Abstract
BACKGROUND AND OBJECTIVES: Global health is seriously threatened by the rise of carbapenem-resistant Enterobacterales (CRE). The bla (NDM) gene, a key carbapenemase coding gene, causes global health concern due to its multidrug resistance and easy spread through mobile genetic elements. This study aimed to identify and genetically characterize the bla (NDM) genes from uropathogens, its antibiotic susceptibility, and its correlation with global sequences. MATERIALS AND METHODS: Urine samples were processed following microbiological guidelines. Isolates were identified using API-20E. Antibiotic susceptibility was tested using disc diffusion method, and bacterial DNAs were extracted for bla (NDM) gene sequencing for phylogenetic analysis. RESULTS: CREs were detected in 11.92% (n=51) of the 428 Enterobacterales. Among CRE isolates, 45% (n=23) were positive for bla (NDM) gene harbored by Klebsiella pneumoniae (57%), followed by Escherichia coli (26%). Uropathogenic CRE, harboring bla (NDM), revealed susceptibility of 34.78%, 60.87%, and 65.22% to amikacin, nitrofurantoin, and fosfomycin respectively. The bla (NDM-5) variant was most common (69.57%), followed by bla (NDM-1) (26.09%) and bla (NDM-7) (4.35%). Phylogenetic analysis revealed that bla (NDM) variants exhibit diverse relationships with Pakistani and worldwide sequences. CONCLUSION: The significant presence of bla (NDM) in uropathogens, along with extensive antibiotic resistance, underscores the urgent need for continuous monitoring and antibiotic stewardship programs to manage the growing threat of CRE infections.