{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T02:00:29Z","timestamp":1793066429246,"version":"4.5.0"},"reference-count":103,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T00:00:00Z","timestamp":1687737600000},"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. Antibiot."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Among Gram-negative bacteria (GNB), <jats:italic>Enterobacterales<\/jats:italic> (<jats:italic>Enterobacterales<\/jats:italic>), such as <jats:italic>Escherichia coli<\/jats:italic> (<jats:italic>E. coli<\/jats:italic>) and <jats:italic>Klebsiella pneumoniae<\/jats:italic> (<jats:italic>K. pneumoniae<\/jats:italic>), are the most clinically relevant pathogens in healthcare settings. Infections secondary to these pathogens are widely common but multidrug resistance (MDR) in <jats:italic>Enterobacterales<\/jats:italic> has become a significant challenge with increased morbidity, mortality, and cost of management. The escalating global prevalence of MDR in <jats:italic>Enterobacterales<\/jats:italic> has led to limited treatment options, raising an urgent need for novel antimicrobial therapy(s) and detailed studies exploring underlying resistance mechanisms. In <jats:italic>Enterobacterales<\/jats:italic>, the prime antimicrobial resistance mechanism against \u03b2-lactam antibiotics is mainly the production of \u03b2-lactamases, particularly extended-spectrum \u03b2-lactamases (ESBLs). Although the Gulf region is witnessing major challenges from infections secondary to MDR GNB, the extent of the problem has not been fully evaluated. Therefore, this review aims to address the prevalence and genetic characterization of ESBL-producing <jats:italic>Enterobacterales<\/jats:italic> in the Gulf Cooperation Council (GCC) countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PubMed\u00ae (National Library of Medicine, Bethesda, MD, USA) search was conducted, which looked for academic articles discussing the epidemiology of MDR <jats:italic>Enterobacterales<\/jats:italic> in the GCC countries, published in the last 5 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and conclusions<\/jats:title><jats:p>In GCC countries there is a high prevalence rate of MDR <jats:italic>Enterobacterales<\/jats:italic>, particularly ESBLs. Prevalence rates of ESBL-producing <jats:italic>Enterobacterales<\/jats:italic> among the <jats:italic>Enterobacterales<\/jats:italic> in general clinical samples in the GCC region is 21.6%\u201329.3%, with a slightly higher prevalence rate in intensive care unit patients (17.3\u201331.3%) and in patients with urinary tract infections (25.2%\u201331.7%). ESBL carriers have also been noted in the general community. ESBL-producing <jats:italic>Enterobacterales<\/jats:italic> from the GCC region show high levels of resistance to ampicillin, aztreonam, third-\/fourth-generation cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole. Intermediate resistance rates are observed against nitrofurantoin, piperacillin\/tazobactam, and gentamicin, with increasing resistance observed against tigecycline. The isolates demonstrate low-level resistance to carbapenems, fosfomycin, colistin, and amikacin. <jats:italic>Enterobacterales<\/jats:italic> isolates that are concomitant ESBL producers and are carbapenem resistant have been increasingly reported and demonstrate alarmingly increased antibiotic resistance patterns compared with ESBL <jats:italic>Enterobacterales<\/jats:italic>. The most prevalent genes for ESBL resistance in the <jats:italic>Enterobacterales<\/jats:italic> isolates in the GCC region are: <jats:italic>bla<\/jats:italic><jats:sub>CTX-M<\/jats:sub> (subtype group 1) followed by\/co-dominated by <jats:italic>bla<\/jats:italic><jats:sub>TEM<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>SHV<\/jats:sub>, whereas the most common carbapenem-resistant genes are <jats:italic>bla<\/jats:italic><jats:sub>OXA-48<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>NDM-1<\/jats:sub>.