{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:31:10Z","timestamp":1793298670152,"version":"4.5.0"},"reference-count":70,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T00:00:00Z","timestamp":1665446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>\n                    The prevalence of Carbapenem-resistant\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    (CRKP) is currently increasing worldwide, prompting WHO to classify it as an urgent public health threat. CRKP is considered a difficult to treat organism owing to limited therapeutic options. In this study, a total of 24 CRKP clinical isolates were randomly collected from Salmaniya Medical Complex, Bahrain. Bacterial identification and antibiotic susceptibility testing were performed, on MALDI-TOF and VITEK-2 compact, respectively. The isolates were screened for carbapenem resistance markers (\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM,<\/jats:sub>\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-23,<\/jats:sub>\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-48<\/jats:sub>\n                    and\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-51<\/jats:sub>\n                    ) and plasmid-mediated quinolone resistance genes (\n                    <jats:italic>qnrA, qnrB<\/jats:italic>\n                    , and\n                    <jats:italic>qnrS<\/jats:italic>\n                    ) by monoplex PCR. On the other hand, only colistin-resistant isolates (n=12) were screened for MCR-1, MCR-2 and MCR-3 genes by monoplex PCR. Moreover, the Genetic environment of\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM<\/jats:sub>\n                    , integrons analysis, and molecular characterization of plasmids was also performed. Antibiotic susceptibility revealed that all the isolates (100%) were resistant to ceftolozane\/tazobactam, piperacillin\/tazobactam, 96% resistant to ceftazidime, trimethoprim\/sulfamethoxazole, 92% resistant to meropenem, gentamicin and cefepime, 88% resistant to ciprofloxacin, imipenem, and 37% resistant to amikacin. Ceftazidime\/avibactam showed the least resistance (12%). 75% (n=12\/16) were resistant to colistin and 44% (n=7\/16) showed intermediate susceptibility to tigecycline. The detection of resistant determinants showed that the majority (95.8%) of CRKP harbored\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM-1<\/jats:sub>\n                    , followed by\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-48<\/jats:sub>\n                    (91.6%)\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-51<\/jats:sub>\n                    (45.8%), and\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-23<\/jats:sub>\n                    (41.6%). Sequencing of the\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM<\/jats:sub>\n                    amplicons revealed the presence of\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM-1<\/jats:sub>\n                    . Alarmingly, 100% of isolates showed the presence of\n                    <jats:italic>qnrS<\/jats:italic>\n                    . These predominant genes were distributed in various combinations wherein the majority were\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM-1<\/jats:sub>\n                    +\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-51<\/jats:sub>\n                    +\n                    <jats:italic>qnrS<\/jats:italic>\n                    +\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-48<\/jats:sub>\n                    (n =10, 41.7%),\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM-1<\/jats:sub>\n                    +\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-23<\/jats:sub>\n                    +\n                    <jats:italic>qnrS<\/jats:italic>\n                    +\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-48<\/jats:sub>\n                    (n=8, 33.3%), among others. In conclusion, the resistance rate to most antibiotics is very high in our region, including colistin and tigecycline, and the genetic environment of CRKP is complex with the carriage of multiple resistance markers. Resistance to ceftazidime\/avibactam is uncommon and hence can be used as a valuable option for empirical therapy. Molecular data on resistance markers and the genetic environment of CRKP is lacking from this geographical region; this would be the first report addressing the subject matter. Surveillance and strict infection control strategies should be reinforced in clinical settings to curb the emergence and spread of such isolates.