1
|
Chamoun K, Farah M, Araj G, Daoud Z, Moghnieh R, Salameh P, Saade D, Mokhbat J, Abboud E, Hamze M, Abboud E, Jisr T, Haddad A, Feghali R, Azar N, El-Zaatari M, Chedid M, Haddad C, Zouain Dib Nehme M, Barakat A, Husni R. Surveillance of antimicrobial resistance in Lebanese hospitals: retrospective nationwide compiled data. Int J Infect Dis 2016; 46:64-70. [PMID: 26996458 DOI: 10.1016/j.ijid.2016.03.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/09/2016] [Accepted: 03/12/2016] [Indexed: 10/22/2022] Open
Abstract
Antimicrobial resistance is closely linked to antimicrobial use and is a growing concern worldwide. Antimicrobial resistance increases healthcare costs substantially in many countries, including Lebanon. National data from Lebanon have, in the most part, been limited to a few academic hospitals. The Lebanese Society of Infectious Diseases conducted a retrospective study to better describe the antimicrobial susceptibility patterns of bacterial isolates in Lebanon. Data were based on records retrieved from the bacteriology laboratories of 16 different Lebanese hospitals between January 2011 and December 2013. The susceptibility results of a total 20684 Gram-positive and 55594 Gram-negative bacteria were analyzed. The prevalence rate of methicillin-resistant Staphylococcus aureus was 27.6% and of vancomycin-resistant Enterococcus spp was 1%. Streptococcus pneumoniae had susceptibilities of 46% to oxacillin, 63% to erythromycin, and 98% to levofloxacin. Streptococcus pyogenes had susceptibilities of 94% to erythromycin and 95% to clindamycin. The mean ampicillin susceptibility of Haemophilus influenzae, Salmonella spp, and Shigella spp isolates was 79%, 81.3%, and 62.2%, respectively. The extended-spectrum beta-lactamase production rate for Escherichia coli was 32.3% and for Klebsiella spp was 29.2%. Acinetobacter spp showed high resistance to most antimicrobials, with low resistance to colistin (17.1%). Pseudomonas spp susceptibilities to piperacillin-tazobactam and imipenem were lower than 80% (79.7% and 72.8%, respectively). This study provides population-specific data that are valuable in guiding antimicrobial use in Lebanon and neighbouring countries and will help in the establishment of a surveillance system for antimicrobial resistance following the implementation of a nationwide standardization of laboratory methods and data entry.
Collapse
Affiliation(s)
- Kamal Chamoun
- Department of Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Maya Farah
- Department of Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Georges Araj
- Department of Microbiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad Daoud
- Department of Microbiology, Faculty of Medicine, University of Balamand and Centre Hospitalier du nord Hospital, Beirut, Lebanon
| | - Rima Moghnieh
- Department of Infectious Diseases, Makassed Hospital, Beirut, Lebanon
| | - Pascale Salameh
- School of Pharmacy, Pharmacy Practice Department, Lebanese American University, Byblos, Lebanon
| | - Danielle Saade
- Epidemiological Surveillance Unit, Ministry of Public Health, Beirut, Lebanon
| | - Jacques Mokhbat
- Department of Internal Medicine, Division of Infectious Diseases, Lebanese American University - Rizk Hospital, Beirut, Lebanon
| | - Emme Abboud
- Department of Microbiology, Mount Lebanon Hospital, Beirut, Lebanon
| | - Monzer Hamze
- Department of Microbiology, NINI Hospital, Tripoli, Lebanon
| | - Edmond Abboud
- Department of Microbiology, Middle East Institute of Health, Mount Lebanon, Lebanon
| | - Tamima Jisr
- Department of Microbiology, Makassed Hospital, Beirut, Lebanon
| | - Antoine Haddad
- Department of Microbiology, Sacré Coeur Hospital, Mount Lebanon, Lebanon
| | - Rita Feghali
- Department of Microbiology, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Nadim Azar
- Department of Microbiology, Hotel Dieu de France Hospital, Beirut, Lebanon
| | | | - Marwan Chedid
- Department of Microbiology, Mazloum Hospital, Tripoli, Lebanon
| | - Christian Haddad
- Department of Microbiology, Notre Dame des Secours Hospital, Byblos, Lebanon
| | | | - Angelique Barakat
- Department of Microbiology, Bellevue Hospital, Mount Lebanon, Lebanon
| | - Rola Husni
- Department of Internal Medicine, Division of Infectious Diseases, Lebanese American University - Rizk Hospital, Beirut, Lebanon.