<\/jats:p><\/jats:sec>","DOI":"10.3389\/frabi.2023.1177954","type":"journal-article","created":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T12:26:20Z","timestamp":1687782380000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":23,"title":["Prevalence and genetic characterization of clinically relevant extended-spectrum \u03b2-lactamase-producing Enterobacterales in the Gulf Cooperation Council countries"],"prefix":"10.3389","volume":"2","author":[{"given":"Hamad A.","family":"Hadi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hissa","family":"Al-Hail","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leena Elsheikh","family":"Aboidris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmood","family":"Al-Orphaly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazen A. Sid","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bincy Gladson","family":"Samuel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hana Adam","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali A.","family":"Sultan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sini","family":"Skariah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,6,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10091778","article-title":"The prevalence of multidrug-resistant escherichia coli producing ESBL among Male and female patients with urinary tract infections in Riyadh region, Saudi Arabia","volume":"10","author":"Abalkhail","year":"2022","journal-title":"Healthcare (Basel)"},{"key":"B2","first-page":"2759","article-title":"Molecular characterization of multidrug resistant e. coli associated to urinary tract infection in taif, Saudi Arabia","volume":"33","author":"Abdallah","year":"2020","journal-title":"Pak J. Pharm. Sci."},{"key":"B3","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1007\/s12028-019-00856-8","article-title":"Health care-associated infections in a neurocritical care unit of a developing country","volume":"32","author":"Abulhasan","year":"2020","journal-title":"Neurocrit. Care"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics10080935","article-title":"Antibiotics prescribing in intensive care settings during the COVID-19 era: a systematic review","volume":"10","author":"Abu-Rub","year":"2021","journal-title":"Antibiotics (Basel)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.5001\/omj.2022.89","article-title":"Evaluation of in vitro activity of Ceftazidime\/Avibactam and Ceftolozane\/Tazobactam against ESBL-producing enterobacterales isolated from intensive care units from Qatar","volume":"37","author":"Ahmed","year":"2022","journal-title":"Oman Med. J."},{"key":"B6","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":"B7","doi-asserted-by":"publisher","first-page":"6736897","DOI":"10.1155\/2019\/6736897","article-title":"Cooccurrence of NDM-1, ESBL, RmtC, AAC(6')-ib, and QnrB in clonally related klebsiella pneumoniae isolates together with coexistence of CMY-4 and AAC(6')-ib in enterobacter cloacae isolates from Saudi Arabia","volume":"2019","author":"Al-Agamy","year":"2019","journal-title":"BioMed. Res. Int."},{"key":"B8","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s12941-018-0255-z","article-title":"An evaluation of e. coli in urinary tract infection in emergency department at KAMC in Riyadh, Saudi Arabia: retrospective study","volume":"17","author":"Alanazi","year":"2018","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1745835","DOI":"10.1155\/2022\/1745835","article-title":"Comparative metabolic characterization of extraintestinal pathogenic escherichia coli blood isolates from Saudi Arabia","volume":"2022","author":"Alangari","year":"2022","journal-title":"J. Trop. Med."},{"key":"B10","first-page":"88","article-title":"Neonatal screening for genetic blood diseases","volume":"29","author":"Al-Arayyed","year":"2007","journal-title":"Bahrain Med. Bull."},{"key":"B11","doi-asserted-by":"publisher","first-page":"650","DOI":"10.3390\/clinpract11030080","article-title":"Antimicrobial resistance patterns and ESBL of uropathogens isolated from adult females in najran region of Saudi Arabia","volume":"11","author":"Alasmary","year":"2021","journal-title":"Clin. Pract."},{"key":"B12","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1159\/000527640","article-title":"Etiology and antibiotic susceptibility patterns of urinary tract infections in children in a general hospital in Kuwait: a 5-year retrospective study","volume":"31","author":"Al Benwan","year":"2022","journal-title":"Med. Princ. Pract."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.10060","article-title":"Rising klebsiella pneumoniae infections and its expanding drug resistance in the intensive care unit of a tertiary healthcare hospital, Saudi Arabia","volume":"12","author":"Al Bshabshe","year":"2020","journal-title":"Cureus"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.12098","article-title":"Antimicrobial-resistant bacteria and prescription of antibiotics at a tertiary care hospital in Riyadh, Saudi Arabia","volume":"12","author":"Aldawsari","year":"2020","journal-title":"Cureus"},{"key":"B15","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1016\/j.jiph.2019.12.001","article-title":"ESBL expression and antibiotic resistance patterns in a hospital in Saudi Arabia: do healthcare staff have the whole picture","volume":"13","author":"Aldrazi","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1159\/000319912","article-title":"Molecular characterization and epidemiology of extended-spectrum beta-lactamase-producing escherichia coli and klebsiella pneumoniae isolates in the united Arab Emirates","volume":"20","author":"Alfaresi","year":"2011","journal-title":"Med. Princ. Pract."