\n                  <\/jats:p>","DOI":"10.3389\/fcimb.2022.1033305","type":"journal-article","created":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T03:58:31Z","timestamp":1665460711000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":30,"title":["Clinical carbapenem-resistant Klebsiella pneumoniae isolates simultaneously harboring blaNDM-1, blaOXA types and qnrS genes from the Kingdom of Bahrain: Resistance profile and genetic environment"],"prefix":"10.3389","volume":"12","author":[{"given":"Mohammad","family":"Shahid","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayeem","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nermin Kamal","family":"Saeed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd","family":"Shadab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronni Mol","family":"Joji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Al-Mahmeed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid M.","family":"Bindayna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled Saeed","family":"Tabbara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fazal K.","family":"Dar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2018.00407","article-title":"Occurrence of blaNDM variants among enterobacteriaceae from a neonatal intensive care unit in a northern India hospital","volume":"9","author":"Ahmad","year":"2018","journal-title":"Front. Microbiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.jiph.2017.03.010","article-title":"Characterization of carbapenemases, ESBLs, and plasmid-mediated quinolone determinants in carbapenem-insensitive escherichia coli and klebsiella pneumoniae in Riyadh hospitals","volume":"11","author":"Al-Agamy","year":"2018","journal-title":"J. Infect. Public Health"},{"key":"B3","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.ijid.2017.06.007","article-title":"Comparison of antimicrobial activity between ceftolozane-tazobactam and ceftazidime-avibactam against multidrug-resistant isolates of escherichia coli, klebsiella pneumoniae, and pseudomonas aeruginosa","volume":"62","author":"Alatoom","year":"2017","journal-title":"Int. J. Infect. Dis."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2019.34.162.19998","article-title":"Outbreak of colistin-resistant organisms at a tertiary hospital in Riyadh, Saudi arabi","volume":"34","author":"Al Mayahi","year":"2019","journal-title":"Pan. Afr. Med. J."},{"key":"B5","doi-asserted-by":"publisher","first-page":"23","DOI":"10.15537\/smj.2018.1.21094","article-title":"The emergence of carbapenem-resistant klebsiella pneumoniae isolates producing OXA-48 and NDM in the southern (Asir) province, Saudi Arabia","volume":"39","author":"Al-Zahrani","year":"2018","journal-title":"Saudi Med. J."},{"key":"B6","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.diagmicrobio.2008.08.011","article-title":"Tigecycline in vitro activity against commonly encountered multidrug-resistant gram-negative pathogens in a middle Eastern country","volume":"62","author":"Araj","year":"2008","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"B7","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1016\/j.jgar.2020.06.009","article-title":"Molecular mechanisms and prevalence of colistin resistance of klebsiella pneumoniae in the middle East region: A review over the last 5 years","volume":"22","author":"Aris","year":"2020","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"B8","unstructured":"2019"},{"key":"B9","doi-asserted-by":"publisher","first-page":"E421","DOI":"10.1111\/1469-0691.12247","article-title":"Emergence of klebsiella pneumoniae co-producing NDM-type and OXA-181 carbapenemases","volume":"19","author":"Balm","year":"2013","journal-title":"Clin. Microbiol. Infect."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e02448","DOI":"10.1128\/mBio.02448-17","article-title":"Carbapenem-resistant klebsiella pneumoniae exhibiting clinically undetected colistin heteroresistance leads to treatment failure in a murine model of infection","volume":"9","author":"Band","year":"2018","journal-title":"mBio"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1097\/IM9.0000000000000002","article-title":"Acquired resistance to colistin via chromosomal and plasmid-mediated mechanisms in klebsiella pneumoniae","volume":"1","author":"Berglund","year":"2019","journal-title":"Infect. Microbes Dis."