| | | |
Collapse
|
3
|
Mokaddas EM, Rotimi VO, Albert MJ. Increasing Prevalence of Antimicrobial Resistance in Streptococcus pneumoniae in Kuwait: Implications for Therapy. Microb Drug Resist 2007; 13:227-33. [DOI: 10.1089/mdr.2007.774] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eiman M. Mokaddas
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Vincent O. Rotimi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - M. John Albert
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| |
Collapse
|
5
|
Daoud Z, Cocozaki A, Hakime N. Antimicrobial susceptibility patterns of Haemophilus influenzae and Streptococcus pneumoniae isolates in a Beirut general university hospital between 2000 and 2004. Clin Microbiol Infect 2006; 12:86-90. [PMID: 16460553 DOI: 10.1111/j.1469-0691.2005.01303.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Susceptibility patterns of Streptococcus pneumoniae and Haemophilus influenzae collected over a 5-year period in a Beirut general university hospital were studied. Only 40.6-50% of S. pneumoniae isolates were susceptible to penicillin G. Susceptibility to clindamycin and erythromycin decreased from 94.1% and 89.7%, respectively, in 2000 to 75% and 71.9%, respectively, in 2004. All isolates were susceptible to ceftriaxone, ciprofloxacin and vancomycin. For H. influenzae, no resistance was observed to amoxycillin-clavulanate, ceftriaxone, ciprofloxacin and rifampicin, with >92% of isolates showing susceptibility to cefuroxime, chloramphenicol, erythromycin and tetracycline. The proportion of beta-lactamase-positive isolates varied between 22.7 and 30.8%.
Collapse
Affiliation(s)
- Z Daoud
- University of Balamand and Clinical Microbiology Laboratory of the Saint George University Hospital, Beirut, Lebanon.
| | | | | |
Collapse
|
6
|
Felmingham D, Feldman C, Hryniewicz W, Klugman K, Kohno S, Low DE, Mendes C, Rodloff AC. Surveillance of resistance in bacteria causing community-acquired respiratory tract infections. Clin Microbiol Infect 2002; 8 Suppl 2:12-42. [PMID: 12427206 DOI: 10.1046/j.1469-0691.8.s.2.5.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bacterial resistance to antibiotics in community-acquired respiratory tract infections is a serious problem and is increasing in prevalence world-wide at an alarming rate. Streptococcus pneumoniae, one of the main organisms implicated in respiratory tract infections, has developed multiple resistance mechanisms to combat the effects of most commonly used classes of antibiotics, particularly the beta-lactams (penicillin, aminopenicillins and cephalosporins) and macrolides. Furthermore, multidrug-resistant strains of S. pneumoniae have spread to all regions of the world, often via resistant genetic clones. A similar spread of resistance has been reported for other major respiratory tract pathogens, including Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes. To develop and support resistance control strategies it is imperative to obtain accurate data on the prevalence, geographic distribution and antibiotic susceptibility of respiratory tract pathogens and how this relates to antibiotic prescribing patterns. In recent years, significant progress has been made in developing longitudinal national and international surveillance programs to monitor antibiotic resistance, such that the prevalence of resistance and underlying trends over time are now well documented for most parts of Europe, and many parts of Asia and the Americas. However, resistance surveillance data from parts of the developing world (regions of Central America, Africa, Asia and Central/Eastern Europe) remain poor. The quantity and quality of surveillance data is very heterogeneous; thus there is a clear need to standardize or validate the data collection, analysis and interpretative criteria used across studies. If disseminated effectively these data can be used to guide empiric antibiotic therapy, and to support-and monitor the impact of-interventions on antibiotic resistance.