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1304793","DOI":"10.1155\/2018\/1304793","article-title":"First report of bla(CTX-M-28) in enterobacteriaceae isolates in the united Arab Emirates","volume":"2018","author":"Alfaresi","year":"2018","journal-title":"J. Pathog."},{"key":"B18","doi-asserted-by":"publisher","first-page":"302","DOI":"10.2991\/jegh.k.210524.001","article-title":"Epidemiology and microbiological profile of common healthcare associated infections among patients in the intensive care unit of a general hospital in Kuwait: a retrospective observational study","volume":"11","author":"Alfouzan","year":"2021","journal-title":"J. Epidemiol. Glob. Health"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.15537\/smj.2018.12.23273","article-title":"Risk factors and molecular features of extended-spectrum beta-lactamase producing bacteria at southwest of Saudi Arabia","volume":"39","author":"Al-Garni","year":"2018","journal-title":"Saudi Med. J."},{"key":"B20","doi-asserted-by":"publisher","first-page":"4653","DOI":"10.2147\/IDR.S283488","article-title":"Multidrug-resistant and extensively drug-resistant enterobacteriaceae: prevalence, treatments, and outcomes - a retrospective cohort study","volume":"13","author":"Alkofide","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"B21","doi-asserted-by":"publisher","first-page":"345","DOI":"10.4103\/ua.ua_67_22","article-title":"Trends of antimicrobial resistance in patients with complicated urinary tract infection: suggested empirical therapy and lessons learned from a retrospective observational study in Oman","volume":"14","author":"Al Mamari","year":"2022","journal-title":"Urol. Ann."},{"key":"B22","doi-asserted-by":"publisher","first-page":"2843","DOI":"10.2147\/IDR.S317079","article-title":"CTX-M-15 positive escherichia coli and klebsiella pneumoniae outbreak in the neonatal intensive care unit of a maternity hospital in ha'il, Saudi Arabia","volume":"14","author":"Almogbel","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"B23","doi-asserted-by":"publisher","first-page":"3026851","DOI":"10.1155\/2018\/3026851","article-title":"Prevalence of multidrug resistance and extended-spectrum \u03b2-lactamase carriage of clinical uropathogenic escherichia coli isolates in Riyadh, Saudi Arabia","volume":"2018","author":"Alqasim","year":"2018","journal-title":"Int. J. Microbiol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.ijid.2019.04.004","article-title":"Exploring bacterial resistance in northern Oman, a foundation for implementing evidence-based antimicrobial stewardship program","volume":"83","author":"Al Rahmany","year":"2019","journal-title":"Int. J. Infect. Dis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"dlab159","DOI":"10.1093\/jacamr\/dlab159","article-title":"Evaluation of the in vitro activity of ceftaroline, ceftazidime\/avibactam and comparator antimicrobial agents against clinical isolates from paediatric patients in Kuwait: ATLAS data 2012-19","volume":"3","author":"Al-Sweih","year":"2021","journal-title":"JAC Antimicrob. Resist."},{"key":"B26","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1016\/j.jiph.2020.01.004","article-title":"Antimicrobial resistance of gram-negative bacteria: a six-year longitudinal study in a hospital in Saudi Arabia","volume":"13","author":"Al-Tawfiq","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"B27","doi-asserted-by":"publisher","first-page":"449","DOI":"10.4103\/JPBS.JPBS_294_19","article-title":"Bacteria causing urinary tract infections and its antibiotic susceptibility pattern at tertiary hospital in Al-baha region, Saudi Arabia: a retrospective study","volume":"12","author":"Alzahrani","year":"2020","journal-title":"J. Pharm. Bioallied Sci."