740. Emerging NDM-1 ‚-Lactamase-Producing† Enterobacteriaceae in Kuwait
Session: Poster Abstract Session: Antimicrobials: Resistance Mechanisms
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C

Enterobacteriaceae producing New Delhi-metallo-β-lactamase-1 (NDM-1) present a recognized threat to the healthcare system. Most NDM-positive isolates are multidrug resistant but remain susceptible to colistin and tigecycline. They are often reported from patients with travel or healthcare links in other countries. Our objective is to report an emerging upsurge in the incidence of NDM-1 producing Enterobacteriaceae isolated from patients in Kuwait with no travel history.  


Isolates with reduced susceptibility to carbapenems were collected over a 2-year period from patients in a major hospital in Kuwait. They were identified by VITEK-II system and their susceptibility tested against 18 antibiotics according to CLSI, (2012) guidelines. The carbapenem-resistant (CR) isolates were screened for NDM production using phenotypic methods. The presence of NDM-1 was detected by PCR and sequencing. Transconjugants were constructed from Escherichia coli J53 and clonality determined by PFGE.


Of a total of 59 Enterobacteriaceae isolates resistant to at least one of the tested carbapenem, 9 (15.3%), made up of 5 Klebsiella pneumoniae, 2 E. coli, 1 Morganella morganii and 1 Provindentia stuartii, were NDM-1 positive. They were isolated from patients with UTI (6/9),  soft tissue infections (2) and bacteremia (1). Six were nosocomially acquired and remaining 3 community-acquired. The isolates were resistant to the β-lactams, including aztreonam, and amikacin; 6 were resistant to ciprofloxacin. All but 2 were susceptible to colistin and tigecycline. The isolates harbored plasmids of varying sizes transferrable to E. coli recipient but were clonally heterogeneous. Attributable mortality rate was 33.3%. Of the 9 patients, 4 were Kuwaitis, 3 Indians, 1 Egyptian and 1 Jordanian; none had traveled outside Kuwait in the preceding 2 years prior to hospital admissions.      


Emergence of CR Enterobacteriaceae in Kuwait is a new phenomenon and finding  over 15% to be NDM-1 producers in patients with no travel history has added another dimension to problem of antibiotic resistance in this small country. National surveillance and stringent infection control strategies are required to prevent their spread.

Vincent Rotimi, MD, PhD1, Wafaa Jamal, MD, PhD1, John Albert, PhD1, Fatima Khodakhast, BSc2 and Laurent Poirel, PhD3, (1)Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait, (2)Microbiology, Faculty Medicine, Kuwait University, Safat, Kuwait, (3)Hopital de Bicetre, Le Kremlin Bicetre, France


V. Rotimi, None

W. Jamal, None

J. Albert, None

F. Khodakhast, None

L. Poirel, None

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