},{"key":"B12","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.ijantimicag.2015.08.011","article-title":"A resurgence of \u03b2-lactamase inhibitor combinations effective against multidrug-resistant gram-negative pathogens","volume":"46","author":"Bush","year":"2015","journal-title":"Int. J. Antimicrob. Agents"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e00047","DOI":"10.1128\/CMR.00047-19","article-title":"Epidemiology of beta-Lactamase-Producing pathogens","volume":"33","author":"Bush","year":"2020","journal-title":"Clin. Microbiol. Rev."},{"key":"B14","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/1476-0711-13-16","article-title":"Molecular characterization of clinical multidrug-resistant klebsiella pneumoniae isolates","volume":"13","author":"Cao","year":"2014","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1186\/2047-2994-1-11","article-title":"Ready for a world without antibiotics? the pensieres antibiotic resistance call to action","volume":"1","author":"Carlet","year":"2012","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"B16","doi-asserted-by":"publisher","first-page":"5623","DOI":"10.1128\/aac.01267-16","article-title":"Detection of mcr-1 among escherichia coli clinical isolates collected worldwide as part of the SENTRY antimicrobial surveillance program in 2014 and 2015","volume":"60","author":"Castanheira","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"B17","first-page":"48","article-title":"The investigation of oxacillinase\/metallo-beta-lactamase genes and clonal analysis in carbapenem-resistant klebsiella pneumoniae","volume":"24","author":"Cetinkol","year":"2016","journal-title":"Infez Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"295","DOI":"10.2471\/blt.21.287752","article-title":"Antimicrobial resistance and the COVID-19 pandemic","volume":"100","author":"Choudhury","year":"2022","journal-title":"Bull. World Health Organ"},{"key":"B19","doi-asserted-by":"publisher","first-page":"5947","DOI":"10.1128\/aac.03180-14","article-title":"Whole-genome assembly of klebsiella pneumoniae coproducing NDM-1 and OXA-232 carbapenemases using single-molecule, real-time sequencing","volume":"58","author":"Doi","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1038\/s41426-018-0146-6","article-title":"Tracking microevolution events among ST11 carbapenemase-producing hypervirulent klebsiella pneumoniae outbreak strains","volume":"7","author":"Dong","year":"2018","journal-title":"Emerg. Microbes Infect."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1128\/aac.05583-11","article-title":"Association of the emerging carbapenemase NDM-1 with a bleomycin resistance protein in enterobacteriaceae and acinetobacter baumannii","volume":"56","author":"Dortet","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.2147\/idr.s244064","article-title":"The first Egyptian report showing the Co-existence of bla (NDM-25), bla (OXA-23), bla (OXA-181), and bla (GES-1) among carbapenem-resistant k. pneumoniae clinical isolates genotyped by BOX-PCR","volume":"13","author":"El-Badawy","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.12816\/0046244","article-title":"Co-Occurrence of plasmid-mediated quinolone resistance and carbapenemases in klebsiella pneumoniae isolates in assiut, Egypt","volume":"26","author":"El-Feky","year":"2017","journal-title":"Egypt J. Med. Microbiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"FSO438","DOI":"10.2144\/fsoa-2019-0098","article-title":"A review on bacterial resistance to carbapenems: epidemiology, detection and treatment options","volume":"6","author":"Elshamy","year":"2020","journal-title":"Future Sci. OA"},{"key":"B25","volume-title":"Outbreak of carbapenemase-producing (NDM-1 and OXA-48) and colistin-resistant klebsiella pneumoniae ST307, north-east Germany 2019","year":"2019"},{"key":"B26","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1016\/j.ijantimicag.2014.01.032","article-title":"Ceftolozane\/tazobactam activity tested against gram-negative bacterial isolates from hospitalised patients with pneumonia in US and European medical centres, (2012)","volume":"43","author":"Farrell","year":"2014","journal-title":"Int. J. Antimicrob. Agents"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1093\/jac\/dku025","article-title":"Ceftazidime\/avibactam activity tested against gram-negative bacteria isolated from bloodstream, pneumonia, intra-abdominal and urinary tract infections in US medical centres, (2012)","volume":"69","author":"Flamm","year":"2014","journal-title":"J. Antimicrob. Chemother."