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare9111564","article-title":"Retrospective analysis of antimicrobial susceptibility of uropathogens isolated from pediatric patients in tertiary hospital at Al-baha region, Saudi Arabia","volume":"9","author":"Alzahrani","year":"2021","journal-title":"Healthcare (Basel)"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.9714","article-title":"Prevalence of klebsiella pneumoniae antibiotic resistance in Medina, Saudi arabi -2018","volume":"12","author":"Al-Zalabani","year":"2020","journal-title":"Cureus"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.581711","article-title":"Molecular characterization of extended-spectrum \u03b2-Lactamase-Producing escherichia coli and klebsiella pneumoniae among the pediatric population in Qatar","volume":"11","author":"Andres","year":"2020","journal-title":"Front. Microbiol."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.771510","article-title":"Antibiotic resistance: one health one world outlook","volume":"11","author":"Aslam","year":"2021","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics10030247","article-title":"Distribution of extended-spectrum beta-lactamase (ESBL)-encoding genes among multidrug-resistant gram-negative pathogens collected from three different countries","volume":"10","author":"Azab","year":"2021","journal-title":"Antibiotics (Basel)"},{"key":"B33","doi-asserted-by":"publisher","first-page":"174","DOI":"10.3923\/pjbs.2019.174.179","article-title":"Molecular-diversity, prevalence and antibiotic susceptibility of pathogenic klebsiella pneumoniae under Saudi condition","volume":"22","author":"Azim","year":"2019","journal-title":"Pak J. Biol. Sci."},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens10091097","article-title":"Genetic analysis, population structure, and characterisation of multidrug-resistant klebsiella pneumoniae from the Al-hofuf region of Saudi Arabia","volume":"10","author":"Badger-Emeka","year":"2021","journal-title":"Pathogens"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens11060631","article-title":"A three-year look at the phylogenetic profile, antimicrobial resistance, and associated virulence genes of uropathogenic escherichia coli","volume":"11","author":"Badger-Emeka","year":"2022","journal-title":"Pathogens"},{"key":"B36","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.jhin.2021.01.027","article-title":"Clinical characteristics and risk factors for the isolation of multi-drug-resistant gram-negative bacteria from critically ill patients with COVID-19","volume":"110","author":"Baiou","year":"2021","journal-title":"J. Hosp. Infect."},{"key":"B37","doi-asserted-by":"publisher","first-page":"220","DOI":"10.3855\/jidc.9517","article-title":"Antimicrobial susceptibility of microorganisms causing urinary tract infections in Saudi Arabia","volume":"12","author":"Balkhi","year":"2018","journal-title":"J. Infect. Dev. Ctries"},{"key":"B38","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.jgar.2020.07.013","article-title":"High burden of resistant gram negative pathogens causing device-associated healthcare infections in a tertiary care setting in Saudi arabi -2016","volume":"23","author":"Balkhy","year":"2020","journal-title":"J. Glob Antimicrob. Resist."},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0233704","article-title":"Pathogenic spectrum of blood stream infections and resistance pattern in gram-negative bacteria from aljouf region of Saudi Arabia","volume":"15","author":"Bandy","year":"2020","journal-title":"PloS One"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics10060744","article-title":"ESBL activity, MDR, and carbapenem resistance among predominant enterobacterales isolated in 2019","volume":"10","author":"Bandy","year":"2021","journal-title":"Antibiotics (Basel)"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1464","DOI":"10.1007\/s00134-017-4878-x","article-title":"Antimicrobial resistance in the next 30 years, humankind, bugs and drugs: a visionary approach","volume":"43","author":"Bassetti","year":"2017","journal-title":"Intensive Care Med."},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3390\/children9050629","article-title":"Antibiogram of urinary tract infections and sepsis among infants in neonatal intensive care unit","volume":"9","author":"Bazaid","year":"2022","journal-title":"Children (Basel)"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.2147\/IDR.S299846","article-title":"Antimicrobial surveillance for bacterial uropathogens in ha'il, Saudi Arabia: a five-year multicenter retrospective study","volume":"14","author":"Bazaid","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"B44","doi-asserted-by":"publisher","first-page":"3386","DOI":"10.1093\/jac\/dkaa326","article-title":"Antibiotic use in patients with COVID-19: a 'snapshot' infectious diseases international research initiative (ID-IRI) survey","volume":"75","author":"Beovic","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4103\/sjmms.sjmms_638_21","article-title":"Antibiotic-resistance genes in e. coli strains in GCC countries: a meta-analysis","volume":"10","author":"Bindayna","year":"2022","journal-title":"Saudi J. Med. Med. Sci."