الفهرس 
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Abstract
The recent worldwide emergence of resistance against the powerful antibiotic carbapenem in Enterobacteriaceae establishes an important developing public health threat. Infections caused by Carbapenem-Resistant Enteric Bacteria (CRE) are very difficult to treat and have been associated with high mortality rate. Carbapenems are the last-line of therapy for treatment nosocomial infections and community-acquired infections. Resistance to broad-spectrum antimicrobials, such as the extended-spectrum Cephalosporins, is a major problem among Gram-Negative pathogens, including Acinetobacter sp., Pseudomonas sp. and Enterobacteriaceae (Orsi et al., 2011).
Enterobacteriaceae are important opportunist pathogens, they are normal inhabitants of the intestinal flora and become the most common human pathogens, causing infections that range from cystitis to pyelonephritis, septicemia, pneumonia, peritonitis, meningitis, and device-associated infections. They are among the major etiologic agents that cause healthcare-associated infections (HAIs). They spread easily between humans by hand carriage as well as contaminated food and water. Multidrug-resistant Gram-negative rods are becoming an increasingly difficult problem in hospitals and long-term care facilities (CDC, 2012; Kallen et al., 2013).
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β-lactam such as penicillins, cephalosporins, carbapenems and monobactams represent 60% of all antimicrobial agent used. They are preferred because of their efficacy and safety and because their activity can be extended or restored by chemical manipulation, however, their heavy usage has been selected strongly for resistance These antibacterial agent are crucial for treating life-threatening hospital-acquired infections such as those linked with transplantation, hospitalizations in intensive-care units, and surgery, and the emergence of carbapenem resistance bacteria leaves the hospitals with no effective drugs (Livermore and Woodford, 2006; Sievert et al., 2013; Temkin et al., 2014).
Resistance to carbapenems (doripenem, ertapenem, imipenem, faropenem, and meropenem) is mostly mediated through beta-lactamases and also due to carbapenemases enzymes (KPC, NDM, IMP, VIM, and OXA-84), which encoded by the bla genes usually located on mobile genetics elements “plasmid-mediated”, facilitating horizontal transmission between different gram-negative species. Fast and accurate detection of carbapenem resistance is crucial (critical) for guiding the treatment of the individual patient as well as instituting proper infection control (IC) measures to limit the spread of the organism (Nordmann et al., 2012).
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1. Hospital-Acquired Infections:
A hospital-acquired infections (HAI), also called a