 (2021).","journal-title":"Clin. Infect. Dis."},{"key":"49160_CR7","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/j.jinf.2016.07.002","volume":"73","author":"MJ Satlin","year":"2016","unstructured":"Satlin, M. J. et al. Bacteremia due to carbapenem-resistant Enterobacteriaceae in neutropenic patients with hematologic malignancies. J. Infect. 73, 336\u2013345 (2016).","journal-title":"J. Infect."},{"key":"49160_CR8","doi-asserted-by":"publisher","first-page":"e0131372","DOI":"10.1371\/journal.pone.0131372","volume":"10","author":"\u00c1 Sonnevend","year":"2015","unstructured":"Sonnevend, \u00c1. et al. Characterization of carbapenem-resistant Enterobacteriaceae with high rate of autochthonous transmission in the Arabian Peninsula. PLoS ONE 10, e0131372 (2015).","journal-title":"PLoS ONE"},{"key":"49160_CR9","doi-asserted-by":"publisher","first-page":"501","DOI":"10.2217\/17460913.2.5.501","volume":"2","author":"L Poirel","year":"2007","unstructured":"Poirel, L., Pitout, J. D. & Nordmann, P. Carbapenemases: Molecular diversity and clinical consequences. Future Microbiol. 2, 501\u2013512 (2007).","journal-title":"Future Microbiol."},{"key":"49160_CR10","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.bjid.2020.07.006","volume":"24","author":"JES Costa","year":"2020","unstructured":"Costa, J. E. S., Nogueira, K. S. & Cunha, C. A. Carbapenem-resistant bacilli in a hospital in southern Brazil: Prevalence and therapeutic implications. Braz. J. Infect. Dis. 24, 380\u2013385 (2020).","journal-title":"Braz. J. Infect. Dis."},{"key":"49160_CR11","doi-asserted-by":"publisher","DOI":"10.1128\/aac.01730-01717","author":"K van Loon","year":"2018","unstructured":"van Loon, K. & Voor in \u2018t holtVos, A. F. M. C. A systematic review and meta-analyses of the clinical epidemiology of carbapenem-resistant Enterobacteriaceae. Antimicrob. Agents Chemother. https:\/\/doi.org\/10.1128\/aac.01730-01717 (2018).","journal-title":"Antimicrob. Agents Chemother."},{"key":"49160_CR12","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.1007\/s10096-021-04185-7","volume":"40","author":"FB Abid","year":"2021","unstructured":"Abid, F. B. et al. Molecular characterization of clinical carbapenem-resistant Enterobacterales from Qatar. Eur. J. Clin. Microbiol. Infect. Dis. 40, 1779\u20131785 (2021).","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"49160_CR13","doi-asserted-by":"publisher","first-page":"106340","DOI":"10.1016\/j.ijantimicag.2021.106340","volume":"57","author":"SS Tang","year":"2021","unstructured":"Tang, S. S., Chee, E., Teo, J. Q., Chlebicki, M. P. & Kwa, A. L. Incidence of a subsequent carbapenem-resistant Enterobacteriaceae infection after previous colonisation or infection: A prospective cohort study. Int. J. Antimicrob. Agents 57, 106340 (2021).","journal-title":"Int. J. Antimicrob. Agents"},{"key":"49160_CR14","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1007\/978-3-030-76320-6_20","volume-title":"Biochemistry of Drug Resistance","author":"MM Idrees","year":"2021","unstructured":"Idrees, M. M. & Saeed, A. Biochemistry of Drug Resistance 505\u2013538 (Springer, Cham, 2021)."},{"key":"49160_CR15","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s13756-018-0346-9","volume":"7","author":"DJ Livorsi","year":"2018","unstructured":"Livorsi, D. J. et al. A systematic review of the epidemiology of carbapenem-resistant Enterobacteriaceae in the United States. Antimicrob. Resist. Infect. Control 7, 55 (2018).","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"49160_CR16","doi-asserted-by":"publisher","first-page":"16333","DOI":"10.1038\/s41598-024-64992-8","volume":"14","author":"B Tuhamize","year":"2024","unstructured":"Tuhamize, B. & Bazira, J. Carbapenem-resistant Enterobacteriaceae in the livestock, humans and environmental samples around the globe: A systematic review and meta-analysis. Sci. Rep. 14, 16333 (2024).","journal-title":"Sci. Rep."