Prevalence and Molecular Characteristics of Carbapenemase-Producing Enterobacteriaceae Among Intensive Care Unit patients: A Cross-Sectional Study in North of Iran
Abstract
Background: Carbapenems are often used as last-line agents for treating serious healthcare-associated infections (HCAIs) caused by multidrug-resistant strains. Moreover, increasing resistance to this class of antibiotics has been a major concern worldwide. In the present study, we report the prevalence and molecular characteristics of CPE among intensive care unit patients from university hospitals in Sari, North of Iran.
Materials and Methods: One hundred non-repeated clinical specimens were obtained from hospitalized patients in ICUs of four teaching hospitals in Sari, North of Iran. The API 20E system was used to identify the Enterobacteriaceae. Antibiotic susceptibility testing was performed by the disk diffusion and E-test methods. Subsequently, the MHT and CDT tests were used to identify carbapenemaseproducing clinical isolates, and polymerase chain reaction (PCR) was used to detect the presence of NDM-1, VIM, and OXA-48 genes in the isolates’ chromosomal DNA.
Results: The most enterobacterial isolates in the present study included Escherichia coli (37%), Klebsiella pneumoniae (21%), and Serratia rubidaea (10%), respectively. The most and least effective antibiotics against the clinical isolates were amikacin and meropenem, with resistance rates of 24% and 73%, respectively, while 51% of the isolates were imipenem-resistant. Also, 58 isolates were detected as multidrug resistant (MDR) of which all of them were carbapenem-resistant. Among 73 carbapenem-resistant isolates, 35 (47.9%) and 33 (45.2%) of them were MHT and CDT positive, respectively. Moreover, 30.1%, 31.5%, and 38.3% of these isolates contained VIM, NDM-1, and OXA-48 carbapenemase encoding genes, respectively.
Conclusions: This work demonstrates that the MHT is not a reliable test for the study of strains producing OXA-48 or VIM carbapenemases. Additionally, there was a significant association between the presence of carbapenem resistance genes and K. pneumoniae isolates. It seems that the presence of at least two of these genes can be one of the main reasons for resistance to carbapenems in Enterobacteriaceae.
[1] [Oliveira J, Reygaert WC. Gram-negative bacteria. In: StatPearls [Internet]. StatPearls Publishing; 2023.
[2] Paterson DL, Doi Y. Enterobacteriaceae. In: Antimicrobial Drug Resistance: Clinical and Epidemiological Aspects, Volume 2. Springer; 2017. p. 889-98. https://doi.org/10.1007/978-3-319-47266-9_8
[3] van Loon K, Voor in 't holt AF, Vos MC. A systematic review and meta-analyses of the clinical epidemiology of carbapenem-resistant Enterobacteriaceae. Antimicrob Agents Chemother. 2018;62(1):10-1128. https://doi.org/10.1128/AAC.01730-17
[4] Smith HZ, Hollingshead CM, Kendall B. Carbapenem-resistant enterobacterales. In: StatPearls [Internet]. StatPearls Publishing; 2024.
