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Nukaly HY, Aljuhani RA, Alhartani MM, Alhindi YZ, Asif U, Alshanberi AM, Alsanosi SM. Knowledge of Antibiotic Use and Resistance Among Medical Students in Saudi Arabia. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:501-512. [PMID: 38835809 PMCID: PMC11149621 DOI: 10.2147/amep.s462490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/26/2024] [Indexed: 06/06/2024]
Abstract
Introduction The World Health Organization (WHO) has placed great importance on providing thorough, hands-on training to medical students regarding responsible and appropriate antibiotic prescription. Accordingly, this study aims to gain a better perspective on the knowledge of antibiotic use and resistance among medical students in Jeddah, Saudi Arabia. Methods A questionnaire-based cross-sectional study was conducted among medical students in Jeddah, Saudi Arabia, from 1 September to 30 November 2023. The categorical variables are presented as frequencies and percentages. Mann-Whitney and Kruskal-Wallis tests were used to compare the outcomes, and generalised linear regression models were constructed to predict the students' knowledge of antibiotics and antibiotic resistance. A p-value of < 0.05 was taken to indicate statistical significance. Results The study included a total of 353 medical students. First-year medical students represented 28.60% of the participants, while females represented 76.80%. Most participants (92.40%) agreed that antibiotics are effective against bacteria, whereas only 25.20% agreed about antibiotics' effectiveness against viruses. More than half of the participants (53.80%) believed that bacterial infections can be resolved without antibiotics. A significant majority (78.20%) agreed that the unnecessary use of antibiotics makes them less effective. More than half of the participants (56.90%) acknowledged that infections caused by resistant bacteria are increasing in Saudi Arabia, and two-thirds (75.10%) believed that healthcare workers could effectively reduce antibiotic resistance in Saudi Arabia. Male students had low knowledge about antibiotics [Beta = -1.429, 95% CI (-2.618, -0.241), P value = 0.019]. Conclusion Improving the curriculum by incorporating topics like resistance mechanisms and responsible antibiotic usage can address the knowledge gap among male students. This comprehensive training, utilizing various educational methods, is essential for fostering responsible antibiotic practices among future healthcare professionals.
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Affiliation(s)
- Houriah Y Nukaly
- General Medicine Practice Program, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Raghad A Aljuhani
- General Medicine Practice Program, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Mahinar M Alhartani
- General Medicine Practice Program, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Yosra Z Alhindi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Uzma Asif
- General Medicine Practice Program, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Asim M Alshanberi
- General Medicine Practice Program, Batterjee Medical College, Jeddah, Saudi Arabia
- Department of Community Medicine and Pilgrims Health Care, Umm Alqura University, Makkah, Saudi Arabia
| | - Safaa M Alsanosi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Al-Sarar D, Moussa IM, Alhetheel A. Antibiotic susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated at tertiary care hospital in Riyadh, Saudi Arabia. Medicine (Baltimore) 2024; 103:e37860. [PMID: 38640320 PMCID: PMC11029994 DOI: 10.1097/md.0000000000037860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/28/2024] [Accepted: 03/20/2024] [Indexed: 04/21/2024] Open
Abstract
Staphylococcus aureus is an important human pathogen that has a major impact on public health. The objective of the present work was to determine the prevalence and the pattern of antibiotic susceptibility in S aureus (MRSA) isolates from the King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia. The isolates were collected from different body sites of infection and the antibiotic susceptibility was confirmed on the Vitek 2 system. A total of 371 MRSA isolates from clinical samples were received over a 12-month period from January 2021 to December 2021. The results showed that infection was predominant among males (55.8%) and most of the isolates occurred in the older age groups, with a mean age of 43.7 years and an age span from <1 to 89 years old. The majority (34.5%) recovered from wound infection followed by (14.6%) from blood. We have observed peaks of MRSA infections during the autumn, especially in September and November. All MRSA isolates were resistant to Amoxicillin + clavulanic acid, Ampicillin, Imipenem, Oxacillin, Cloxacillin, and Penicillin while all isolates were sensitive to Daptomycin and Nitrofurantoin. Furthermore, Vancomycin was resistant in (0.3%) of MRSA isolates, and (2.9%) was resistant to Linezolid. The current study concluded that MRSA strains had developed resistance toward 24 tested antibiotics, including the previous effective drugs vancomycin and linezolid. Therefore, there is an urgent need for continuous review of infection control practices to prevent any further spread of resistant strains.
