{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T01:32:52Z","timestamp":1790472772737,"version":"4.1.0"},"reference-count":77,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,22]],"date-time":"2021-02-22T00:00:00Z","timestamp":1613952000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014035","name":"Armed Forces Health Surveillance Branch","doi-asserted-by":"publisher","award":["PROMIS ID 20160270153 FY17"],"award-info":[{"award-number":["PROMIS ID 20160270153 FY17"]}],"id":[{"id":"10.13039\/100014035","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Carbapenem-resistant gram-negative bacteria are an increasingly significant clinical threat globally. This risk may be underestimated in Kenya as only four carbapenemase genes in three bacterial species have been described. The study aimed to understand the antibiotic resistance profiles, genes, sequence types, and distribution of carbapenem-resistant gram-negative bacteria from patients in six hospitals across five Kenyan counties by bacterial culture, antibiotic susceptibility testing, and whole-genome sequence analysis. Forty-eight, non-duplicate, carbapenem non-susceptible, clinical isolates were identified across the five counties (predominantly in Nairobi and Kisii): twenty-seven <jats:italic>Acinetobacter baumannii<\/jats:italic>, fourteen <jats:italic>Pseudomonas aeruginosa<\/jats:italic>, three <jats:italic>Escherichia coli<\/jats:italic>, two <jats:italic>Enterobacter cloacae<\/jats:italic>, and two <jats:italic>Klebsiella pneumoniae<\/jats:italic>. All isolates were non-susceptible to \u03b2-lactam drugs with variable susceptibility to tigecycline (66%), minocycline (52.9%), tetracycline (29.4%), and levofloxacin (22.9%). Thirteen <jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic> isolates were resistant to all antibiotics tested. Eleven carbapenemase genes were identified: <jats:italic>bla<\/jats:italic><jats:sub>NDM-1,<\/jats:sub> <jats:italic>bla<\/jats:italic><jats:sub>OXA-23, -58, -66, -69, and -91<\/jats:sub> in <jats:italic>A<\/jats:italic>. <jats:italic>baumannii (<\/jats:italic>STs 1, 2, 164 and a novel ST1475), <jats:italic>bla<\/jats:italic><jats:sub>NDM-1<\/jats:sub> in <jats:italic>E<\/jats:italic>. <jats:italic>cloacae<\/jats:italic> (STs 25,182), <jats:italic>bla<\/jats:italic><jats:sub>NDM-1<\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>VIM-1and -6<\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>OXA-50<\/jats:sub> in <jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic> (STs 316, 357, 654, and1203), <jats:italic>bla<\/jats:italic><jats:sub>OXA-181,<\/jats:sub> <jats:italic>bla<\/jats:italic><jats:sub>NDM-1<\/jats:sub> in <jats:italic>K<\/jats:italic>. <jats:italic>pneumoniae<\/jats:italic> (STs 147 and 219), and <jats:italic>bla<\/jats:italic><jats:sub>NDM-5<\/jats:sub> in <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> (ST164). Five <jats:italic>A<\/jats:italic>. <jats:italic>baumannii<\/jats:italic> isolates had two carbapenemases, <jats:italic>bla<\/jats:italic><jats:sub>NDM-1,<\/jats:sub> and either <jats:italic>bla<\/jats:italic><jats:sub>OXA-23<\/jats:sub> (4) or <jats:italic>bla<\/jats:italic><jats:sub>OXA-58<\/jats:sub> (1). AmpC genes were detected in <jats:italic>A<\/jats:italic>. <jats:italic>baumannii (bla<\/jats:italic><jats:sub>ADC-25<\/jats:sub>), <jats:italic>E<\/jats:italic>. <jats:italic>cloacae<\/jats:italic> (<jats:italic>bla<\/jats:italic><jats:sub>DHA-1 and<\/jats:sub> <jats:italic>bla<\/jats:italic><jats:sub>ACT-6, 16<\/jats:sub>), and <jats:italic>K<\/jats:italic>. <jats:italic>pneumoniae<\/jats:italic> (bla<jats:sub>CMY<\/jats:sub>). Significant multiple-drug resistant genes were the pan-aminoglycoside resistance16srRNA methyltransferase <jats:italic>arm<\/jats:italic>A, <jats:italic>rmt<\/jats:italic>B, <jats:italic>rmt<\/jats:italic>C, and <jats:italic>rmt<\/jats:italic>F genes. This study is the first to report <jats:italic>bla<\/jats:italic><jats:sub>OXA-420, -58, -181, VIM-6,<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>NDM-5<\/jats:sub> in Kenyan isolates. High-risk STs of <jats:italic>A<\/jats:italic>. <jats:italic>baumannii<\/jats:italic> (ST1475, ST2), <jats:italic>E<\/jats:italic>. <jats:italic>cloacae<\/jats:italic> ST182, <jats:italic>K<\/jats:italic>. <jats:italic>pneumoniae<\/jats:italic> ST147, <jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic> (ST357, 654), and <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> ST167, ST648 were identified which present considerable therapeutic danger. The study recommends urgent carbapenem use regulation and containment of high-risk carbapenem-resistant bacteria.<\/jats:p>","DOI":"10.1371\/journal.pone.0246937","type":"journal-article","created":{"date-parts":[[2021,2,22]],"date-time":"2021-02-22T18:28:50Z","timestamp":1614018530000},"page":"e0246937","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":49,"title":["Detection of diverse carbapenem and multidrug resistance genes and high-risk strain types among carbapenem non-susceptible clinical isolates of target gram-negative bacteria in Kenya"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1418-6523","authenticated-orcid":true,"given":"Lillian","family":"Musila","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Kyany\u2019a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosslyn","family":"Maybank","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Stam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Oundo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willie","family":"Sang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,22]]},"reference":[{"key":"pone.0246937.ref001","volume-title":"Antimicrobial 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