[5] Bonnin RA, Jousset AB, Emeraud C, Oueslati S, Dortet L, Naas T. Genetic diversity, biochemical properties, and detection methods of minor carbapenemases in Enterobacterales. Front Med. 2021;7:616490. https://doi.org/10.3389/fmed.2020.616490
[6] Angelini FA, Pegels ER, Quiroga M. Evaluation of phenotypic methods for the detection of carbapenemases applicable to low complexity laboratories. Rev Cienc y Tecnol RECyT. 2021;36(1):14-23. https://doi.org/10.36995/j.recyt.2021.36.002
[7] Junaid K. Molecular Diversity of NDM-1, NDM-5, NDM-6, and NDM-7 Variants of New Delhi Metallo-β-Lactamases and Their Impact on Drug Resistance. Clin Lab. 2021;(8). https://doi.org/10.7754/Clin.Lab.2021.201214
[8] Weber A, Denkel L, Geffers C, Kola A, Maechler F. NDM-1 plasmid clustering reflects clonal transmission of Klebsiella pneumoniae ST147 in four hospitals in Berlin, Germany. Antimicrob Resist Infect Control. 2025 Oct;14(1):114. https://doi.org/10.1186/s13756-025-01639-x
[9] Zhang D, Shuai Z, Hou Q, Liu Y, Li S, Han H. Emergence of NDM-1 on IncR-IncFIA (HI1) plasmid in carbapenem-resistant Kluyvera ascorbata from China. Front Microbiol. 2025;16:1666215. https://doi.org/10.3389/fmicb.2025.1666215
[10] Pérez-Lazo G, Sandoval-Ahumada R, Tairo-Cerron C, Ballena-López J, Soto-Febres F, Loyola S. Thirty-Day Mortality Associated With Carbapenemase-Producing Enterobacterales Bloodstream Infections at a Referral Hospital in Peru, 2020-2023. Open forum Infect Dis. 2025 Dec;12(12):ofaf729. https://doi.org/10.1093/ofid/ofaf729
[11] Pesesky MW, Hussain T, Wallace M, Wang B, Andleeb S, Burnham CAD, et al. KPC and NDM-1 genes in related Enterobacteriaceae strains and plasmids from Pakistan and the United States. Emerg Infect Dis. 2015;21(6):1034. https://doi.org/10.3201/eid2106.141504
[12] Walsh TR, Weeks J, Livermore DM, Toleman MA. Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study. Lancet Infect Dis. 2011;11(5):355-62. https://doi.org/10.1016/S1473-3099(11)70059-7
[13] E. BS, Alison H, Richard P, M. LD, William H. OXA-48-Like β-Lactamases: Global Epidemiology, Treatment Options, and Development Pipeline. Antimicrob Agents Chemother [Internet]. 2022 Jul 20;66(8):e00216-22. Available from: https://doi.org/10.1128/aac.00216-22 https://doi.org/10.1128/aac.00216-22
[14] Poirel L, Héritier C, Tolün V, Nordmann P. Emergence of oxacillinase-mediated resistance to imipenem in Klebsiella pneumoniae. Antimicrob Agents Chemother. 2004 Jan;48(1):15-22. https://doi.org/10.1128/AAC.48.1.15-22.2004
[15] Stojanoski V, Hu L, Sankaran B, Wang F, Tao P, Prasad BVV, et al. Mechanistic basis of OXA-48-like β-lactamases' hydrolysis of carbapenems. ACS Infect Dis. 2021;7(2):445-60. https://doi.org/10.1021/acsinfecdis.0c00798
[16] Zakhour J, El Ayoubi LW, Kanj SS. Metallo-beta-lactamases: mechanisms, treatment challenges, and future prospects. Expert Rev Anti Infect Ther [Internet]. 2024 Apr 2;22(4):189-201. Available from: https://doi.org/10.1080/14787210.2024.2311213 https://doi.org/10.1080/14787210.2024.2311213
[17] Boyd SE, Livermore DM, Hooper DC, Hope WW. Metallo-β-Lactamases: Structure, Function, Epidemiology, Treatment Options, and the Development Pipeline. Antimicrob Agents Chemother. 2020 Sep;64(10). https://doi.org/10.1128/AAC.00397-20
[18] Winn Washington C, Allen SD, Janda WM, Koneman EW, Procop GW, Schreckenberger PC, et al. Koneman's Color Atlas and Textbook of Diagnostic Microbiolgy. Lippincott, Williams & Wilkins; 2006.