},{"key":"B28","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1016\/j.cmi.2015.12.002","article-title":"The negative impact of antibiotic resistance","volume":"22","author":"Friedman","year":"2016","journal-title":"Clin. Microbiol. Infect."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.3390\/antibiotics11081108","article-title":"Characterization of carbapenem-resistant k. pneumoniae isolated from intensive care units of zagazig university hospitals","volume":"11","author":"Gandor","year":"2022","journal-title":"Antibiotics (Basel)"},{"key":"B30","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.jiac.2021.10.009","article-title":"Molecular characterization of carbapenemase producing klebsiella pneumoniae strains by multiplex PCR and PFGE methods: The first k.pneumoniae isolates co-producing OXA-48\/KPC and KPC\/NDM in Turkey","volume":"28","author":"Gen\u00e7","year":"2022","journal-title":"J. Infect. Chemother."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0047636","article-title":"Prevalence of plasmid-mediated quinolone resistance and aminoglycoside resistance determinants among carbapeneme non-susceptible enterobacter cloacae","volume":"7","author":"Huang","year":"2012","journal-title":"PloS One"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0152638","article-title":"High prevalence of new Delhi metallo-\u03b2-Lactamase-1 (NDM-1) producers among carbapenem-resistant enterobacteriaceae in Kuwait","volume":"11","author":"Jamal","year":"2016","journal-title":"PloS One"},{"key":"B33","doi-asserted-by":"publisher","first-page":"529","DOI":"10.3343\/alm.2016.36.6.529","article-title":"Prevalence and molecular characteristics of carbapenemase-producing enterobacteriaceae from five hospitals in Korea","volume":"36","author":"Jeong","year":"2016","journal-title":"Ann. Lab. Med."},{"key":"B34","doi-asserted-by":"publisher","first-page":"4490","DOI":"10.1128\/aac.00107-16","article-title":"Global dissemination of blaKPC into bacterial species beyond klebsiella pneumoniae and In vitro susceptibility to ceftazidime-avibactam and aztreonam-avibactam","volume":"60","author":"Kazmierczak","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"B35","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1007\/978-981-16-9097-6_7","article-title":"Class d type beta-lactamases,\" in beta-lactam resistance","volume-title":"Gram-negative bacteria: Threats and challenges","author":"Khan","year":"2022"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12866-017-1012-8","article-title":"Structure, genetics and worldwide spread of new Delhi metallo-\u03b2-lactamase (NDM): a threat to public health","volume":"17","author":"Khan","year":"2017","journal-title":"BMC Microbiol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"334","DOI":"10.3855\/jidc.11056","article-title":"Enterobacterial infection in Saudi Arabia: First record of klebsiella pneumoniae with triple carbapenemase genes resistance","volume":"13","author":"Khan","year":"2019","journal-title":"J. Infect. Dev. Ctries"},{"key":"B38","doi-asserted-by":"publisher","first-page":"13","DOI":"10.2147\/CE.S40698","article-title":"Ceftazidime\u2013avibactam: an evidence-based review of its pharmacology and potential use in the treatment of gram-negative bacterial infections","volume":"9","author":"Lagac\u00e9-Wiens","year":"2014","journal-title":"Core Evid."},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0075805","article-title":"Structural diversity of class 1 integrons and their associated gene cassettes in klebsiella pneumoniae isolates from a hospital in China","volume":"8","author":"Li","year":"2013","journal-title":"PloS One"},{"key":"B40","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1017\/S0950268814000995","article-title":"First description of NDM-1-, KPC-2-, VIM-2- and IMP-4-producing klebsiella pneumoniae strains in a single Chinese teaching hospital","volume":"143","author":"Liu","year":"2014","journal-title":"Epidemiol. Infect."},{"key":"B41","doi-asserted-by":"publisher","first-page":"S28","DOI":"10.1093\/infdis\/jiw282","article-title":"The epidemiology of carbapenem-resistant enterobacteriaceae: The impact and evolution of a global menace","volume":"215","author":"Logan","year":"2017","journal-title":"J. Infect. Dis."},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/871947","article-title":"Emergence of carbapenem-resistant klebsiella pneumoniae: Progressive spread and four-year period of observation in a cardiac surgery division","volume":"2015","author":"Lombardi","year":"2015","journal-title":"BioMed. Res. Int."