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Affiliation(s)
- Dalia Al-Sarar
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Ihab M. Moussa
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Abdulkarim Alhetheel
- Department of Pathology, College of Medicine and University Hospitals, King Saud University, Riyadh, Saudi Arabia
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Almutairi H, Albahadel H, Alhifany AA, Aldalbahi H, Alnezary FS, Alqusi I, Mobark MA, Saeed Almutairi M. Prevalence and antimicrobial susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA) at a maternity and children hospital in Saudi Arabia: A cross-sectional study. Saudi Pharm J 2024; 32:102001. [PMID: 38439950 PMCID: PMC10909782 DOI: 10.1016/j.jsps.2024.102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) pathogens are considered a serious global health threat, leading to increased mortality and antimicrobial resistance. Rates in Saudi Arabia remain high, necessitating continuous surveillance. This study investigates MRSA prevalence and susceptibility at a Saudi maternity and children's hospital. Method A cross-sectional study was conducted on pediatric (<18 years) and maternal patients with S. aureus infection from Jan. 2020 to March. 2022. Bacterial strains were obtained from patient's clinical specimens and was identified by standard method. The BD Phoenix™ M50 was used for antibiotic susceptibility tests and MRSA detection. Data were analysed using descriptive and inferential statistics (Chi-square test) with SPSS software. Results Out of 152 S. aureus cases, 114/152 (75 %) were pediatric and 38/152 (25 %) were maternal patients. The overall MRSA infection was 69/152 (45.4 %). Among pediatrics, 31/54 (57.4 %) MRSA cases were female; over 30/54 (56 %) were under 1 year old; and most MRSA infections were obtained from skin 29/54 (53.7 %) compared to other sites of infections (p = 0.024). Among maternal cases, 15/38 (39.5 %) were MRSA, primarily from wound infections 14/15 (93.3 %) compared to other sites of infections (p = 0.39). All MRSA isolates were sensitive to vancomycin and linezolid. While 51/60(85 %) were sensitive to Trimethoprim/ sulfamethoxazole. Conclusion This investigation found a high prevalence of MRSA among pediatrics and maternal inpatients, indicating a significant burden. All MRSA isolates were susceptible to vancomycin but demonstrated variable sensitivity to other antibiotics. These findings highlight the need for ongoing surveillance, infection control strategies, and research into alternative treatment options to combat this major public health threat.
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Affiliation(s)
- Hadiah Almutairi
- Department of Pharmacy Practice, College of Pharmacy, University of Hafr Albatin, Saudi Arabia
| | - Heyam Albahadel
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim 51452, Saudi Arabia
| | - Abdullah A. Alhifany
- Pharmaceutical Practices Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hind Aldalbahi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim 51452, Saudi Arabia
| | - Faris S. Alnezary
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah 41477, Saudi Arabia
| | - Ibrahim Alqusi
- Laboratory Department, Maternity and Children Hospital in Buraydah City, Ministry of Health, Qassim, Saudi Arabia
| | - Mugahid A. Mobark
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim 51452, Saudi Arabia
| | - Masaad Saeed Almutairi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim 51452, Saudi Arabia
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Thabit AK, Alabbasi AY, Alnezary FS, Almasoudi IA. An Overview of Antimicrobial Resistance in Saudi Arabia (2013-2023) and the Need for National Surveillance. Microorganisms 2023; 11:2086. [PMID: 37630646 PMCID: PMC10460018 DOI: 10.3390/microorganisms11082086] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Antimicrobial resistance (AMR) is a well-recognized global threat. The World Health Organization (WHO) issued a report ranking the critical types of bacterial resistance that need to be monitored. Several studies from individual institutions in Saudi Arabia have reported rates of antimicrobial resistance using automated methods. However, no national surveillance study has been conducted to date using gold standard methods for antimicrobial susceptibility testing. This review summarizes AMR rates for major bacterial pathogens in Saudi Arabia and provides a justification for the need for a national surveillance project. In Saudi Arabia, AMR rates for both Gram-positive and Gram-negative bacteria are on the rise. Surveillance studies help identify AMR trends and emergence of outbreaks. The WHO has started a program, the Global Antimicrobial Resistance Surveillance System (GLASS), encouraging its member states, including Saudi Arabia, to conduct antimicrobial surveillance studies to estimate AMR rates worldwide. Of the microbiological methods used to test antimicrobial susceptibility, only broth microdilution (BMD) is considered the "gold standard." As AMR studies in Saudi Arabia are sparse, mostly limited to single centers and were conducted using automated methods, a national AMR surveillance project is needed to evaluate the current status and to inform stewardship decisions.