[19] Jorgensen JH, Turnidge JD. Susceptibility test methods: dilution and disk diffusion methods. Man Clin Microbiol. 2015;1253-73. https://doi.org/10.1128/9781555817381.ch71
[20] Wayne PA. Clinical and laboratory standards institute. Performance standards for antimicrobial susceptibility testing. 2011;
[21] Lee K, Chong Y, Shin HB, Kim YA, Yong D, Yum JH. Modified Hodge and EDTA-disk synergy tests to screen metallo-β-lactamase-producing strains of Pseudomonas and Acinetobactet species. Clin Microbiol Infect. 2001;7(2):88-91. https://doi.org/10.1046/j.1469-0691.2001.00204.x
[22] Lee K, Lim YS, Yong D, Yum JH, Chong Y. Evaluation of the Hodge test and the imipenem-EDTA double-disk synergy test for differentiating metallo-β-lactamase-producing isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol. 2003;41(10):4623-9. https://doi.org/10.1128/JCM.41.10.4623-4629.2003
[23] Bilozor A, Balode A, Chakhunashvili G, Chumachenko T, Egorova S, Ivanova M, et al. Application of molecular methods for carbapenemase detection. Front Microbiol. 2019;10:1755. https://doi.org/10.3389/fmicb.2019.01755
[24] Baran I, Aksu N. Phenotypic and genotypic characteristics of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Turkey 2016. Ann Clin Microbiol Antimicrob. 2016;15(1):20. https://doi.org/10.1186/s12941-016-0136-2
[25] Song W, Hong SG, Yong D, Jeong SH, Kim HS, Kim HS, et al. Combined use of the modified Hodge test and carbapenemase inhibition test for detection of carbapenemase-producing Enterobacteriaceae and metallo-β-lactamase-producing Pseudomonas spp. Ann Lab Med. 2015;35(2):212. https://doi.org/10.3343/alm.2015.35.2.212
[26] Solgi H, Badamchi A, Shahcheraghi F, Badmasti F, Akbari M, Behzadfar M. A comparative evaluation of five phenotypic methods for identification of carbapenemase-producing Enterobacteriaceae: a modified carbapenemase detection test. Microbiol Spectr. 2024;12(7):e00386-24. https://doi.org/10.1128/spectrum.00386-24
[27] Loqman S, Soraa N, Diene SM, Rolain JM. Dissemination of carbapenemases (OXA-48, NDM and VIM) producing enterobacteriaceae isolated from the Mohamed VI university hospital in marrakech, Morocco. Antibiotics. 2021;10(5):492. https://doi.org/10.3390/antibiotics10050492
[28] Carrër A, Poirel L, Yilmaz M, Akan OA, Feriha C, Cuzon G, et al. Spread of OXA-48-encoding plasmid in Turkey and beyond. Antimicrob Agents Chemother. 2010 Mar;54(3):1369-73. https://doi.org/10.1128/AAC.01312-09
[29] Aslan AT, Kırbaş E, Sancak B, Tanrıverdi ES, Otlu B, Gürsoy NC, et al. A retrospective observational cohort study of the clinical epidemiology of bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae in an OXA-48 endemic setting. Int J Antimicrob Agents [Internet]. 2022;59(4):106554. Available from: https://www.sciencedirect.com/science/article/pii/S0924857922000486 https://doi.org/10.1016/j.ijantimicag.2022.106554
[30] Matsumura Y, Peirano G, Devinney R, Bradford PA, Motyl MR, Adams MD, et al. Genomic epidemiology of global VIM-producing Enterobacteriaceae. J Antimicrob Chemother. 2017;72(8):2249-58. https://doi.org/10.1093/jac/dkx148
[31] Kanj SS, Kantecki M, Arhin FF, Gheorghe M. Epidemiology and outcomes associated with MBL-producing Enterobacterales: A systematic literature review. Int J Antimicrob Agents. 2025;107449. https://doi.org/10.1016/j.ijantimicag.2025.107449
[32] Izdebski R, Baraniak A, Żabicka D, Sękowska A, Gospodarek-Komkowska E, Hryniewicz W, et al. VIM/IMP carbapenemase-producing Enterobacteriaceae in Poland: epidemic Enterobacter hormaechei and Klebsiella oxytoca lineages. J Antimicrob Chemother. 2018;73(10):2675-81. https://doi.org/10.1093/jac/dky257
[33] Bitar I, Papagiannitsis CC, Kraftova L, Marchetti VM, Petinaki E, Finianos M, et al. Implication of different replicons in the spread of the VIM-1-encoding integron, In110, in Enterobacterales from Czech hospitals. Front Microbiol. 2023;13:993240. https://doi.org/10.3389/fmicb.2022.993240
[34] Heller I, Grif K, Orth D. Emergence of VIM-1-carbapenemase-producing Enterobacter cloacae in Tyrol, Austria. J Med Microbiol. 2012;61(4):567-71. https://doi.org/10.1099/jmm.0.038646-0
[35] Nucleo E, Spalla M, Piazza A, Caltagirone MS, Asticcioli S, Debiaggi M, et al. Emergence of a VIM-1 MBL and CTX-M-15 ESβL-producing Klebsiella pneumoniae clone from acute and rehabilitation hospitals in Italy. New Microbiol. 2013;36(3):279-82.
