Contemporary multicentre analysis of carbapenemases distribution among clinical carbapenem-resistant Enterobacterales in Lebanon

Background Contemporary multicentre data on carbapenemase distribution among carbapenem-resistant Enterobacterales (CRE) in Lebanon remain limited. This study aimed to characterize the distribution of carbapenemase enzyme families among clinical CRE isolates collected from Lebanese hospitals. Methods A multicentre study was conducted across 14 hospitals representing different Lebanese regions between March and October 2025. CRE isolates were centrally processed using standardized phenotypic microbiological methods and interpreted according to the 2025 European Committee on Antimicrobial Susceptibility Testing breakpoints. Carbapenemase identification was performed using NG-Test® CARBA-5. Agreement between phenotypic prediction and rapid immunochromatographic testing was evaluated. Results A total of 59 non-duplicate CRE isolates from individual patients were included. New Delhi metallo-β-lactamase (NDM) was the predominant carbapenemase enzyme family (64.4%), followed by OXA-48–like enzymes (23.7%), with co-production observed in 10.2% of isolates. Among carbapenem-resistant Escherichia coli (34 isolates), NDM predominated (73.5%). In contrast, carbapenem-resistant Klebsiella pneumoniae (15 isolates) more frequently harboured OXA-48–like enzymes (53.3%), although NDM-producing isolates were also identified (33.3%). No NDM-producing isolate was susceptible to ceftazidime–avibactam, whereas OXA-48–like producers retained higher susceptibility (71.4%). Phenotypic carbapenemase prediction showed high agreement with NG-Test® CARBA-5 results (κ = 0.89), including 100% sensitivity for metallo-β-lactamase detection. Conclusions NDM was the predominant carbapenemase among CRE isolates recovered from participating Lebanese hospitals, while Oxacillinase-48 carbapenemase (OXA-48)–like enzymes remained common. These findings highlight the importance of carbapenemase-specific characterization, as therapeutic options differ according to the underlying resistance mechanism. Rapid carbapenemase detection using NG-Test® CARBA-5, coupled with phenotypic prediction, may support resistance mechanism-guided therapy, antimicrobial stewardship and surveillance efforts.