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The emergence of carbapenemaseresistant Enterobacteriaceae (CRE) is an imminent threat to public health obligating, the development of novel β-lactam/β-lactamase inhibitors to combat its relentless spread, an example of which is ceftazidime-avibactam (CAZAVI). Since its introduction in 2015, worldwide data continues to pour in describing different mechanisms of treatment failure, primarily mediated by members of metallo-β-lactamase (MBL), Klebsiella pneumoniae carbapenemase (KPC), and oxacillinase (OXA) enzymes. Case Report: We report a case of a previously healthy 22-year-old male who was admitted to the critical care burn unit as a case of third-degree chemical burn injury involving 80% of his body surface area. His tissue cultures grew Klebsiella pneumoniae which was resistant to CAZ-AVI. Further analysis of resistance patterns by Xpert® Carba-R detected the presence of both NDM (New Delhi metallo-β-lactamase) and OXA-48 mutation genes. Conclusion: OXA-48-mediated carbapenemase resistance is a regional threat in the Middle East and it is increasingly expanding in terms of its epidemiology and activity against novel antimicrobials. This activity is primarily mediated by mutant doubling and plasmid adaptation and can be horizontally acquired by coexistence with other resistant genes. We are reporting the first OXA-48-mediated CAZ-AVI resistance in the western region of Saudi Arabia which raises the concern about CRE spread in the country. Necessitating wiser use of available genotypic testing coupled with strict adherence of infection control protocols and antimicrobial stewardship programs.

OXA-48 carbapenemase-mediated ceftazidime-avibactam resistance; first reported case in Saudi Arabia’s western region and review of literature