},{"key":"B46","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/j.micpath.2018.07.035","article-title":"Identification of novel DNA sequence associated with pathogenicity island III536 locus in uropathogenic escherichia coli isolate and distribution of virulence determinants in beta-lactam resistant isolates","volume":"123","author":"Bin Thani","year":"2018","journal-title":"Microb. Pathog."},{"key":"B47","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1097\/QCO.0000000000000863","article-title":"Controversies over the management of infections caused by amp-c- and ESBL-producing enterobacterales : what questions remain for future studies","volume":"35","author":"Burillo","year":"2022","journal-title":"Curr. Opin. Infect. Dis."},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01076-18","article-title":"Past and present perspectives on \u03b2-lactamases","volume":"62","author":"Bush","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"B49","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.ijid.2017.10.025","article-title":"Beta-lactam resistance among enterobacteriaceae in Cambodia: the four-year itch","volume":"66","author":"Caron","year":"2018","journal-title":"Int. J. Infect. Dis."},{"key":"B50","doi-asserted-by":"publisher","first-page":"41","DOI":"10.4137\/MBI.S780","article-title":"Distribution and resistance trends of community associated urinary tract pathogens in sharjah, UAE","volume":"2008","author":"Dash","year":"2008","journal-title":"Microbiol. Insights"},{"key":"B51","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s12941-018-0256-y","article-title":"The frequency of klebsiella pneumonia encoding genes for CTX-m, TEM-1 and SHV-1 extended-spectrum beta lactamases enzymes isolated from urinary tract infection","volume":"17","author":"Dehshiri","year":"2018","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"B52","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1186\/s12879-020-4939-6","article-title":"High contribution and impact of resistant gram negative pathogens causing surgical site infections at a multi-hospital healthcare system in Saudi arabi -2016","volume":"20","author":"El-Saed","year":"2020","journal-title":"BMC Infect. Dis."},{"key":"B53","doi-asserted-by":"publisher","first-page":"2323","DOI":"10.1007\/s10096-021-04288-1","article-title":"Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: an international ID-IRI survey","volume":"40","author":"El-Sokkary","year":"2021","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-018-0381-6","article-title":"Molecular characterization of extended spectrum [beta] -lactamases enterobacteriaceae causing lower urinary tract infection among pediatric population","volume":"7","author":"Eltai","year":"2018","journal-title":"Antimicrobial Resistance Infection Control"},{"key":"B55","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s13756-018-0381-6","article-title":"Molecular characterization of extended spectrum \u03b2 -lactamases enterobacteriaceae causing lower urinary tract infection among pediatric population","volume":"7","author":"Eltai","year":"2018","journal-title":"Antimicrobial Resistance Infection Control"},{"key":"B56","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s12866-020-01732-8","article-title":"Antibiotic resistance and virulence patterns of pathogenic escherichia coli strains associated with acute gastroenteritis among children in Qatar","volume":"20","author":"Eltai","year":"2020","journal-title":"BMC Microbiol."},{"key":"B57","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s13756-018-0369-2","article-title":"Prevalence of antibiotic resistant escherichia coli isolates from fecal samples of food handlers in Qatar","volume":"7","author":"Eltai","year":"2018","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"B58","doi-asserted-by":"publisher","first-page":"Doc05","DOI":"10.3205\/dgkh000290","article-title":"Antibiotic resistance: what is so special about multidrug-resistant gram-negative bacteria","volume":"12","author":"Exner","year":"2017","journal-title":"GMS Hyg Infect. Control"},{"key":"B59","doi-asserted-by":"publisher","first-page":"252","DOI":"10.15537\/smj.2019.3.23947","article-title":"Trends in antimicrobial susceptibility patterns in king fahad medical city, Riyadh, Saudi Arabia","volume":"40","author":"Farah","year":"2019","journal-title":"Saudi Med. J."