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Affiliation(s)
- Abrar K. Thabit
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd, Jeddah 22254-2265, Saudi Arabia
| | - Afaq Y. Alabbasi
- Eastern Health Cluster, Ministry of Health, Dammam 32253, Saudi Arabia
| | - Faris S. Alnezary
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Madinah 41477, Saudi Arabia
| | - Imtinan A. Almasoudi
- Clinical Pharmacy Department, King Saud Medical City, Ministry of Health, Riyadh 12746, Saudi Arabia
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Al-Said HM, Alghamdi A, Ashgar SS, Jalal NA, Faidah HS, Johargy AK, Momenah AM, Barhameen AA, Hariri SH, Bantun F, Althobiany E, Khidir EB. Isolation and Detection of Drug-Resistant Bacterial Pathogens in Postoperative Wound Infections at a Tertiary Care Hospital in Saudi Arabia. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:229-234. [PMID: 37533663 PMCID: PMC10393095 DOI: 10.4103/sjmms.sjmms_405_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/02/2023] [Accepted: 06/07/2023] [Indexed: 08/04/2023]
Abstract
Background Surgical site infections (SSIs), especially when caused by multidrug-resistant (MDR) bacteria, are a major healthcare concern worldwide. For optimal treatment and prevention of antimicrobial resistance, it is important for clinicians to be aware of local drug-resistant bacterial pathogens that cause SSIs. Objective To determine the frequency patterns of drug-resistant bacterial strains causing SSIs at a tertiary care hospital in Saudi Arabia. Methods This retrospective study was conducted at the Microbiology laboratory of Al-Noor Specialist Hospital, Makkah, Saudi Arabia, and included wound swab samples from all cases of SSI between January 01, 2017, and December 31, 2021. The swabs were processed for the identification of bacterial strains and their resistance pattern to antibiotics according to the Clinical and Laboratory Standards Institute. Results A total of 5409 wound swabs were analyzed, of which 3604 samples (66.6%) were from male. Most samples were from the Department of Surgery (43.3%). A total of 14 bacterial strains were isolated, of which 9 were Gram-negative bacteria. The most common isolates were Klebsiella pneumoniae, followed by Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and vancomycin-resistant S. aureus (VRSA). In terms of MDR in 2021, the highest rate of carbapenem-resistance was in A. baumannii (97%). MDR was as follows: A. baumannii, 97%; K. pneumoniae, 81%; E. coli, 71%; MRSA, 60%; P. aeruginosa, 33%; VRE, 22%; and VRSA, 2%. Conclusion This study showed that in the city of Makkah, Saudi Arabia, the rates of MDR bacteria are high, with the majority being Gram-negative.
