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Case Report
OXA-48 carbapenemase-mediated ceftazidime-avibactam resistance; first reported case in Saudi Arabia’s western region and review of literature
1 Internal Medicine Resident, Department of Internal Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
2 Infectious Diseases Consultant, Department of Internal Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
3 Senior Clinical Scientist in Clinical Microbiology and Molecular Infectious Diseases, Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital, Jeddah, Saudi Arabia
Address correspondence to:
Yasser Al Dabbagh
23214, Jeddah, Western Region,
Saudi Arabia
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Article ID: 101046Z01YD2019
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How to cite this article
Al Dabbagh Y, Hassan R, Bahabri N, Qutub M. OXA- 48 carbapenemase-mediated ceftazidime-avibactam resistance; first reported case in Saudi Arabia’s western region and review of literature. Int J Case Rep Images 2019;10:101046Z01YD2019.ABSTRACT
Introduction: The emergence of carbapenemaseresistant Enterobacteriaceae (CRE) is an imminent threat to public health obligating, the development of novel β-lactam/β-lactamase inhibitors to combat its relentless spread, an example of which is ceftazidime-avibactam (CAZAVI). Since its introduction in 2015, worldwide data continues to pour in describing different mechanisms of treatment failure, primarily mediated by members of metallo-β-lactamase (MBL), Klebsiella pneumoniae carbapenemase (KPC), and oxacillinase (OXA) enzymes.
Case Report: We report a case of a previously healthy 22-year-old male who was admitted to the critical care burn unit as a case of third-degree chemical burn injury involving 80% of his body surface area. His tissue cultures grew Klebsiella pneumoniae which was resistant to CAZ-AVI. Further analysis of resistance patterns by Xpert® Carba-R detected the presence of both NDM (New Delhi metallo-β-lactamase) and OXA-48 mutation genes.
Conclusion: OXA-48-mediated carbapenemase resistance is a regional threat in the Middle East and it is increasingly expanding in terms of its epidemiology and activity against novel antimicrobials. This activity is primarily mediated by mutant doubling and plasmid adaptation and can be horizontally acquired by coexistence with other resistant genes. We are reporting the first OXA-48-mediated CAZ-AVI resistance in the western region of Saudi Arabia which raises the concern about CRE spread in the country. Necessitating wiser use of available genotypic testing coupled with strict adherence of infection control protocols and antimicrobial stewardship programs.
Keywords: Carbapenemase, Ceftazidime-avibactam, Enterobacteriaceae, OXA-48
SUPPORTING INFORMATION
Author Contributions
Yasser Al Dabbagh - Final approval of the version to be published
Rola Hassan - Acquisition of data, Drafting the article, Final approval of the version to be published
Nezar Bahabri - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Mohammed Qutub - Analysis of data, Interpretation of data, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Yasser Al Dabbagh et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