},{"key":"B60","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1586\/14787210.2016.1106940","article-title":"Infection control implications of heterogeneous resistance mechanisms in carbapenem-resistant enterobacteriaceae (CRE)","volume":"14","author":"Goodman","year":"2016","journal-title":"Expert Rev. Anti Infect. Ther."},{"key":"B61","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1016\/j.jhin.2020.09.004","article-title":"Mapping hospital antimicrobial stewardship programmes in the gulf cooperation council states against international standards: a systematic review","volume":"106","author":"Hashad","year":"2020","journal-title":"J. Hosp Infect."},{"key":"B62","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/2047-2994-2-31","article-title":"Antimicrobial resistance: a global view from the 2013 world healthcare-associated infections forum","volume":"2","author":"Huttner","year":"2013","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"B63","doi-asserted-by":"publisher","first-page":"6054694","DOI":"10.1155\/2019\/6054694","article-title":"Phenotypic characterization and antibiotic resistance patterns of extended-spectrum beta-lactamase- and AmpC beta-Lactamase-Producing gram-negative bacteria in a referral hospital, Saudi Arabia","volume":"2019","author":"Ibrahim","year":"2019","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"B64","doi-asserted-by":"publisher","first-page":"1450","DOI":"10.3892\/etm.2021.10885","article-title":"Emergence of bla TEM, bla CTX-m, bla SHV and bla OXA genes in multidrug-resistant enterobacteriaceae and acinetobacter baumannii in Saudi Arabia","volume":"22","author":"Ibrahim","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12010164","article-title":"Prevalence and antibiogram pattern of klebsiella pneumoniae in a tertiary care hospital in makkah, Saudi Arabia: an 11-year experience","volume":"12","author":"Jalal","year":"2023","journal-title":"Antibiotics (Basel)"},{"key":"B66","doi-asserted-by":"publisher","first-page":"287","DOI":"10.4103\/atm.ATM_523_20","article-title":"Molecular detection of plasmid-derived AmpC beta-lactamase among clinical strains of enterobacteriaceae in Bahrain","volume":"16","author":"Joji","year":"2021","journal-title":"Ann. Thorac. Med."},{"key":"B67","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.4314\/ejhs.v32i6.20","article-title":"Extended-spectrum beta-lactamase and carbapenem-resistant gram-negative pathogens in makkah, Saudi Arabia","volume":"32","author":"Kabrah","year":"2022","journal-title":"Ethiop J. Health Sci."},{"key":"B68","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.4314\/ejhs.v31i6.19","article-title":"Antibiotic resistance profile of common bacteria isolated from blood stream, lower respiratory tract and urinary infections in intensive care unit in Saudi Arabia: a retrospective study","volume":"31","author":"Kabrah","year":"2021","journal-title":"Ethiop J. Health Sci."},{"key":"B69","doi-asserted-by":"publisher","first-page":"106535","DOI":"10.1016\/j.ijantimicag.2022.106535","article-title":"Prevalence of ESBL non-CRE escherichia coli and klebsiella pneumoniae among clinical isolates collected by the SMART global surveillance programme from 2015 to 2019","volume":"59","author":"Karlowsky","year":"2022","journal-title":"Int. J. Antimicrob. Agents"},{"key":"B70","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.jiph.2020.12.001","article-title":"Molecular characterization of multidrug resistant klebsiella pneumoniae clinical isolates recovered from king abdulaziz specialist hospital at taif city, Saudi Arabia","volume":"14","author":"Lagha","year":"2021","journal-title":"J. Infect. Public Health"},{"key":"B71","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/j.cmi.2022.12.006","article-title":"Antibiotic resistance associated with the COVID-19 pandemic: a systematic review and meta-analysis","volume":"29","author":"Langford","year":"2023","journal-title":"Clin. Microbiol. Infect"},{"key":"B72","first-page":"370","article-title":"Does antibiotic restriction prevent resistance","volume":"4","author":"Mcgowan","year":"1996","journal-title":"New Horiz."