The threat of carbapenem-resistant Enterobacteriaceae in Lebanon: An update on the regional and local epidemiology

SummaryBacterial resistance to antimicrobial agents is increasing. Complex resistant mechanisms have resulted in a wide spectrum of species and strains with multidrug-resistant patterns. In addition to the production of extended-spectrum-β-lactamases (ESBLs), Gram-negative rods have acquired the capacity to hydrolyze carbapenem antibiotics by means of carbapenemases. The enzyme that has gained the most publicity recently is the New Delhi metallo-β-lactamase (NDM-1). This enzyme and others are now spreading from their homeland on the Indian subcontinent to other continents, primarily via medical tourists. This spread contributes to be a global threat in an era when no potent antibiotics are expected to be developed. Patients coming from countries where antimicrobial use is not restricted, such as Iraq, may harbor similar organisms. Reports from the Middle East and Arabian countries describing the occurrence of carbapenem-resistant Enterobacteriaceae are rare. In this communication, an update on the epidemiology, prevalence and mechanisms of carbapenem-resistant Enterobacteriaceae in Lebanon and the surrounding region will be addressed in addition to the detection methods and required infection control practices.

► Carbapenem-resistant Enterobacteriaceae (CRE) are on the rise imposing serious medical threats and challenges to treatment. ► Acquisition of NDM-1 gene among CRE exacerbated the danger of their spread and treatment. ► Suspicion, screening, and prompt detection of such isolates is crucial for patients management and infection control aspects. ► Understanding the local and global epidemiology of such seriously resistant pathogens helps guide their control. ► Limited treatment options are available: colistin, tigecycline, fosfomycin, and other few investigational drugs.