{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:50:25Z","timestamp":1790707825472,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","license":[{"start":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T00:00:00Z","timestamp":1564358400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011665","name":"Deanship of Scientific Research, King Saud University","doi-asserted-by":"publisher","award":["RGP-038"],"award-info":[{"award-number":["RGP-038"]}],"id":[{"id":"10.13039\/501100011665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BioMed Research International"],"published-print":{"date-parts":[[2019,7,29]]},"abstract":"<jats:p>The aim of this study was to investigate the mechanisms responsible for resistance to antimicrobials in a collection of enterobacterial isolates recovered from two hospitals in Saudi Arabia. A total of six strains isolated from different patients showing high resistance to carbapenems was recovered in 2015 from two different hospitals, with four being<jats:italic> Klebsiella pneumoniae<\/jats:italic> and two<jats:italic> Enterobacter cloacae. <\/jats:italic>All isolates except one<jats:italic> K. pneumoniae<\/jats:italic> were resistant to tigecycline, but only one<jats:italic> K. pneumoniae <\/jats:italic>was resistant to colistin. All produced a carbapenemase according to the Carba NP test, and all were positive for the EDTA-disk synergy test for detection of MBL. Using PCR followed by sequencing, the four<jats:italic> K. pneumoniae<\/jats:italic> isolates produced the carbapenemase NDM-1, while the two<jats:italic> E. cloacae<\/jats:italic> isolates produced the carbapenemase VIM-1. Genotyping analysis by Multilocus Sequence Typing (MLST) showed that three out of the four<jats:italic> K. pneumoniae <\/jats:italic>isolates were clonally related. They had been recovered from the same hospital and belonged to Sequence Type (ST) ST152. In contrast, the fourth<jats:italic> K. pneumoniae<\/jats:italic> isolate belonged to ST572. Noticeably, the NDM-1-producing<jats:italic> K. pneumoniae<\/jats:italic> additionally produced an extended-spectrum \u00df-lactamase (ESBL) of the CTX-M type, together with OXA-1 and TEM-1. Surprisingly, the three clonally related isolates produced different CTX-M variants, namely, CTX-M-3, CTX-M-57, and CTX-M-82, and coproduced QnrB, which confers quinolone resistance, and the 16S rRNA methylase RmtC, which confers high resistance to all aminoglycosides. The AAC(6\u2032)-Ib acetyltransferase was detected in both<jats:italic> K. pneumoniae<\/jats:italic> and<jats:italic> E. cloacae<\/jats:italic>. Mating-out assays using<jats:italic> Escherichia coli <\/jats:italic>as recipient were successful for all isolates. The <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mi>b<\/mml:mi><mml:mi>l<\/mml:mi><mml:msub><mml:mrow><mml:mi>a<\/mml:mi><\/mml:mrow><mml:mrow><mml:mtext>NDM-1<\/mml:mtext><\/mml:mrow><\/mml:msub><\/mml:math> gene was always identified on a 70-kb plasmid, whereas the <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><mml:mi>b<\/mml:mi><mml:mi>l<\/mml:mi><mml:msub><mml:mrow><mml:mi>a<\/mml:mi><\/mml:mrow><mml:mrow><mml:mtext>VIM-1<\/mml:mtext><\/mml:mrow><\/mml:msub><\/mml:math> gene was located on either a 60-kb or a 150-kb plasmid the two<jats:italic> E. cloacae<\/jats:italic> isolates, respectively. To the best of our knowledge, this is the first report of the coexistence of an MBL (NDM-1), an ESBL (CTX-M), a 16S rRNA methylase (RmtC), an acetyltransferase (AAC[6\u2032]-Ib), and a quinolone resistance enzyme (QnrB) in<jats:italic> K. pneumoniae <\/jats:italic>isolates recovered from different patients during an outbreak in a Saudi Arabian hospital.<\/jats:p>","DOI":"10.1155\/2019\/6736897","type":"journal-article","created":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T19:31:59Z","timestamp":1564428719000},"page":"1-7","source":"Crossref","is-referenced-by-count":13,"title":["Cooccurrence of NDM-1, ESBL, RmtC, AAC(6\u2032)-Ib, and QnrB in Clonally Related<i> Klebsiella pneumoniae<\/i> Isolates Together with Coexistence of CMY-4 and AAC(6\u2032)-Ib in<i> Enterobacter cloacae<\/i> Isolates from Saudi Arabia"],"prefix":"10.1155","volume":"2019","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9868-0355","authenticated-orcid":true,"given":"Mohamed H.","family":"Al-Agamy","sequence":"first","affiliation":[{"name":"Department of Pharmaceutics, College of Pharmacy, King Saud University, 11451 Riyadh 2457, Saudi Arabia"},{"name":"Microbiology and Immunology Department, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2315-6801","authenticated-orcid":true,"given":"Taghrid S.","family":"El-Mahdy","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Faculty of Pharmacy, Helwan University, Cairo, Egypt"},{"name":"Department of Microbiology, Faculty of Pharmacy, Ahram Canadian University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hesham H.","family":"Radwan","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutics, College of Pharmacy, King Saud University, 11451 Riyadh 2457, Saudi 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