{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:06:27Z","timestamp":1789689987720,"version":"4.0.1"},"reference-count":38,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>This study aimed to determine the prevalence of carbapenem-resistant Enterobacterales (CRE), to characterize their molecular resistance mechanisms, and to assess associated clinical outcomes among intensive care unit (ICU) patients in Tunisia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted from January to March 2025 in the ICU of Habib Thameur Hospital and included all patients with clinically significant CRE infections. Resistance determinants were identified using multiplex polymerase chain reaction with reverse dot blot hybridization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 95 ICU admissions, 17 patients developed CRE infections, corresponding to an incidence density of 21.6 cases per 1,000 patient-days. All infections were hospital-acquired. The most frequent risk factors were the presence of central venous and urinary catheters (16 patients each) and mechanical ventilation (15 patients).\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      predominated, accounting for 26 of 27 isolates, all of which were multidrug-resistant (MDR), with a median antibiotic resistance index of 1.00. The bla\n                      <jats:sub>NDM<\/jats:sub>\n                      and bla\n                      <jats:sub>OXA-48<\/jats:sub>\n                      genes were detected in 81.5% and 77.8% of isolates, respectively, with 70.4% co-producing both carbapenemases. All\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      isolates harbored bla\n                      <jats:sub>SHV<\/jats:sub>\n                      and\/or bla\n                      <jats:sub>CTX-M<\/jats:sub>\n                      , while a single\n                      <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                      isolate carried bla\n                      <jats:sub>OXA-48<\/jats:sub>\n                      . Cluster analysis revealed strong associations between \u03b2-lactamase production and resistance to aminoglycosides and fluoroquinolones, suggesting co-selection of MDR strains. Empirical antimicrobial therapy was appropriate in only 47% of cases, and ICU mortality reached 82.4%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      These findings highlight an alarmingly high burden of CRE infections in this ICU, driven mainly by\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      co-producing NDM and OXA-48, and underscore the urgent need for strengthened infection control and antimicrobial stewardship strategies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10766294261460634","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T16:45:08Z","timestamp":1781541908000},"page":"503-510","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Burden of Carbapenemase-Producing Enterobacterales in Critical Care Settings: Insights from a Tunisian Intensive Care Unit"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1917-5181","authenticated-orcid":false,"given":"Manel","family":"Ennaceur","sequence":"first","affiliation":[{"name":"Laboratory Department, Habib Thameur Hospital, Tunis, Tunisia."},{"name":"Biology Department, University of Monastir Faculty of Pharmacy of Monastir, Monastir, Tunisia."},{"name":"Laboratory of Microorganisms and Active Bio-molecules (LR03ES03), University of Tunis El Manar Faculty of Sciences of Tunis, Tunis, Tunisia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Sedghiani","sequence":"additional","affiliation":[{"name":"ICU and Emergency Department, Habib Thameur Hospital, Tunis, Tunisia."},{"name":"University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Othmen","family":"Bacha","sequence":"additional","affiliation":[{"name":"Laboratory Department, Habib Thameur Hospital, Tunis, Tunisia."},{"name":"Biology Department, University of Monastir Faculty of Pharmacy of Monastir, Monastir, Tunisia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Chouaieb","sequence":"additional","affiliation":[{"name":"Laboratory Department, Habib Thameur Hospital, Tunis, Tunisia."},{"name":"Biology Department, University of Monastir Faculty of Pharmacy of Monastir, Monastir, Tunisia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nebiha","family":"Bosrali-Flafoul","sequence":"additional","affiliation":[{"name":"ICU and Emergency Department, Habib Thameur Hospital, Tunis, Tunisia."},{"name":"University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1475221"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.24976\/Discov.Med.202436188.177"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-021-01712-0"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12941-023-00636-5"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-10848-8"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2019.00074"},{"key":"e_1_3_3_8_1","volume-title":"WHO bacterial priority pathogens list 2024","author":"World Health Organization","year":"2024","unstructured":"7.World Health Organization. WHO bacterial priority pathogens list 2024. Geneva: WHO; 2024."