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Affiliation(s)
- Hamdi M. Al-Said
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ahmed Alghamdi
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sami S. Ashgar
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Naif A. Jalal
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hani S. Faidah
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ayman K. Johargy
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Aiman M. Momenah
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abeer A. Barhameen
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sumyya H. Hariri
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Farkad Bantun
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Essa Althobiany
- Department of Medical Microbiology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Elshiekh B. Khidir
- Department of Laboratory Medicine, Faculty of Applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia
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Momenah AM, Bakri RA, Jalal NA, Ashgar SS, Felemban RF, Bantun F, Hariri SH, Barhameen AA, Faidah H, AL-Said HM. Antimicrobial Resistance Pattern of Pseudomonas aeruginosa: An 11-Year Experience in a Tertiary Care Hospital in Makkah, Saudi Arabia. Infect Drug Resist 2023; 16:4113-4122. [PMID: 37396063 PMCID: PMC10312329 DOI: 10.2147/idr.s409726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose Pseudomonas aeruginosa (P. aeruginosa) is a common causative pathogen in healthcare settings and displays increasing levels of resistance to common antimicrobial drugs. Its capacity to resist has been reported in multiple locations across the world. This study evaluates current levels of antibiotic resistance and seeks to understand antibiotic resistance patterns in the context of the clinical isolates of P. aeruginosa. Methods All clinical isolates were cultured at 37 °C for 24 h in different media: blood sheep agar, McConkey agar, and cystine-lactose-electrolyte-deficient agar (CLED), bacterial identification and antibiotic susceptibility patterns were determined using the Vitek-2 (bioMérieux) automated system. Results In total, there were 61,029 patient specimens, of which 5534 were identified as non-duplicated P. aeruginosa clinical isolates, most being from males aged over 60 years. The research findings revealed that the maximum antibiotic resistance associated with P. aeruginosa isolates was found in colistin (97%), which was followed by piperacillin/tazobactam (75.8%). The maximum resistance rates in P. aeruginosa isolates were found in relation to cefepime (42.7%,) which was followed by ciprofloxacin (34.3%). Conclusion The antibiotic resistance rate during the first six years of the research period was notably higher than in the last years, due to the application of infection control protocols and strict policies to control antibiotic prescriptions in all Saudi hospitals.
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Affiliation(s)
- Aiman M Momenah
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Rafat Ahmed Bakri
- University Medical Center, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Naif A Jalal
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sami S Ashgar
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Rakan Fahad Felemban
- Department of Laboratory and Blood Bank, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Farkad Bantun
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sumyya H Hariri
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abeer A Barhameen
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hani Faidah
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hamdi M AL-Said
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Alsehemi AF, Alharbi EA, Al-amash BB, Alrais AI, Elbadawy HM, Alahmadi YM. Assessment of risk factors associated with multidrug-resistant organism infections among patients admitted in a tertiary hospital - a retrospective study. Saudi Pharm J 2023. [DOI: 10.1016/j.jsps.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Yahya RO. Problems Associated with Co-Infection by Multidrug-Resistant Klebsiella pneumoniae in COVID-19 Patients: A Review. Healthcare (Basel) 2022; 10:healthcare10122412. [PMID: 36553936 PMCID: PMC9778403 DOI: 10.3390/healthcare10122412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
To date, coronavirus disease 2019 (COVID-19) and its variants have been reported as a novel public health concern threatening us worldwide. The presence of Klebsiella pneumoniae in COVID-19-infected patients is a major problem due to its resistance to multiple antibiotics, and it can possibly make the management of COVID-19 in patients more problematic. The impact of co-infection by K. pneumoniae on COVID-19 patients was explored in the current review. The spread of K. pneumoniae as a co-infection among critically ill COVID-19 patients, particularly throughout hospitalization, was identified and recorded via numerous reports. Alarmingly, the extensive application of antibiotics in the initial diagnosis of COVID-19 infection may reduce bacterial co-infection, but it increases the antibiotic resistance of bacteria such as the strains of K. pneumoniae. The correct detection of multidrug-resistant K. pneumoniae can offer a supportive reference for the diagnosis and therapeutic management of COVID-19 patients. Furthermore, the prevention and control of K. pneumoniae are required to minimize the risk of COVID-19. The aim of the present review is, therefore, to report on the virulence factors of the K. pneumonia genotypes, the drug resistance of K. pneumonia, and the impact of K. pneumoniae co-infection with COVID-19 on patients through a study of the published scientific papers, reports, and case studies.