},{"key":"B43","doi-asserted-by":"publisher","first-page":"492","DOI":"10.3390\/antibiotics10050492","article-title":"Dissemination of carbapenemases (OXA-48, NDM and VIM) producing enterobacteriaceae isolated from the Mohamed VI university hospital in marrakech, Morocco","volume":"10","author":"Loqman","year":"2021","journal-title":"Antibiotics (Basel)"},{"key":"B44","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1007\/s10096-017-3112-7","article-title":"OXA-48-like carbapenemases producing enterobacteriaceae in different niches","volume":"37","author":"Mairi","year":"2018","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2015.00601","article-title":"Occurrence of classes I and II integrons in enterobacteriaceae collected from zagazig university hospitals, Egypt","volume":"6","author":"Malek","year":"2015","journal-title":"Front. Microbiol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"21","DOI":"10.3126\/ijasbt.v8i1.28252","article-title":"Characterization and plasmid profile of resistant klebsiella pneumoniae isolates in patients with urinary tract infection in nasarawa state, Nigeria","volume":"8","author":"Orole","year":"2020","journal-title":"Int. J. Appl. Sci. Biotechnol."},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.23506","article-title":"Molecular epidemiology and mechanisms of tigecycline resistance in carbapenem-resistant klebsiella pneumoniae isolates","volume":"34","author":"Park","year":"2020","journal-title":"J. Clin. Lab. Anal."},{"key":"B48","doi-asserted-by":"publisher","first-page":"2125","DOI":"10.1128\/AAC.05315-11","article-title":"Emergence of OXA-48-type carbapenemase-producing enterobacteriaceae in German hospitals","volume":"56","author":"Pfeifer","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"B49","doi-asserted-by":"publisher","first-page":"5873","DOI":"10.1128\/AAC.01019-15","article-title":"Carbapenemase-producing klebsiella pneumoniae, a key pathogen set for global nosocomial dominance","volume":"59","author":"Pitout","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"B50","doi-asserted-by":"publisher","first-page":"e00102","DOI":"10.1128\/CMR.00102-19","article-title":"The global ascendency of OXA-48-type carbapenemases","volume":"33","author":"Pitout","year":"2019","journal-title":"Clin. Microbiol. Rev."},{"key":"B51","doi-asserted-by":"publisher","first-page":"2781","DOI":"10.1093\/jac\/dkr384","article-title":"Emergence of NDM-1-producing klebsiella pneumoniae in Morocco","volume":"66","author":"Poirel","year":"2011","journal-title":"J. Antimicrob. Chemother."},{"key":"B52","doi-asserted-by":"publisher","first-page":"5403","DOI":"10.1128\/aac.00585-11","article-title":"Genetic features of blaNDM-1-positive enterobacteriaceae","volume":"55","author":"Poirel","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"B53","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.jgar.2014.03.002","article-title":"In vitro activity of tigecycline and comparators against carbapenem-resistant enterobacteriaceae in Africa\u2013middle East countries: TEST 2007\u20132012","volume":"2","author":"Renteria","year":"2014","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2022.831770","article-title":"Prolonged outbreak of carbapenem and colistin-resistant klebsiella pneumoniae at a Large tertiary hospital in Brazil","volume":"13","author":"Rocha","year":"2022","journal-title":"Front. Microbiol."},{"key":"B55","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1093\/cid\/ciw805","article-title":"Colistin resistance in carbapenem-resistant klebsiella pneumoniae: Laboratory detection and impact on mortality","volume":"64","author":"Rojas","year":"2017","journal-title":"Clin. Infect. Dis. an Off. Publ. Infect. Dis. Soc. America"},{"key":"B56","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1089\/mdr.2020.0217","article-title":"Antimicrobial activity of ceftazidime-avibactam, ceftolozane-tazobactam and comparators tested against pseudomonas aeruginosa and klebsiella pneumoniae isolates from united states medical centers in 2016-2018","volume":"27","author":"Sader","year":"2021","journal-title":"Microb. Drug Resist."