},{"key":"49160_CR17","doi-asserted-by":"publisher","first-page":"28","DOI":"10.66585\/ohmi.2025.1.0005","volume":"1","author":"KO Akinyemi","year":"2025","unstructured":"Akinyemi, K. O. & Abdelmegid, S. W. Commentary on: Molecular epidemiological exploration of carbapenem-resistant Enterobacteriaceae in Africa from a one health perspective. One Health Microbiol. Infect. 1, 28\u201330 (2025).","journal-title":"One Health Microbiol. Infect."},{"key":"49160_CR18","doi-asserted-by":"publisher","first-page":"3","DOI":"10.66585\/ohmi.2025.1.0002","volume":"1","author":"NB Alhaji","year":"2025","unstructured":"Alhaji, N. B. Molecular epidemiological exploration of carbapenem-resistant Enterobacteriaceae in Africa from one health perspective: A systematic review. One Health Microbiol. Infect. 1, 3\u201311 (2025).","journal-title":"One Health Microbiol. Infect."},{"key":"49160_CR19","first-page":"249","volume-title":"Annual Reports in Medicinal Chemistry","author":"Y He","year":"2014","unstructured":"He, Y., Lawrence, J., Liu, C. & Yin, N. Annual Reports in Medicinal Chemistry Vol. 49, 249\u2013266 (Elsevier, Amsterdam, 2014)."},{"key":"49160_CR20","doi-asserted-by":"publisher","first-page":"63","DOI":"10.5144\/0256-4947.2021.63","volume":"41","author":"H Al-Abdely","year":"2021","unstructured":"Al-Abdely, H. et al. Molecular characterization of carbapenem-resistant Enterobacterales in thirteen tertiary care hospitals in Saudi Arabia. Ann. Saudi Med. 41, 63\u201370 (2021).","journal-title":"Ann. Saudi Med."},{"key":"49160_CR21","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1186\/s12879-022-07507-y","volume":"22","author":"BM Alraddadi","year":"2022","unstructured":"Alraddadi, B. M. et al. Molecular epidemiology and outcome of carbapenem-resistant Enterobacterales in Saudi Arabia. BMC Infect. Dis. 22, 542 (2022).","journal-title":"BMC Infect. Dis."},{"key":"49160_CR22","doi-asserted-by":"publisher","first-page":"2321","DOI":"10.1128\/JCM.00193-17","volume":"55","author":"VM Pierce","year":"2017","unstructured":"Pierce, V. M. et al. Modified carbapenem inactivation method for phenotypic detection of carbapenemase production among Enterobacteriaceae. J. Clin. Microbiol. 55, 2321\u20132333 (2017).","journal-title":"J. Clin. Microbiol."},{"key":"49160_CR23","doi-asserted-by":"publisher","first-page":"53","DOI":"10.24171\/j.phrp.2020.11.1.08","volume":"11","author":"JA Choi","year":"2020","unstructured":"Choi, J. A., Bae, S. M., Kim, J. W. & Lee, K. J. Development of a two triplex real-time polymerase chain reaction for rapid detection of six carbapenemase genes in Enterobacteriaceae. Osong Public Health Res. Perspect. 11, 53 (2020).","journal-title":"Osong Public Health Res. Perspect."},{"key":"49160_CR24","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.annemergmed.2018.05.011","volume":"72","author":"Centers for Disease Control and Prevention","year":"2018","unstructured":"Centers for Disease Control and Prevention. Investigation of carbapenemase-producing carbapenem-resistant Enterobacteriaceae among patients at a community hospital\u2014Kentucky, 2016. Ann. Emerg. Med. 72, 59\u201360 (2018).","journal-title":"Ann. Emerg. Med."},{"key":"49160_CR25","unstructured":"Suay-Garc\u00eda, B. & P\u00e9rez-Gracia, M. T. Present and future of carbapenem-resistant Enterobacteriaceae infections. In Advances in Clinical Immunology, Medical Microbiology, COVID-19, and Big Data 435\u2013456 (2021)."