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Affiliation(s)
- Reham Omar Yahya
- Basic Sciences Department, College of Sciences and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11671, Saudi Arabia;
- King Abduallah International Medical Research Center, Riyadh 11481, Saudi Arabia
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Activity of ceftolozane/tazobactam against clinical isolates of Pseudomonas aeruginosa from patients in the Middle East and Africa - Study for Monitoring Antimicrobial Resistance Trends (SMART) 2017-2020. Int J Infect Dis 2022; 125:250-257. [PMID: 36244599 DOI: 10.1016/j.ijid.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES We evaluated the activity of ceftolozane/tazobactam (C/T), and comparators against clinical Pseudomonas aeruginosa isolates collected for the global Study for Monitoring Antimicrobial Resistance Trends (SMART) surveillance program in ten countries in the Middle East and Africa to augment scarce standardized surveillance data in this region. METHODS Minimum inhibitory concentrations (MICs) were determined using Clinical and Laboratory Standards Institute broth microdilution and interpreted with European Committee on Antimicrobial Susceptibility Testing breakpoints. P. aeruginosa isolates testing with C/T MIC >4 mg/l or imipenem MIC >2 mg/l were screened for β-lactamase genes. RESULTS C/T was active against 91.4% and 87.0% of P. aeruginosa isolates from the Middle East and Africa, respectively (14-21 and 7-16 percentage points higher than most β-lactam comparators, respectively). Considerable variation in susceptibility was seen across countries, which largely correlated with the observed prevalence of carbapenemases and/or extended-spectrum β-lactamases. Differences across countries were smaller for C/T than for the β-lactam comparators, ranging from 81% C/T-susceptible among isolates from Jordan to 95% for Qatar. Among subsets resistant to meropenem, ceftazidime, or piperacillin/tazobactam, C/T maintained activity against 51-73% of isolates from the Middle East and against 27-54% from Africa (where metallo-β-lactamase and GES carbapenemase rates were higher). CONCLUSION Given the desirability of β-lactam use among clinicians, C/T represents an important option in the treatment of infections caused by P. aeruginosa.
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Torumkuney D, Dolgum S, van Hasselt J, Abdullah W, Keles N. Country data on AMR in Saudi Arabia in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome. J Antimicrob Chemother 2022; 77:i70-i76. [PMID: 36065727 PMCID: PMC9445845 DOI: 10.1093/jac/dkac219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. Objectives To review AMR in Saudi Arabia and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize a further rise in AMR within Saudi Arabia and improve patient outcomes. Methods National AMR initiatives, antibiotic use and prescribing, and availability of susceptibility data, particularly for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used locally for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) were also reviewed, plus local antibiotic availability. Insights from a clinician in Saudi Arabia were sought to contextualize this information. Conclusions Various initiatives are underway in Saudi Arabia, including a National Action Plan for AMR, which was published in 2017. However, AMR is rising and knowledge about appropriate antibiotic use seems to be lacking among physicians and the general public. Various international guidelines are utilized by clinicians in Saudi Arabia, but a more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Saudi Arabia could make management guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve patient outcomes.
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Affiliation(s)
- Didem Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - Saeed Dolgum
- Pediatric Infectious Diseases, Dr. Suliman ALhabib Hospital, Riyadh, Saudi Arabia
| | - James van Hasselt
- GlaxoSmithKline, The Campus, Flushing Meadows, 57 Sloane Street, Bryanston, Gauteng 2021, South Africa
| | - Walid Abdullah
- GlaxoSmithKline, Headquarters Business Park, Corniche Road, Jeddah 21544, Saudi Arabia
| | - Nergis Keles
- GlaxoSmithKline, Büyükdere Cad. No: 173, 1. Levent Plaza B Blok 34394 Levent, İstanbul, Türkiye
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Alhumaid S, Al Mutair A, Al Alawi Z, Alzahrani AJ, Tobaiqy M, Alresasi AM, Bu-Shehab I, Al-Hadary I, Alhmeed N, Alismail M, Aldera AH, AlHbabi F, Al-Shammari H, Rabaan AA, Al-Omari A. Antimicrobial susceptibility of gram-positive and gram-negative bacteria: a 5-year retrospective analysis at a multi-hospital healthcare system in Saudi Arabia. Ann Clin Microbiol Antimicrob 2021; 20:43. [PMID: 34118930 PMCID: PMC8196925 DOI: 10.1186/s12941-021-00450-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/02/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Studying time-related changes in susceptible pathogens causing healthcare-associated infections (HAIs) is vital in improving local antimicrobial and infection control practices. OBJECTIVES Describe susceptibility patterns to several antimicrobials in gram-positive and