Background: Increasing rate of resistant infections is a challenge to healthcare negatively impacting therapeutic and financial outcomes. Targeted antimicrobial stewardship interventions are needed to counteract this global crisis. On large scale, we sought to identify the prevalence of resistant pathogens and their susceptibility pattern in Northern Oman. Material and method: Retrospective analysis of all isolates processed by Suhar Hospital microbiology laboratory between Jan1st, 2016 and Dec31st, 2017. Organism identification, susceptibility and phenotyping were performed following CLSI standards and duplicate isolates were excluded. Pertinent microbiological data were collected and analyzed. Results: Of 15,733 samples included, Gram-negative bacteria predominate by 67.76%, Gram-positive (29%) and Candida species (2.63%). Frequently isolated Gram-negative bacteria were Escherichia coli (32.39%), Pseudomonas aeruginosa (22.16%), Klebsiellapneumoniae (19.97%) and Acinetobacter baumannii (5.22%), there was virtually no resistance to colistin and tigecycline, while a growing resistance toward ciprofloxacin and meropenem was observed. Resistant E. coli and K. pneumoniae were isolated from bloodstream infection (12%). While Gram-positives were MSSA (27.23%), Streptococcus agalactiae (25.36%), MRSA (16.10%) and CoNS (12.1 %), they were almost universally susceptible to daptomycin and linezolid with low resistance (8~20%) to clindamycin. Approximately, 50% of Staphylococci (MRSA and CoNS) required vancomycin treatment. Conclusion: Study findings should guide targeted stewardship interventions to optimize antibiotic prescriptions. Empirical treatment options should be revised, drug-bug match therapy instituted promptly and newer agents considered. Prescribing restriction of formulary antimicrobials that still retain their activity towards bugslike colistin, linezolid and tigecycline-is a mandatory action. Review empiric use of ciprofloxacin and meropenem to counteract growing resistance.

BackgroundSurveillance and characterization of bacterial isolates are the preliminary approaches to optimize the use of antibiotics and guide both clinical and institutional decisions surrounding the perspicacious use of antibiotics. We sought to describe the local prevalence of bacterial resistance to direct our stewardship interventions.MethodsResearchApproval was obtained from Ministry of Health, Sultanate of Oman. We surveyed all bacterial isolates collected by microbiology laboratory of Sohar Hospital (450-bed tertiary care facility serving patients of northern Oman) between January 1, 2016 to December 31, 2017. Acquired data included; patient demographics, requesting ward, relevant dates (admission, discharge, sample request and collection, result release), specimen type, isolate identification, and sensitivity. Samples from the same patient collected within less than a week with identical phenotype were excluded.ResultsIsolates (n = 15,733) were Gram-positive 29%, Gram-negative 67%, Candida species 23%, other fungi 0.3%, mycobacteria 0.4%. Of Gram-positive group, Staphylococcus aureus (MSSA 27% and MRSA16%), S. agalactiae 25%, coagulase negative staphylococci 12% and others (18 organisms) 19%. Vancomycin was active against 99% of tested isolates. Of Gram-negative group, E. coli 32%, P. aeruginosa 22%, K. pneumoniae 19%, A. baumannii 5%, P. mirabilis 4%, and others (57 organisms) 13%. Extended spectrum β-lactamase production was detected in 12% of cases, while phenotypic colorimetric testing revealed 4% carbapenemase production. Critical care units accommodated 70% of cases with carbapenem resistance infections consisting of 43% pneumonia, 27% blood stream infections, and 12% urinary tract infections.ConclusionVancomycin resistance is limited, cefazolin, and other β-lactams are appropriate empirical agents for a wide range of cases, adequate vancomycin dosing and monitoring should be emphasized to hinder resistance development. Increasing number of carbapenem-resistant cases are being encountered, necessitating consideration of early detection and treatment, appropriate alternative agents and combinations, in addition to a multi-disciplinary approach to treat these recalcitrant infections.Disclosures All authors: No reported disclosures.