},{"key":"49160_CR26","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1128\/JCM.02771-15","volume":"54","author":"JD Lutgring","year":"2016","unstructured":"Lutgring, J. D. & Limbago, B. M. The problem of carbapenemase-producing-carbapenem-resistant-Enterobacteriaceae detection. J. Clin. Microbiol. 54, 529\u2013534 (2016).","journal-title":"J. Clin. Microbiol."},{"key":"49160_CR27","first-page":"35050","volume":"15","author":"R Taha","year":"2023","unstructured":"Taha, R. et al. Prevalence of carbapenem-resistant Enterobacteriaceae in Western Saudi Arabia and increasing trends in the antimicrobial resistance of Enterobacteriaceae. Cureus 15, 35050 (2023).","journal-title":"Cureus"},{"key":"49160_CR28","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S219635","author":"H Zou","year":"2019","unstructured":"Zou, H. et al. CP-CRE\/non-CP-CRE stratification and CRE resistance mechanism determination help in better managing CRE bacteremia using ceftazidime\u2013avibactam and aztreonam\u2013avibactam. Infect. Drug Resist. https:\/\/doi.org\/10.2147\/IDR.S219635 (2019).","journal-title":"Infect. Drug Resist."},{"key":"49160_CR29","first-page":"60353","volume":"63","author":"Protection of Human Subjects","year":"1998","unstructured":"Protection of Human Subjects. Categories of research that may be reviewed by the institutional review board (IRB) through an expedited review procedureFDA. Notice. Fed. Regist. 63, 60353\u201360356 (1998).","journal-title":"Fed. Regist."},{"key":"49160_CR30","volume-title":"Protecting Data Privacy in Health Services Research","author":"Division of Health Care Services, and Committee on the Role of Institutional Review Boards in Health Services Research Data Privacy Protection","year":"2001","unstructured":"Division of Health Care Services, and Committee on the Role of Institutional Review Boards in Health Services Research Data Privacy Protection. Protecting Data Privacy in Health Services Research (National Academies Press, Washington, D.C., 2001)."},{"key":"49160_CR31","first-page":"1","volume":"2006","author":"DH Pincus","year":"2006","unstructured":"Pincus, D. H. Microbial identification using the bioM\u00e9rieux Vitek\u00ae 2 system. Encycl. Rapid Microbiol. Methods Bethesda Parenter. Drug Assoc. 2006, 1\u201332 (2006).","journal-title":"Encycl. Rapid Microbiol. Methods Bethesda Parenter. Drug Assoc."},{"key":"49160_CR32","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1016\/j.jiph.2016.05.012","volume":"10","author":"AM Bazzi","year":"2017","unstructured":"Bazzi, A. M., Rabaan, A. A., Fawarah, M. M. & Al-Tawfiq, J. A. Direct identification and susceptibility testing of positive blood cultures using high speed cold centrifugation and Vitek II system. J. Infect. Public Health. 10, 299\u2013307 (2017).","journal-title":"J. Infect. Public Health."},{"key":"49160_CR33","unstructured":"The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. https:\/\/www.eucast.org (2025)."},{"key":"49160_CR34","first-page":"488","volume":"1","author":"S Sunkar","year":"2013","unstructured":"Sunkar, S. & Nachiyar, V. Endophytes as potential nanofactories. Int. J. Chem. Environ. Biol. Sci. 1, 488\u2013491 (2013).","journal-title":"Int. J. Chem. Environ. Biol. Sci."},{"key":"49160_CR35","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S392035","author":"Y Xu","year":"2022","unstructured":"Xu, Y. et al. A rapid carbapenemase genes detection method with Xpert Carba-R from positive blood cultures compared with NG-test Carba 5 and sequencing. Infect. Drug Resist. https:\/\/doi.org\/10.2147\/IDR.S392035 (2022).","journal-title":"Infect. Drug Resist."},{"key":"49160_CR36","unstructured":"Smith, H. Z., Hollingshead, H. C., Kendall, B. Carbapenem-resistant Enterobacterales. [Updated 2024 Feb 2]. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK551704\/ (2025)."