},{"key":"B73","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1016\/j.jgar.2021.04.009","article-title":"Monitoring antibiotic resistance profiles of faecal isolates of enterobacteriaceae and the prevalence of carbapenem-resistant isolates among food handlers in Kuwait","volume":"25","author":"Moghnia","year":"2021","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"B74","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11111564","article-title":"Genomic study of chromosomally and plasmid-mediated multidrug resistance and virulence determinants in klebsiella pneumoniae isolates obtained from a tertiary hospital in Al-kharj, KSA","volume":"11","author":"Moglad","year":"2022","journal-title":"Antibiotics (Basel)"},{"key":"B75","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.29236","article-title":"Microbial etiology and antibiotic resistance patterns of urinary tract pathogens in hospitalized infants in Bahrain: a tertiary care center experience","volume":"14","author":"Mohammed","year":"2022","journal-title":"Cureus"},{"key":"B76","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/j.ijsu.2010.02.007","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"8","author":"Moher","year":"2010","journal-title":"Int. J. Surg."},{"key":"B77","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.jgar.2021.03.009","article-title":"Five-year resistance trends in pathogens causing healthcare-associated infections at a multi-hospital healthcare system in Saudi arabi -2019","volume":"25","author":"Mutair","year":"2021","journal-title":"J. Glob Antimicrob. Resist."},{"key":"B78","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1016\/j.ijregi.2022.05.001","article-title":"Epidemiology of urinary tract infection in adults caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae - a case-control study from Qatar","volume":"3","author":"Naushad","year":"2022","journal-title":"IJID Reg."},{"key":"B79","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s13756-018-0336-y","article-title":"Estimating the burden of antimicrobial resistance: a systematic literature review","volume":"7","author":"Naylor","year":"2018","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"B80","doi-asserted-by":"publisher","first-page":"S521","DOI":"10.1093\/cid\/ciz824","article-title":"Epidemiology and diagnostics of carbapenem resistance in gram-negative bacteria","volume":"69","author":"Nordmann","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"B81","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11111597","article-title":"Genomic characterization of colistin-resistant isolates from the king fahad medical city, kingdom of Saudi Arabia","volume":"11","author":"Okdah","year":"2022","journal-title":"Antibiotics (Basel)"},{"key":"B82","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1097\/PAT.0000000000000237","article-title":"Resistance mechanisms in enterobacteriaceae","volume":"47","author":"Partridge","year":"2015","journal-title":"Pathology"},{"key":"B83","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.581711","article-title":"Molecular characterization of extended-spectrum beta-Lactamase-Producing escherichia coli and klebsiella pneumoniae among the pediatric population in Qatar","volume":"11","author":"Perez-Lopez","year":"2020","journal-title":"Front. Microbiol."},{"key":"B84","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.tmaid.2018.01.007","article-title":"Community-acquired urinary tract infections due to extended-spectrum \u03b2 -lactamase-producing organisms in united Arab Emirates","volume":"22","author":"Ranjan Dash","year":"2018","journal-title":"Travel Med. Infect. Dis."},{"key":"B85","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens11121397","article-title":"Prognosis of extended-Spectrum-Beta-Lactamase-Producing agents in emphysematous pyelonephritis-results from a Large, multicenter series","volume":"11","author":"Robles-Torres","year":"2022","journal-title":"Pathogens"},{"key":"B86","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s13613-015-0061-0","article-title":"Mechanisms of antimicrobial resistance in gram-negative bacilli","volume":"5","author":"Ruppe","year":"2015","journal-title":"Ann. Intensive Care"},{"key":"B87","doi-asserted-by":"publisher","DOI":"10.5001\/omj.2021.95","article-title":"Antimicrobial susceptibilities of urinary extended-spectrum beta-lactamase escherichia coli to fosfomycin","volume":"36","author":"Saeed","year":"2021","journal-title":"Oman Med. J."},{"key":"B88","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":"B89","doi-asserted-by":"publisher","first-page":"769","DOI":"10.2147\/IDR.S394777","article-title":"Pathogen burden among ICU patients in a tertiary care hospital in hail Saudi Arabia with particular reference to beta-lactamases profile","volume":"16","author":"Saleem","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"B90","doi-asserted-by":"publisher","first-page":"AJBSR.MS.ID.000636","DOI":"10.34297\/AJBSR.2019.03.000636","article-title":"The distribution of ESBL-producing enterobacteriaceae: Leicestershire UK compared to worldwide","volume":"3","author":"Samarasinghe","year":"2019","journal-title":"Am. J. Biomed. Sci. Res."