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Background Carbapenem-resistant Enterobacterales (CRE), currently listed by the World Health Organization (WHO) as top priority critical pathogens, are a major global menace to human health. In low- and middle-income countries (LMICs) the threat is mounting fueled by selective pressures caused by antibiotic abuse and inadequate diagnostic resources. Methods This study phenotypically and genotypically characterized carbapenem resistance among 115 Enterobacterales isolates including 76  Klebsiella (K.) pneumoniae,  19  Escherichia (E.) coli,  14  Shigella (S.) sonnei , 5  Enterobacter (E.) cloacae , and 1  Proteus (P.) mirabilis . Results Ninety-three isolates (80.9%) were carbapenem-resistant with an alarming 57.5% carbapenem non-susceptibility in isolates collected from the outpatient department. Molecular characterization of the carbapenemases (CPases) encoding genes showed that  bla  NDM  (80.5%) was the most prevalent; it was detected in 62 isolates (54  K  . pneumoniae,  6  E. coli  and 2  S. sonnei ), followed by  bla  VIM  (36.4%) which was observed in 28 isolates (24  K  . pneumoniae , 3  E. coli  and 1  E. cloacae ). Other CPases included  bla  KPC  (28.6%; in 20  K  . pneumoniae , 1  E. coli  and 1  S. sonnei ),  bla  OXA-48  (26%; in 17  K  . pneumoniae , 1  E. coli ,1  E. cloacae  and 1  P. mirabilis ),  bla  IMP  (6.5%; in 5  K  . pneumoniae ) and  bla  SPM  (1.3%; in  K. pneumoniae ). Notably more than half of the Enterobacterales isolates (54.5%) co-harboured more than one CPase-encoding gene. Co-existence of  bla  NDM  and  bla  VIM  genes was the most dominant (31.2%), followed by association of  bla  NDM  and  bla  KPC  (24.7%), then  bla  VIM  and  bla  KPC  (13%). Moreover, the effects of different genotypes on meropenem MIC values were assessed, and a statistically significant difference between the genotype (Ambler classes A and B) and the genotype (Ambler classes B and D) was recorded. Conclusion The current findings may serve for a better understanding of the context of CRE in Egypt, associated drivers and CPases.

antimicrobial resistance and infection control

Phenotype-genotype correlations among carbapenem-resistant Enterobacterales recovered from four Egyptian hospitals with the report of SPM carbapenemase