},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2022.106528"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.3934\/microbiol.2018.3.482"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz830"},{"key":"e_1_3_3_12_1","volume-title":"Rapport national de surveillance de la r\u00e9sistance bact\u00e9rienne 2023","author":"Laboratoire de l\u2019Antibior\u00e9sistance en Tunisie","year":"2023","unstructured":"11.Laboratoire de l\u2019Antibior\u00e9sistance en Tunisie. Rapport national de surveillance de la r\u00e9sistance bact\u00e9rienne 2023. Tunis: Ministry of Health; 2023."},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2018.0013"},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2023.1109418"},{"key":"e_1_3_3_15_1","volume-title":"REMIC: R\u00e9f\u00e9rentiel en microbiologie m\u00e9dicale","author":"Soci\u00e9t\u00e9 Fran\u00e7aise de Microbiologie","year":"2022","unstructured":"14.Soci\u00e9t\u00e9 Fran\u00e7aise de Microbiologie. REMIC: R\u00e9f\u00e9rentiel en microbiologie m\u00e9dicale. 7th ed. Paris: SFM; 2022.","edition":"7"},{"key":"e_1_3_3_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-022-07885-3"},{"key":"e_1_3_3_17_1","unstructured":"16.European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 14.0; 2024."},{"key":"e_1_3_3_18_1","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2022.0264"},{"key":"e_1_3_3_19_1","first-page":"0000442","article-title":"Surveillance of multidrug-resistant bacteria in ICU","volume":"36","author":"Fehri Z","year":"2025","unstructured":"18.Fehri Z, , Azouzi F, , Ghali N, et al. Surveillance of multidrug-resistant bacteria in ICU. Rev Res Med Microbiol 2025;36:0000442.","journal-title":"Rev Res Med Microbiol"},{"key":"e_1_3_3_20_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2024.1370553"},{"key":"e_1_3_3_21_1","volume-title":"Healthcare-associated infections","author":"European Centre for Disease Prevention and Control","year":"2023","unstructured":"20.European Centre for Disease Prevention and Control. Healthcare-associated infections. Stockholm: ECDC; 2023."},{"key":"e_1_3_3_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2023.103491"},{"key":"e_1_3_3_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2019.08.012"},{"key":"e_1_3_3_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.meegid.2025.105787"},{"key":"e_1_3_3_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics14070657"},{"key":"e_1_3_3_26_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina61071220"},{"key":"e_1_3_3_27_1","doi-asserted-by":"publisher","DOI":"10.7324\/JAPS.2022.120307"},{"key":"e_1_3_3_28_1","doi-asserted-by":"publisher","DOI":"10.1099\/mgen.0.000567"},{"issue":"10","key":"e_1_3_3_29_1","first-page":"1035","article-title":"Antimicrobial resistance in ICU","volume":"39","author":"Brahim ME","year":"2018","unstructured":"28.Brahim ME. Antimicrobial resistance in ICU. Saudi Med J 2018;39(10):1035\u20131043; doi: 10.15537\/smj.2018.10.22944","journal-title":"Saudi Med J"},{"key":"e_1_3_3_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medmal.2018.10.010"},{"key":"e_1_3_3_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/lam.13658"},{"key":"e_1_3_3_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2018.08.022"},{"key":"e_1_3_3_33_1","doi-asserted-by":"crossref","unstructured":"32.Ennaceur M Mesbeh HB Bacha O et al. First report of the mcr-1 gene in colistin-resistant Klebsiella pneumoniae in a tertiary care hospital in Tunisia. BMC Infect Dis (2026); doi: 10.1186\/s12879-026-13562-6","DOI":"10.1186\/s12879-026-13562-6"},{"key":"e_1_3_3_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2021.11.025"},{"key":"e_1_3_3_35_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.681731"},{"key":"e_1_3_3_36_1","unstructured":"35.World Health Organization. Global report on infection prevention and control. Geneva: WHO; 2022."},{"key":"e_1_3_3_37_1","doi-asserted-by":"publisher","DOI":"10.1128\/aac.00924-24"},{"key":"e_1_3_3_38_1","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12081255"},{"key":"e_1_3_3_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-024-01271-9"}],"container-title":["Microbial Drug Resistance"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10766294261460634","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10766294261460634","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10766294261460634","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T23:19:23Z","timestamp":1789687163000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10766294261460634"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":38,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11,1]]}},"alternative-id":["10.1177\/10766294261460634"],"URL":"https:\/\/doi.org\/10.1177\/10766294261460634","relation":{},"ISSN":["1076-6294","1931-8448"],"issn-type":[{"value":"1076-6294","type":"print"},{"value":"1931-8448","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]}}}