},{"key":"49160_CR37","doi-asserted-by":"publisher","first-page":"623574","DOI":"10.3389\/fmicb.2020.623574","volume":"11","author":"CA Black","year":"2021","unstructured":"Black, C. A. et al. Predominance of non-carbapenemase producing carbapenem-resistant enterobacterales in South Texas. Front. Microbiol. 11, 623574 (2021).","journal-title":"Front. Microbiol."},{"key":"49160_CR38","doi-asserted-by":"publisher","first-page":"123","DOI":"10.70749\/ijbr.v3i6.1466","volume":"3","author":"A Abbas","year":"2025","unstructured":"Abbas, A. et al. Nanoparticles in infectious disease control: Microbial synthesis, antimicrobial mechanisms, and therapeutic innovations. Indus. J. Biosci. Res. 3, 123\u2013128 (2025).","journal-title":"Indus. J. Biosci. Res."},{"key":"49160_CR39","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1080\/02648725.2022.2122297","volume":"39","author":"AD Teklemariam","year":"2023","unstructured":"Teklemariam, A. D. et al. Bacterial co-infections and antimicrobial resistance associated with the coronavirus disease 2019 infection. Biotechnol. Genet. Eng. Rev. 39, 259\u2013280 (2023).","journal-title":"Biotechnol. Genet. Eng. Rev."},{"key":"49160_CR40","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1128\/AAC.46.3.940-940.2002","volume":"46","author":"RG Nelson","year":"2002","unstructured":"Nelson, R. G. & Rosowsky, A. Dicyclic and tricyclic diaminopyrimidine derivatives as potent inhibitors of Cryptosporidium parvum dihydrofolate reductase: Structure-activity and structure-selectivity correlations. Antimicrob. Agents Chemother. 46, 940\u2013940 (2002).","journal-title":"Antimicrob. Agents Chemother."},{"key":"49160_CR41","doi-asserted-by":"publisher","DOI":"10.1186\/s12866-026-04770-w","author":"SR Alharbi","year":"2026","unstructured":"Alharbi, S. R. et al. Epidemiology and carbapenemase gene distribution among carbapenem-resistant enterobacterales: A two-year retrospective study in a Saudi tertiary hospital. BMC Microbiol. https:\/\/doi.org\/10.1186\/s12866-026-04770-w (2026).","journal-title":"BMC Microbiol."},{"key":"49160_CR42","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1186\/s12879-025-11276-9","volume":"25","author":"MO Olaitan","year":"2025","unstructured":"Olaitan, M. O. et al. Extended-spectrum beta-lactam-resistant Klebsiella pneumoniae in Sub-Saharan Africa: A systematic review and meta-analysis from a one health perspective. BMC Infect. Dis. 25, 843. https:\/\/doi.org\/10.1186\/s12879-025-11276-9 (2025).","journal-title":"BMC Infect. Dis."},{"key":"49160_CR43","doi-asserted-by":"publisher","DOI":"10.1016\/j.idnow.2025.105243","author":"L Dubreuil","year":"2026","unstructured":"Dubreuil, L. Antimicrobial susceptibility testing of anaerobes\u2212challenges and potential solutions for identifying breakpoints using the disk-diffusion method, based on re-analysis of a large panel of anaerobes. Infect. Dis. Now https:\/\/doi.org\/10.1016\/j.idnow.2025.105243 (2026).","journal-title":"Infect. Dis. Now"},{"key":"49160_CR44","unstructured":"GXMTB-ULTRA-MII, R. Xpert\u00ae MTB\/RIF ultra (2019)."},{"key":"49160_CR45","doi-asserted-by":"publisher","first-page":"1033305","DOI":"10.3389\/fcimb.2022.1033305","volume":"12","author":"M Shahid","year":"2022","unstructured":"Shahid, M. et al. Clinical carbapenem-resistant Klebsiella pneumoniae isolates simultaneously harboring bla NDM-1, bla OXA types and qnrS genes from the Kingdom of Bahrain: Resistance profile and genetic environment. Front. Cell. Infect. Microbiol. 