{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:35:59Z","timestamp":1781627759234,"version":"3.54.5"},"reference-count":40,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T00:00:00Z","timestamp":1675209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The global spread of carbapenem resistance and the resulting increase in mortality forced the World Health Organization (WHO) to claim carbapenem-resistant enterobacteriaceae (CRE) as global priority pathogens. Our study aimed to determine the prevalence of carbapenemase-encoding genes and major plasmid incompatibility groups among Gram-negative hospital-based isolates in Egypt. Material and Methods: This cross-sectional study was carried out at Mansoura University Hospitals over 12 months, from January to December 2019. All the isolates were tested for carbapenem resistance. The selected isolates were screened by conventional polymerase chain reaction (PCR) for the presence of carbapenemase genes, namely blaKPC, blaIMP, blaVIM, and blaNDM-1. PCR-based plasmid replicon typing was performed using the commercial PBRT kit. Results: Out of 150 isolates, only 30 (20.0%) demonstrated carbapenem resistance. Klebsiella pneumoniae was the most resistant of all isolated bacteria, and blaNDM was the predominant carbapenemases gene, while the most prevalent plasmid replicons were the F replicon combination (FIA, FIB, and FII) and A\/C. Plasmids were detected only in Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, and Pseudomonas aeruginosa. Remarkably, we found a statistically significant association between carbapenemase genes and plasmid replicons, including blaNDM, IncA\/C, and IncX. Conclusions: Our study demonstrated an alarming rise of plasmid-mediated carbapenem-resistant bacteria in our locality. The coexistence of resistance genes and plasmids highlights the importance of a targeted antibiotic surveillance program and the development of alternative therapeutic options at the local and international levels. Based on our results, we suggest a large-scale study with more Enterobacteriaceae isolates, testing other carbapenemase-encoding genes, and comparing the replicon typing method with other plasmid detection methods. We also recommend a national action plan to control the irrational use of antibiotics in Egypt.<\/jats:p>","DOI":"10.3390\/medicina59020285","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T02:52:02Z","timestamp":1675219922000},"page":"285","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Carbapenem Resistance in Gram-Negative Bacteria: A Hospital-Based Study in Egypt"],"prefix":"10.3390","volume":"59","author":[{"given":"Amira Abd","family":"Elrahem","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Mansoura University, Mansoura City 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noha","family":"El-Mashad","sequence":"additional","affiliation":[{"name":"Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura City 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0179-2869","authenticated-orcid":false,"given":"Mohammed","family":"Elshaer","sequence":"additional","affiliation":[{"name":"Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura City 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6687-3758","authenticated-orcid":false,"given":"Hazem","family":"Ramadan","sequence":"additional","affiliation":[{"name":"Hygiene and Zoonoses Department, Faculty of Veterinary Medicine, Mansoura University, Mansoura City 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2390-6505","authenticated-orcid":false,"given":"Giovanni","family":"Damiani","sequence":"additional","affiliation":[{"name":"Young Dermatologists Italian Network (YDIN), 20122 Milan, Italy"},{"name":"Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy"},{"name":"Ph.D. Degree Program in Pharmacological Sciences, Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy"},{"name":"Department of Dermatology, Case Western Reserve University, Cleveland, OH 2109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monir","family":"Bahgat","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura City 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santo Raffaele","family":"Mercuri","sequence":"additional","affiliation":[{"name":"Unit of Dermatology, IRCCS San Raffaele Hospital, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafaa","family":"Elemshaty","sequence":"additional","affiliation":[{"name":"Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura City 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"258","DOI":"10.3389\/fmicb.2013.00258","article-title":"Multidrug resistant commensal Escherichia coli in animals and its impact for public health","volume":"4","author":"Szmolka","year":"2013","journal-title":"Front. 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