Collapse
|
7
|
Mokaddas EM, Wilson S, Sanyal SC. Prevalence of penicillin-resistant Streptococcus pneumoniae in Kuwait. J Chemother 2001; 13:154-60. [PMID: 11330362 DOI: 10.1179/joc.2001.13.2.154] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The worldwide incidence of penicillin-resistant Streptococcus pneumoniae has increased at an alarming rate during the past decade. However, there has been little published data about the extent of this problem in Kuwait. The present study was undertaken to ascertain the preponderance of S. pneumoniae, either resistant or intermediate-resistant to penicillin, other beta-lactams and non-beta-lactam antimicrobials in Kuwait. Two hundred and fifty fresh isolates from as many patients suffering from different clinical conditions were collected from all clinics and hospitals in Kuwait. Optochin sensitivity and bile solubility tests reconfirmed these. Susceptibility testing to penicillin, ampicillin, cefuroxime, ceftriaxone, cefotaxime, imipenem, erythromycin, chloramphenicol, ciprofloxacin and vancomycin was done using E-test strips and to oxacillin, tetracycline, trimethoprim and amoxicillin-clavulanate by disc diffusion technique. Full and intermediate resistance to penicillin was observed in 1.6% and 52.8% of the isolates respectively. Full resistance to third-generation cephalosporins ranged from 0.4% to 3.2%, however, intermediate resistance to these antibiotics varied between 18.8% and 21.2%. Ampicillin resistance was noted in 0.8%, but 40.4% of isolates were intermediately resistant. However, only 0.4% of the isolates showed either intermediate or full resistance to amoxicillin-clavulanate. Resistance to imipenem was observed in 0.4% and intermediate to 13.6% of the organisms. The rates of S. pneumoniae resistant to chloramphenicol, erythromycin, tetracycline and trimethoprim were between 8.4% and 37.6% and intermediate resistance between 1.2% and 17.6% while only 0.4% showed resistance to ciprofloxacin and none to vancomycin. Multiresistance to both beta-lactam and non-beta-lactam antibiotics was observed in 52% of the penicillin-resistant isolates.
Collapse
Affiliation(s)
- E M Mokaddas
- Department of Microbiology, Faculty of Medicine & Ibn Sina Hospital, Kuwait
| | | | | |
Collapse
|
9
|
Araj GF, Bey HA, Itani LY, Kanj SS. Drug-resistant Streptococcus pneumoniae in the Lebanon: implications for presumptive therapy. Int J Antimicrob Agents 1999; 12:349-54. [PMID: 10493612 DOI: 10.1016/s0924-8579(99)00083-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A total of 50 consecutive clinical isolates of Streptococcus pneumoniae, collected between 1996 and 1998, were tested against six antimicrobial agents using the E-test. The percentages of fully resistant (R) and intermediately-R strains, respectively, were: benzyl penicillin 18 and 38%, amoxycillin-clavulanate 6 and 12%, cefuroxime 22 and 16%, ceftriaxone 2 and 16%, and clarithromycin 10%. Fully and or intermediately multidrug-resistance (two or more drugs) was seen in 44% of the isolates, 18% being fully resistant. The MIC breakpoint for cefaclor is not defined by the National Committee for Clinical Laboratory Standards (NCCLS) but MICs showed that: 76% of the isolates had an MIC of < or = 8 mg/l, 4% had an MIC of 16 mg/l and 20% had an MIC of > or = 32 mg/l. There was agreement between the E-test Pen MIC results and the 1 microg oxacillin (oxa) disk diffusion screen test for the 22 susceptible and the nine fully R strains but not for the 19 strains with Pen MICs between 0.1 and 1 mg/l; this shows the importance of MIC determination in such isolates. Penicillin and multiply antibiotic-resistant pneumococci are spreading in Lebanon, emphasizing the necessity to reconsider current treatment regimens in this country.
Collapse
Affiliation(s)
- G F Araj
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon.
| | | | | | | |
Collapse
|