Introduction: Extended-spectrum – beta lactamases (ESBLs) are increasingly detected globally among Escherichia coli and Klebsiella pneumoniae. The correlation between antibiotics use and resistance, though not fully described, has been addressed and shown in several studies. In this study, the profiles of ESBLs in E. coli and K. pneumoniae isolated from two Lebanese hospitals and their relationship to antibiotic consumption were determined. Methodology: A total of 205 E. coli and 67 K. pneumoniae isolates resistant to third- or fourth-generation cephalosporins were collected between January 2011 and January 2012. Antibiotic susceptibility and consumption data were also collected from 2010–2012. Double-disk synergy and Etest ESBL assays were performed, followed by PCR for ESBL genes. Pulsed-field gel electrophoresis (PFGE) was performed for representative isolates. Statistical analysis for consumption and susceptibility data over 3 years was performed. Results: As expected, CTX-M-15 was predominant. In both hospitals, strains of E. coli and K. pneumoniae harbored at least one ESBL, and in some cases (23%) harboured four different ESBLs. A significant correlation was detected between total use of antimicrobial agents and resistance to various antibiotics. This was obvious for the use of penicillins and resistance to aztreonam, ceftazidime and ciprofloxacin, and use of third- and fourth-generation cephalosporins and resistance to ceftazidime, cefuroxime, cefoxitin and ciprofloxacin in both bacteria. Conclusions: This study shows the predominance of CTX-M-15 among cephalosporin-resistant E. coli and K. pneumoniae in Lebanese hospitals and highlights the direct relationship between the use of antibiotics and the emergence of resistance in bacteria.

Introduction: In the last decade, Acinetobacter species have taken a major public health concern. This is mainly due the increased resistance to a wide range of antibiotics causing treatment challenges. In view of the constant population mobilization and the economic crisis that Lebanon is currently facing, it becomes a necessity to re-evaluate the real threat of Acinetobacter spp and its implication in the one health. Methodology: This review was conducted through the analysis of 45 research papers and reports pertaining to Acinetobacter spp performed in Lebanon. More than 82% of the papers consulted were published in international journals and more than 70 percent of them had received impact factor. Results: An in depth description of the involvement of this organism in human infection and its role as potential pathogen or simple colonizer was performed. In addition, the different aspects of resistance, mostly to carbapenems and colistin was studied and summarized. While in animals and environment, susceptible strains were mostly isolated, OXA-23/OXA-24 were predominant in humans. Recently, NDM-1 producing Acinetobacter spp was detected in a Syrian refugee which then was reported in Lebanese patients. The bacterial identification procedures are non-systematic and not always reliable in the Lebanese studies presenting sometimes discrepancies an inconsistency. Conclusion: Acinetobacter is commonly isolated Lebanon. In view of the spread of resistance among these isolated and their dissemination, Infection control measures attempting to control the spread of this genus in and outside hospitals are lacking and thus require more attention and stewardship activities.

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