gram-negative pathogens isolated from patients causing HAIs at three private tertiary care hospitals in Saudi Arabia over a 5-year period. METHODS Data on trends of antimicrobial susceptibility among bacteria causing HAIs events in children and adults at three tertiary private hospitals located in Riyadh and Qassim, Saudi Arabia, were collected retrospectively between 2015 and 2019 using the surveillance data datasets. RESULTS Over a 5-year period, 38,624 pathogens caused 17,539 HAI events in 17,566 patients. About 9450 (53.8%) of patients who suffered HAIs were females and the average age was 41.7 ± 14.3 years (78.1% were adults and 21.9% were children). Gram-negative pathogens were 2.3-times more likely to cause HAIs compared to gram-positive bacteria (71.9% vs. 28.1%). The ranking of causative pathogens in decreasing order was: Escherichia coli (38%), Klebsiella species (15.1%), and Staphylococcus aureus (12.6%). Gram-positive isolates were mostly susceptible to linezolid (91.8%) whereas they were resistant to ampicillin (52.6%), cefoxitin (54.2%), and doxycycline (55.9%). Gram-negative isolates were mostly sensitive to tigecycline (95%) whereas they were resistant to cefotaxime (49.5%) and cefixime (59.6%). During the 5 years, there were relatively stable susceptibility patterns to all tested antimicrobials, except for cefotaxime which shown a susceptibility reduction by 41.4%, among Escherichia coli and Klebsiella species. An increase in the susceptibility of Acinetobacter and Enterobacter and Citrobacter species to all studied antimicrobials was observed except for colistin that had a slight sensitivity reduction in 2019 by 4.3% against Acinetobacter species. However, we noted reduced sensitivity of MRSA, CoNS and Enterococcus species to gentamicin; and increased resistance of MRSA to linezolid and vancomycin. CONCLUSION The observed increase in susceptibility of gram-positive and gram-negative bacteria to studied antimicrobials is important; however, reduced sensitivity of MRSA, CoNS and Enterococcus species to gentamicin; and increased resistance of MRSA to linezolid and vancomycin is a serious threat and calls for effective antimicrobial stewardship programs.
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Affiliation(s)
- Saad Alhumaid
- Administration of Pharmaceutical Care, Alahsa Health Cluster, Ministry of Health, Rashdiah Street, P. O. Box 12944, Alahsa, 31982, Saudi Arabia.
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Alahsa, Saudi Arabia.,School of Nursing, Wollongong University, Wollongong, Australia
| | - Zainab Al Alawi
- Department of Pediatrics, College of Medicine, King Faisal University, Alahsa, Saudi Arabia
| | - Ahmad J Alzahrani
- College of Medicine, Al-Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Mansour Tobaiqy
- Department of Pharmacology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Ahmed M Alresasi
- Administration of Pharmaceutical Care, Alahsa Health Cluster, Ministry of Health, Rashdiah Street, P. O. Box 12944, Alahsa, 31982, Saudi Arabia
| | - Ibrahim Bu-Shehab
- Administration of Pharmaceutical Care, Alahsa Health Cluster, Ministry of Health, Rashdiah Street, P. O. Box 12944, Alahsa, 31982, Saudi Arabia
| | - Issa Al-Hadary
- Administration of Pharmaceutical Care, Alahsa Health Cluster, Ministry of Health, Rashdiah Street, P. O. Box 12944, Alahsa, 31982, Saudi Arabia
| | - Naif Alhmeed
- Naif Alhmeed, Administration of Supply and Shared Services, Ministry of Health, Riyadh, Saudi Arabia
| | - Mossa Alismail
- Pharmacy Department, King Faisal General Hospital, Alahsa, Saudi Arabia
| | - Ahmed H Aldera
- Pharmacy Department, Prince Saud Bin Jalawi Hospital, Alahsa, Saudi Arabia
| | - Fadhil AlHbabi
- Virology Department, Regional Laboratory and Blood Bank, Riyadh, Saudi Arabia
| | - Haifa Al-Shammari
- Department of Histopathology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ali A Rabaan
- Molecular Diagnostics Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Awad Al-Omari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
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12
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Mutair AA, Alhumaid S, Alawi ZA, Zaidi ARZ, Alzahrani AJ, Al-Tawfiq JA, Al-Shammari H, Rabaan AA, Khojah O, Al-Omari A. Five-year resistance trends in pathogens causing healthcare-associated infections at a multi-hospital healthcare system in Saudi Arabia, 2015-2019. J Glob Antimicrob Resist 2021; 25:142-150. [PMID: 33762211 DOI: 10.1016/j.jgar.2021.