[36] Iraz M, Özad Düzgün A, Sandallı C, Doymaz MZ, Akkoyunlu Y, Saral A, et al. Distribution of β-lactamase genes among carbapenem-resistant Klebsiella pneumoniae strains isolated from patients in Turkey. Ann Lab Med. 2015;35(6):595-601. https://doi.org/10.3343/alm.2015.35.6.595
[37] Atrissi J, Milan A, Bressan R, Lucafò M, Petix V, Busetti M, et al. Interplay of OpdP porin and chromosomal carbapenemases in the determination of carbapenem resistance/susceptibility in Pseudomonas aeruginosa. Microbiol Spectr. 2021;9(2):e01186-21. https://doi.org/10.1128/Spectrum.01186-21
[38] Lee YQ, Sri La Sri Ponnampalavanar S, Wong JH, Kong ZX, Ngoi ST, Karunakaran R, et al. Investigation on the mechanisms of carbapenem resistance among the non-carbapenemase-producing carbapenem-resistant Klebsiella pneumoniae. Front Cell Infect Microbiol. 2024;14:1464816. https://doi.org/10.3389/fcimb.2024.1464816
[39] Kanj SS, Kanafani ZA. Current concepts in antimicrobial therapy against resistant gram-negative organisms: extended-spectrum β-lactamase-producing enterobacteriaceae, carbapenem-resistant enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa. In: Mayo Clinic Proceedings. Elsevier; 2011. p. 250-9. https://doi.org/10.4065/mcp.2010.0674
[40] Kilic A, Aktas Z, Bedir O, Gumral R, Bulut Y, Stratton C, et al. Identification and characterization of OXA-48 producing, carbapenem-resistant Enterobacteriaceae isolates in Turkey. Ann Clin Lab Sci. 2011;41(2):161-6.
[2] Paterson DL, Doi Y. Enterobacteriaceae. In: Antimicrobial Drug Resistance: Clinical and Epidemiological Aspects, Volume 2. Springer; 2017. p. 889-98. https://doi.org/10.1007/978-3-319-47266-9_8
[3] van Loon K, Voor in 't holt AF, Vos MC. A systematic review and meta-analyses of the clinical epidemiology of carbapenem-resistant Enterobacteriaceae. Antimicrob Agents Chemother. 2018;62(1):10-1128. https://doi.org/10.1128/AAC.01730-17
[4] Smith HZ, Hollingshead CM, Kendall B. Carbapenem-resistant enterobacterales. In: StatPearls [Internet]. StatPearls Publishing; 2024.