},{"key":"B91","doi-asserted-by":"publisher","first-page":"195","DOI":"10.4103\/jehp.jehp_1517_20","article-title":"Profile and antibiotic-resistance pattern of bacteria isolated from endotracheal secretions of mechanically ventilated patients at a tertiary care hospital","volume":"10","author":"Sannathimmappa","year":"2021","journal-title":"J. Educ. Health Promot"},{"key":"B92","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.20859","article-title":"Prevalence and resistance patterns of pediatric urinary tract infections in Bahrain","volume":"13","author":"Shaaban","year":"2021","journal-title":"Cureus"},{"key":"B93","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s13756-016-0103-x","article-title":"Antimicrobial susceptibility and molecular epidemiology of extended-spectrum beta-lactamase-producing enterobacteriaceae from intensive care units at hamad medical corporation, Qatar","volume":"5","author":"Sid Ahmed","year":"2016","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"B94","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2022.955774","article-title":"High prevalence of extended-spectrum beta-lactamase-producing escherichia coli and klebsiella pneumoniae isolates: a 5-year retrospective study at a tertiary hospital in northern Thailand","volume":"12","author":"Siriphap","year":"2022","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B95","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":"B96","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s13756-016-0115-6","article-title":"Epidemiology and molecular characterization of multidrug-resistant gram-negative bacteria in southeast Asia","volume":"5","author":"Suwantarat","year":"2016","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"B97","volume-title":"Global database for tracking antimicrobial resistance (AMR) country self- assessment survey (TrACSS)","year":"2022"},{"key":"B98","doi-asserted-by":"publisher","DOI":"10.1128\/MRA.00429-20","article-title":"Draft genome sequence of an extended-spectrum beta-Lactamase-Producing klebsiella oxytoca strain bearing mcr-9 from Qatar","volume":"9","author":"Tsui","year":"2020","journal-title":"Microbiol. Resour Announc"},{"key":"B99","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1016\/j.jgar.2020.06.029","article-title":"Plasmid-mediated colistin resistance encoded by mcr-1 gene in escherichia coli co-carrying bla(CTX-M-15) and bla(NDM-1) genes in pediatric patients in Qatar","volume":"22","author":"Tsui","year":"2020","journal-title":"J. Glob Antimicrob. Resist."},{"key":"B100","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1093\/jac\/dkm226","article-title":"Class a carbapenemases","volume":"60","author":"Walther-Rasmussen","year":"2007","journal-title":"J. Antimicrobial Chemotherapy"},{"key":"B101","unstructured":"WHO publishes list of bacteria for which new antibiotics are urgently needed2017"},{"key":"B102","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.jiph.2019.06.011","article-title":"Genomic and antimicrobial resistance genes diversity in multidrug-resistant CTX-m-positive isolates of escherichia coli at a health care facility in jeddah","volume":"13","author":"Yasir","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"B103","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.diagmicrobio.2010.02.012","article-title":"High prevalence of extended-spectrum beta-lactamases and plasmid-mediated AmpC beta-lactamases in enterobacteriaceae isolated from long-term care facilities in Korea","volume":"67","author":"Yoo","year":"2010","journal-title":"Diagn. Microbiol. Infect. Dis."}],"container-title":["Frontiers in Antibiotics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frabi.2023.1177954\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T12:26:31Z","timestamp":1687782391000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frabi.2023.1177954\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,26]]},"references-count":103,"alternative-id":["10.3389\/frabi.2023.1177954"],"URL":"https:\/\/doi.org\/10.3389\/frabi.2023.1177954","relation":{},"ISSN":["2813-2467"],"issn-type":[{"value":"2813-2467","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,26]]},"article-number":"1177954"}}