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Awareness of antimicrobial resistance (AMR) patterns in a given healthcare setting is important to inform the selection of appropriate antimicrobial therapy to reduce the further rise and spread of AMR as well as the rate of healthcare-associated infections (HAIs) and multidrug-resistant (MDR) organisms. We aimed to describe resistance patterns to several antimicrobial agents in pathogens causing HAIs isolated from patients using data gathered at three private tertiary-care hospitals in Saudi Arabia. METHODS Data on trends in AMR among bacteria causing HAIs and MDR events in children and adults at three private hospitals were collected retrospectively (2015-2019) using surveillance data. RESULTS Over the 5-year period, 29 393 pathogens caused 17 539 HAIs in 15 259 patients. Approximately 57.3% of patients were female and the mean age was 38.4 ± 16.8 years (81.4% adults, 18.6% children). Gram-negative pathogens were four times more likely to cause HAIs compared with Gram-positive bacteria (79.3% vs. 20.7%). Ranking of causative pathogens in decreasing order was Escherichia coli (42.2%), Klebsiella spp. (16.8%) and Staphylococcus aureus (13.9%). Acinetobacter spp. were the only pathogens to decrease significantly (7% reduction; P = 0.033). The most common resistant pathogens were extended-spectrum cephalosporin-resistant E. coli (37.1%), extended-spectrum cephalosporin-resistant Klebsiella (27.8%), carbapenem-non-susceptible Acinetobacter spp. (19.5%), carbapenem-non-susceptible Pseudomonas aeruginosa (19.2%) and methicillin-resistant S. aureus (18.6%). CONCLUSION National collaboration is required by prompt feedback to local authorities to tackle regional differences in AMR. This can help plan timely containment interventions to stop and contain microbial threats and swiftly assess their impact.
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Affiliation(s)
- Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia; College of Nursing, Princess Nora University, Riyadh, Saudi Arabia; School of Nursing, University of Wollongong, Australia.
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-ahsa Health Cluster, Ministry of Health, Al-ahsa, Saudi Arabia
| | - Zainab Al Alawi
- Department of Pediatrics, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Abdul Rehman Z Zaidi
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ahmed J Alzahrani
- Department of Pathology, College of Medicine, Al-Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine and Infection Control Unit, Quality and Patient Safety, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haifa Al-Shammari
- Department of Histopathology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ali A Rabaan
- Molecular Diagnostics Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Osamah Khojah
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Laboratory Services, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Awad Al-Omari
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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13
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Nasser M, Palwe S, Bhargava RN, Feuilloley MGJ, Kharat AS. Retrospective Analysis on Antimicrobial Resistance Trends and Prevalence of β-lactamases in Escherichia coli and ESKAPE Pathogens Isolated from Arabian Patients during 2000-2020. Microorganisms 2020; 8:microorganisms8101626. [PMID: 33096921 PMCID: PMC7589750 DOI: 10.3390/microorganisms8101626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022] Open
Abstract
The production of diverse and extended spectrum β-lactamases among Escherichia coli and ESKAPE pathogens is a growing threat to clinicians and public health. We aim to provide a comprehensive analysis of evolving trends of antimicrobial resistance and β-lactamases among E. coli and ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acine to bacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) in the Arabian region. A systematic review was conducted in Medline PubMed on papers published between January 2000 and February 2020 on countries in the Arab region showing different antibiotic resistance among E. coli and ESKAPE pathogens. A total of n = 119,144 clinical isolates were evaluated for antimicrobial resistance in 19 Arab countries. Among these clinical isolates, 74,039 belonged to E. coli and ESKAPE pathogen. Distribution of antibiotic resistance among E. coli and ESKAPE pathogens indicated that E. coli (n = 32,038) was the predominant pathogen followed by K. pneumoniae (n = 17,128), P. aeruginosa (n = 11,074), methicillin-resistant S. aureus (MRSA, n = 4370), A. baumannii (n = 3485) and Enterobacter spp. (n = 1574). There were no reports demonstrating Enterococcus faecium producing β-lactamase. Analyses revealed 19 out of 22 countries reported occurrence of ESBL (Extended-Spectrum β-Lactamase) producing E. coli and ESKAPE pathogens. The present study showed significantly increased resistance rates to various antimicrobial agents over the last 20 years; for instance, cephalosporin resistance increased from 37 to 89.5%, fluoroquinolones from 46.8 to 70.3%, aminoglycosides from 40.2 to 64.4%, mono-bactams from 30.6 to 73.6% and carbapenems from 30.5 to 64.4%. An average of 36.9% of the total isolates were reported to have ESBL phenotype during 2000 to 2020. Molecular analyses showed that among ESBLs and Class A and Class D β-lactamases, blaCTX-M and blaOXA have higher prevalence rates of 57% and 52.7%, respectively. Among Class B β-lactamases, few incidences of blaVIM 27.7% and blaNDM 26.3% were encountered in the Arab region. Conclusion: This review highlights a significant increase in resistance to various classes of antibiotics, including cephalosporins, β-lactam and β-lactamase inhibitor combinations, carbapenems, aminoglycosides and quinolones among E. coli and ESKAPE pathogens in the Arab region.