[5] Bonnin RA, Jousset AB, Emeraud C, Oueslati S, Dortet L, Naas T. Genetic diversity, biochemical properties, and detection methods of minor carbapenemases in Enterobacterales. Front Med. 2021;7:616490. https://doi.org/10.3389/fmed.2020.616490
[6] Angelini FA, Pegels ER, Quiroga M. Evaluation of phenotypic methods for the detection of carbapenemases applicable to low complexity laboratories. Rev Cienc y Tecnol RECyT. 2021;36(1):14-23. https://doi.org/10.36995/j.recyt.2021.36.002
[7] Junaid K. Molecular Diversity of NDM-1, NDM-5, NDM-6, and NDM-7 Variants of New Delhi Metallo-β-Lactamases and Their Impact on Drug Resistance. Clin Lab. 2021;(8). https://doi.org/10.7754/Clin.Lab.2021.201214
[8] Weber A, Denkel L, Geffers C, Kola A, Maechler F. NDM-1 plasmid clustering reflects clonal transmission of Klebsiella pneumoniae ST147 in four hospitals in Berlin, Germany. Antimicrob Resist Infect Control. 2025 Oct;14(1):114. https://doi.org/10.1186/s13756-025-01639-x
[9] Zhang D, Shuai Z, Hou Q, Liu Y, Li S, Han H. Emergence of NDM-1 on IncR-IncFIA (HI1) plasmid in carbapenem-resistant Kluyvera ascorbata from China. Front Microbiol. 2025;16:1666215. https://doi.org/10.3389/fmicb.2025.1666215
[10] Pérez-Lazo G, Sandoval-Ahumada R, Tairo-Cerron C, Ballena-López J, Soto-Febres F, Loyola S. Thirty-Day Mortality Associated With Carbapenemase-Producing Enterobacterales Bloodstream Infections at a Referral Hospital in Peru, 2020-2023. Open forum Infect Dis. 2025 Dec;12(12):ofaf729. https://doi.org/10.1093/ofid/ofaf729
[11] Pesesky MW, Hussain T, Wallace M, Wang B, Andleeb S, Burnham CAD, et al. KPC and NDM-1 genes in related Enterobacteriaceae strains and plasmids from Pakistan and the United States. Emerg Infect Dis. 2015;21(6):1034. https://doi.org/10.3201/eid2106.141504
[12] Walsh TR, Weeks J, Livermore DM, Toleman MA. Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study. Lancet Infect Dis. 2011;11(5):355-62. https://doi.org/10.1016/S1473-3099(11)70059-7
[13] E. BS, Alison H, Richard P, M. LD, William H. OXA-48-Like β-Lactamases: Global Epidemiology, Treatment Options, and Development Pipeline. Antimicrob Agents Chemother [Internet]. 2022 Jul 20;66(8):e00216-22. Available from: https://doi.org/10.1128/aac.00216-22 https://doi.org/10.1128/aac.00216-22
[14] Poirel L, Héritier C, Tolün V, Nordmann P. Emergence of oxacillinase-mediated resistance to imipenem in Klebsiella pneumoniae. Antimicrob Agents Chemother. 2004 Jan;48(1):15-22. https://doi.org/10.1128/AAC.48.1.15-22.2004
[15] Stojanoski V, Hu L, Sankaran B, Wang F, Tao P, Prasad BVV, et al. Mechanistic basis of OXA-48-like β-lactamases' hydrolysis of carbapenems. ACS Infect Dis. 2021;7(2):445-60. https://doi.org/10.1021/acsinfecdis.0c00798
[16] Zakhour J, El Ayoubi LW, Kanj SS. Metallo-beta-lactamases: mechanisms, treatment challenges, and future prospects. Expert Rev Anti Infect Ther [Internet]. 2024 Apr 2;22(4):189-201. Available from: https://doi.org/10.1080/14787210.2024.2311213 https://doi.org/10.1080/14787210.2024.2311213
[17] Boyd SE, Livermore DM, Hooper DC, Hope WW. Metallo-β-Lactamases: Structure, Function, Epidemiology, Treatment Options, and the Development Pipeline. Antimicrob Agents Chemother. 2020 Sep;64(10). https://doi.org/10.1128/AAC.00397-20
[18] Winn Washington C, Allen SD, Janda WM, Koneman EW, Procop GW, Schreckenberger PC, et al. Koneman's Color Atlas and Textbook of Diagnostic Microbiolgy. Lippincott, Williams & Wilkins; 2006.