},{"key":"B57","doi-asserted-by":"publisher","first-page":"111","DOI":"10.4103\/jlp.jlp_101_18","article-title":"Epidemiology of carbapenem-resistant enterobacteriaceae in a tertiary care center in the kingdom of Bahrain","volume":"11","author":"Saeed","year":"2019","journal-title":"J. Lab. Physicians"},{"key":"B58","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s12941-021-00437-8","article-title":"Molecular characteristics of antibiotic-resistant escherichia coli and klebsiella pneumoniae strains isolated from hospitalized patients in Tehran, Iran","volume":"20","author":"Sharahi","year":"2021","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-021-01048-w","article-title":"Extensive outbreak of colistin resistant, carbapenemase (blaOXA-48, blaNDM) producing klebsiella pneumoniae in a large tertiary care hospital, India","volume":"11","author":"Sharma","year":"2022","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"B60","doi-asserted-by":"publisher","first-page":"e1130","DOI":"10.1016\/j.ijid.2013.06.016","article-title":"The emergence of OXA-48- and NDM-1-positive klebsiella pneumoniae in Riyadh, Saudi Arabia","volume":"17","author":"Shibl","year":"2013","journal-title":"Int. J. Infect. Dis."},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0131372","article-title":"Characterization of carbapenem-resistant enterobacteriaceae with high rate of autochthonous transmission in the Arabian peninsula","volume":"10","author":"Sonnevend","year":"2015","journal-title":"PloS One"},{"key":"B62","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1016\/j.clinthera.2015.05.501","article-title":"Susceptibility profile of Ceftolozane\/Tazobactam and other parenteral antimicrobials against escherichia coli, klebsiella pneumoniae, and pseudomonas aeruginosa from US hospitals","volume":"37","author":"Sutherland","year":"2015","journal-title":"Clin. Ther."},{"key":"B63","doi-asserted-by":"publisher","first-page":"214","DOI":"10.21037\/jtd.2017.01.26","article-title":"Potency of parenteral antimicrobials including ceftolozane\/tazobactam against nosocomial respiratory tract pathogens: considerations for empiric and directed therapy","volume":"9","author":"Sutherland","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.o1755","article-title":"Covid-19: Antimicrobial resistance rose dangerously in US during pandemic, CDC says","volume":"378","author":"Tanne","year":"2022","journal-title":"BMJ"},{"key":"B65","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1080\/21505594.2016.1222343","article-title":"The global epidemiology of carbapenemase-producing enterobacteriaceae","volume":"8","author":"van Duin","year":"2017","journal-title":"Virulence"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.1128\/aac.02431-18","article-title":"Results from the China antimicrobial surveillance network (CHINET) in 2017 of the In vitro activities of ceftazidime-avibactam and ceftolozane-tazobactam against clinical isolates of enterobacteriaceae and pseudomonas aeruginosa","volume":"63","author":"Yin","year":"2019","journal-title":"Antimicrob. Agents Chemother."},{"key":"B67","doi-asserted-by":"publisher","first-page":"5046","DOI":"10.1128\/AAC.00774-09","article-title":"Characterization of a new metallo-\u03b2-lactamase gene, bla NDM-1, and a novel erythromycin esterase gene carried on a unique genetic structure in klebsiella pneumoniae sequence type 14 from India","volume":"53","author":"Yong","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"B68","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1038\/s41426-018-0129-7","article-title":"Evolution of tigecycline- and colistin-resistant CRKP (carbapenem-resistant klebsiella pneumoniae) in vivo and its persistence in the GI tract","volume":"7","author":"Zhang","year":"2018","journal-title":"Emerg. Microbes Infect."},{"key":"B69","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1007\/s10096-016-2578-z","article-title":"Outbreak of NDM-1-producing klebsiella pneumoniae ST76 and ST37 isolates in neonates","volume":"35","author":"Zhu","year":"2016","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"B70","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1128\/CMR.00096-12","article-title":"\u03b2-lactamase production in key gram-negative pathogen isolates from the Arabian peninsula","volume":"26","author":"Zowawi","year":"2013","journal-title":"Clin. Microbiol. Rev."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2022.1033305\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T03:58:37Z","timestamp":1665460717000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2022.1033305\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,11]]},"references-count":70,"alternative-id":["10.3389\/fcimb.2022.1033305"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2022.1033305","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,11]]},"article-number":"1033305"}}