Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan.

Carbapenem resistance has become major concern in healthcare settings globally; therefore, its monitoring is crucial for intervention efforts to halt resistance spread. During May 2019-April 2022, 2170 clinical strains were characterized for antimicrobial susceptibility, resistance genes, replicon and sequence types. Overall, 42.1% isolates were carbapenem-resistant, and significantly associated with () ( = 0.008) and species ( = 0.043). Carbapenemases were detected in 82.2% of isolates, with (41.1%) associated with the ICU ( < 0.001), cardiology ( = 0.042), pediatric medicine ( = 0.013) and wound samples ( = 0.041); (32.6%) was associated with the ICU ( < 0.001), cardiology ( = 0.008), pediatric medicine ( < 0.001), general surgery ( = 0.001), general medicine ( = 0.005) and nephrology ( = 0.020); (5.5%) was associated with general surgery ( = 0.029); / (11.4%) was associated with general surgery ( < 0.001), and wound ( = 0.002), urine ( = 0.003) and blood ( = 0.012) samples; / (3.1%) was associated with nephrology ( < 0.001) and urine samples ( < 0.001). Other detected carbapenemases were (3.0%), (2.7%), / (0.1%) and / (0.3%). Sequence type (ST)147 (39.7%) represented the most common sequence type identified among , along with ST11 (23.0%), ST14 (15.4%), ST258 (10.9%) and ST340 (9.6%) while ST405 comprised 34.5% of () isolates followed by ST131 (21.2%), ST101 (19.7%), ST10 (16.0%) and ST69 (7.4%). Plasmid replicon types IncFII, IncA/C, IncN, IncL/M, IncFIIA and IncFIIK were observed. This is first report describing the carbapenem-resistance burden and emergence of -ST147, -ST340 and -ST14 in isolates and -ST69 and /-ST69 in isolates coharboring extended-spectrum beta-lactamases (ESBLs) from Pakistan.