[19] Jorgensen JH, Turnidge JD. Susceptibility test methods: dilution and disk diffusion methods. Man Clin Microbiol. 2015;1253-73. https://doi.org/10.1128/9781555817381.ch71
[20] Wayne PA. Clinical and laboratory standards institute. Performance standards for antimicrobial susceptibility testing. 2011;
[21] Lee K, Chong Y, Shin HB, Kim YA, Yong D, Yum JH. Modified Hodge and EDTA-disk synergy tests to screen metallo-β-lactamase-producing strains of Pseudomonas and Acinetobactet species. Clin Microbiol Infect. 2001;7(2):88-91. https://doi.org/10.1046/j.1469-0691.2001.00204.x
[22] Lee K, Lim YS, Yong D, Yum JH, Chong Y. Evaluation of the Hodge test and the imipenem-EDTA double-disk synergy test for differentiating metallo-β-lactamase-producing isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol. 2003;41(10):4623-9. https://doi.org/10.1128/JCM.41.10.4623-4629.2003
[23] Bilozor A, Balode A, Chakhunashvili G, Chumachenko T, Egorova S, Ivanova M, et al. Application of molecular methods for carbapenemase detection. Front Microbiol. 2019;10:1755. https://doi.org/10.3389/fmicb.2019.01755
[24] Baran I, Aksu N. Phenotypic and genotypic characteristics of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Turkey 2016. Ann Clin Microbiol Antimicrob. 2016;15(1):20. https://doi.org/10.1186/s12941-016-0136-2
[25] Song W, Hong SG, Yong D, Jeong SH, Kim HS, Kim HS, et al. Combined use of the modified Hodge test and carbapenemase inhibition test for detection of carbapenemase-producing Enterobacteriaceae and metallo-β-lactamase-producing Pseudomonas spp. Ann Lab Med. 2015;35(2):212. https://doi.org/10.3343/alm.2015.35.2.212
[26] Solgi H, Badamchi A, Shahcheraghi F, Badmasti F, Akbari M, Behzadfar M. A comparative evaluation of five phenotypic methods for identification of carbapenemase-producing Enterobacteriaceae: a modified carbapenemase detection test. Microbiol Spectr. 2024;12(7):e00386-24. https://doi.org/10.1128/spectrum.00386-24
[27] Loqman S, Soraa N, Diene SM, Rolain JM. Dissemination of carbapenemases (OXA-48, NDM and VIM) producing enterobacteriaceae isolated from the Mohamed VI university hospital in marrakech, Morocco. Antibiotics. 2021;10(5):492. https://doi.org/10.3390/antibiotics10050492
[28] Carrër A, Poirel L, Yilmaz M, Akan OA, Feriha C, Cuzon G, et al. Spread of OXA-48-encoding plasmid in Turkey and beyond. Antimicrob Agents Chemother. 2010 Mar;54(3):1369-73. https://doi.org/10.1128/AAC.01312-09
[29] Aslan AT, Kırbaş E, Sancak B, Tanrıverdi ES, Otlu B, Gürsoy NC, et al. A retrospective observational cohort study of the clinical epidemiology of bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae in an OXA-48 endemic setting. Int J Antimicrob Agents [Internet]. 2022;59(4):106554. Available from: https://www.sciencedirect.com/science/article/pii/S0924857922000486 https://doi.org/10.1016/j.ijantimicag.2022.106554
[30] Matsumura Y, Peirano G, Devinney R, Bradford PA, Motyl MR, Adams MD, et al. Genomic epidemiology of global VIM-producing Enterobacteriaceae. J Antimicrob Chemother. 2017;72(8):2249-58. https://doi.org/10.1093/jac/dkx148