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Affiliation(s)
- Mahfouz Nasser
- Department of Biotechnology, Dr. Babasaheb Ambedkar Marathwada University, Sub-Campus, Osmanabad 413 528, MS, India;
- National Center for Public Health Laboratories, Hodeidah, Yemen
| | - Snehal Palwe
- Department of Environmental Science, S. B. College of Science, Aurangabad 431001, India;
| | - Ram Naresh Bhargava
- Department of Microbiology, Babasaheb Bhimrao Ambedkar University, Lucknow 226025, India;
| | - Marc G. J. Feuilloley
- Laboratory of Microbiology Signals and Microenvironments, LMSM EA 4312, University of Rouen, Normandy, F-27000 Evreux, France
- Correspondence: (M.G.J.F.); (A.S.K.)
| | - Arun S. Kharat
- Laboratory of Applied Microbiology, School of Life Sciences, Jawaharlal Nehru University, New Mehrauli Road, New Delhi 110067, India
- Correspondence: (M.G.J.F.); (A.S.K.)
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Pathogenic spectrum of blood stream infections and resistance pattern in Gram-negative bacteria from Aljouf region of Saudi Arabia. PLoS One 2020; 15:e0233704. [PMID: 32516308 PMCID: PMC7282660 DOI: 10.1371/journal.pone.0233704] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
Background The pathogenic spectrum of bloodstream infections (BSIs) varies across regions. Monitoring the pathogenic profile and antimicrobial resistance is a prerequisite for effective therapy, infection control and for strategies aimed to counter antimicrobial resistance. The pathogenic spectrum of BSIs in blood cultures was analysed, focusing on the resistance patterns of Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae, in Aljouf region. Methods This descriptive cross-sectional study analysed the culture reports of all non-duplicate blood samples collected from January 1 to December 31, 2019. Antibiograms of A. baumannii, E. coli, and K. pneumoniae were analysed for antibiotic resistance. The frequency and percentages of multi-drug, extensively-drug, pan-drug and carbapenem resistance were calculated. Results Of the 222 bloodstream infections, 62.2% and 36.4% were caused by gram-negative and gram-positive bacteria, respectively. Most BSIs occurred in patients aged ≥60 years (59.5%). Among the 103 isolates of the studied Gram-negative bacteria (GNB), 47.6%, 38.8%, and 2.9% were multi-drug, extensively drug and pan-drug resistant respectively. 46% of K. pneumoniae isolates were carbapenemase producers. Resistance to gentamycin, 1st–4th generation cephalosporins, and carbapenems was observed for A. baumannii. More than 70% of E. coli isolates were resistant to 3rd- and 4th-generation cephalosporins. Klebsiella pneumoniae presented a resistance rate of >60% to imipenems. Conclusions Gram-negative bacteria dominate BSIs, with carbapenem-resistant K. pneumoniae most frequently detected in this region. Resistant GNB infections make it challenging to treat geriatric patients. Regional variations in antimicrobial resistance should be continually monitored.
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Al-Tawfiq JA, Rabaan AA, Saunar JV, Bazzi AM. Antimicrobial resistance of gram-negative bacteria: A six-year longitudinal study in a hospital in Saudi Arabia. J Infect Public Health 2020; 13:737-745. [DOI: 10.1016/j.jiph.2020.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 01/05/2020] [Accepted: 01/15/2020] [Indexed: 02/06/2023] Open
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