12, 1033305 (2022).","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"49160_CR46","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.jiph.2019.03.024","volume":"12","author":"F Alotaibi","year":"2019","unstructured":"Alotaibi, F. Carbapenem-resistant Enterobacteriaceae: An update narrative review from Saudi Arabia. J. Infect. Public Health 12, 465\u2013471 (2019).","journal-title":"J. Infect. Public Health"},{"key":"49160_CR47","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1186\/s12879-022-07507-y","volume":"22","author":"BM Alraddadi","year":"2022","unstructured":"Alraddadi, B. M. et al. Molecular epidemiology and outcome of carbapenem-resistant enterobacterales in Saudi Arabia. BMC Infect. Dis. 22, 542. https:\/\/doi.org\/10.1186\/s12879-022-07507-y (2022).","journal-title":"BMC Infect. Dis."},{"key":"49160_CR48","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1093\/aje\/kwv299","volume":"183","author":"BY Lee","year":"2016","unstructured":"Lee, B. Y. et al. The potential trajectory of carbapenem-resistant Enterobacteriaceae, an emerging threat to health-care facilities, and the impact of the centers for disease control and prevention toolkit. Am. J. Epidemiol. 183, 471\u2013479 (2016).","journal-title":"Am. J. Epidemiol."},{"key":"49160_CR49","volume-title":"Growing and Handling of Bacterial Culture","author":"B Bedeni\u0107","year":"2018","unstructured":"Bedeni\u0107, B. & Sardeli\u0107, S. Carbapenemases. In Growing and Handling of Bacterial Culture (IntechOpen, London, 2018)."},{"key":"49160_CR50","doi-asserted-by":"publisher","first-page":"e02020","DOI":"10.1016\/j.idcr.2024.e02020","volume":"37","author":"TA Almangour","year":"2024","unstructured":"Almangour, T. A., Aldajani, G. A., Alhijji, A. & Alsharidi, A. Treatment of a challenging NDM and OXA-48-producing Klebsiella pneumoniae causing skin and soft tissue infection and exhibiting resistance to the combination of ceftazidime-avibactam and aztreonam: A case report. IDCases 37, e02020 (2024).","journal-title":"IDCases"},{"key":"49160_CR51","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1093\/jac\/dkw414","volume":"72","author":"P Trepanier","year":"2017","unstructured":"Trepanier, P. et al. Carbapenemase-producing Enterobacteriaceae in the UK: A national study (EuSCAPE-UK) on prevalence, incidence, laboratory detection methods and infection control measures. J. Antimicrob. Chemother. 72, 596\u2013603 (2017).","journal-title":"J. Antimicrob. Chemother."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-49160-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-49160-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-49160-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:20:26Z","timestamp":1777458026000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-49160-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":51,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["49160"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-49160-4","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]},"assertion":[{"value":"27 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was conducted at the Microbiology lab in Jazan General Hospital, Saudi Arabia. The research protocol was approved by the Research Ethics Committee at Jazan Hospital (No. 23109).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"The study was granted expedited review status as it involved no more than minimal risk to participants, in accordance with 45 CFR 46.110. Patients\u2019 privacy and confidentiality were strictly maintained in compliance with the Declaration of Helsinki and the ethical standards and regulations of the National Committee of Bioethics (NCBE), Kingdom of Saudi Arabia. All patient data were anonymized prior to analysis, and no identifiable personal information was collected or used.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial number"}}],"article-number":"13769"}}