[31] Kanj SS, Kantecki M, Arhin FF, Gheorghe M. Epidemiology and outcomes associated with MBL-producing Enterobacterales: A systematic literature review. Int J Antimicrob Agents. 2025;107449. https://doi.org/10.1016/j.ijantimicag.2025.107449
[32] Izdebski R, Baraniak A, Żabicka D, Sękowska A, Gospodarek-Komkowska E, Hryniewicz W, et al. VIM/IMP carbapenemase-producing Enterobacteriaceae in Poland: epidemic Enterobacter hormaechei and Klebsiella oxytoca lineages. J Antimicrob Chemother. 2018;73(10):2675-81. https://doi.org/10.1093/jac/dky257
[33] Bitar I, Papagiannitsis CC, Kraftova L, Marchetti VM, Petinaki E, Finianos M, et al. Implication of different replicons in the spread of the VIM-1-encoding integron, In110, in Enterobacterales from Czech hospitals. Front Microbiol. 2023;13:993240. https://doi.org/10.3389/fmicb.2022.993240
[34] Heller I, Grif K, Orth D. Emergence of VIM-1-carbapenemase-producing Enterobacter cloacae in Tyrol, Austria. J Med Microbiol. 2012;61(4):567-71. https://doi.org/10.1099/jmm.0.038646-0
[35] Nucleo E, Spalla M, Piazza A, Caltagirone MS, Asticcioli S, Debiaggi M, et al. Emergence of a VIM-1 MBL and CTX-M-15 ESβL-producing Klebsiella pneumoniae clone from acute and rehabilitation hospitals in Italy. New Microbiol. 2013;36(3):279-82.
[36] Iraz M, Özad Düzgün A, Sandallı C, Doymaz MZ, Akkoyunlu Y, Saral A, et al. Distribution of β-lactamase genes among carbapenem-resistant Klebsiella pneumoniae strains isolated from patients in Turkey. Ann Lab Med. 2015;35(6):595-601. https://doi.org/10.3343/alm.2015.35.6.595
[37] Atrissi J, Milan A, Bressan R, Lucafò M, Petix V, Busetti M, et al. Interplay of OpdP porin and chromosomal carbapenemases in the determination of carbapenem resistance/susceptibility in Pseudomonas aeruginosa. Microbiol Spectr. 2021;9(2):e01186-21. https://doi.org/10.1128/Spectrum.01186-21
[38] Lee YQ, Sri La Sri Ponnampalavanar S, Wong JH, Kong ZX, Ngoi ST, Karunakaran R, et al. Investigation on the mechanisms of carbapenem resistance among the non-carbapenemase-producing carbapenem-resistant Klebsiella pneumoniae. Front Cell Infect Microbiol. 2024;14:1464816. https://doi.org/10.3389/fcimb.2024.1464816
[39] Kanj SS, Kanafani ZA. Current concepts in antimicrobial therapy against resistant gram-negative organisms: extended-spectrum β-lactamase-producing enterobacteriaceae, carbapenem-resistant enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa. In: Mayo Clinic Proceedings. Elsevier; 2011. p. 250-9. https://doi.org/10.4065/mcp.2010.0674
[40] Kilic A, Aktas Z, Bedir O, Gumral R, Bulut Y, Stratton C, et al. Identification and characterization of OXA-48 producing, carbapenem-resistant Enterobacteriaceae isolates in Turkey. Ann Clin Lab Sci. 2011;41(2):161-6.
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| Issue | Vol 1 No 1 (2026) | |
| Section | Original Articles | |
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| Enterobacteriaceae Carbapenem NDM-1 VIM OXA-48 | ||
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How to Cite
1.
Gholami M, Haghi A, Ranjbari S, Ahanjan M. Prevalence and Molecular Characteristics of Carbapenemase-Producing Enterobacteriaceae Among Intensive Care Unit patients: A Cross-Sectional Study in North of Iran. ipj. 2026;1(1):14-22.
