A Multi-Point Surveillance for Antimicrobial Resistance Profiles among Clinical Isolates of Gram-Negative Bacteria Recovered from Major Ha’il Hospitals, Saudi Arabia

Abstract

The devastating nosocomial resistance is an on-going global concern. Surveillance of resistance is crucial for efficient patient care. This study was aimed to conduct a surveillance in four major Ha’il Hospitals from September to December 2020. Using a multipoint program, records of 621 non-duplicate Gram-negative cultures were tested across 21 drugs belonging to different categories. Major species were Klebsiella pneumoniae (n = 187, 30%), E. coli (n = 151, 24.5%), Pseudomonas aeruginosa, (n = 84, 13.6%), Acinetobacter baumannii (n = 82, 13.3%), and Proteus mirabilis (n = 46, 7%). Based on recent resistance classifications, A. baumanni, P. aeruginosa, and enteric bacteria were defined as pan-resistant, extremely resistant, and multi-drug resistant, respectively. A. baumannii (35%) and K. pneumoniae (23%) dominated among coinfections in SARS-CoV2 patients. The “other Gram-negative bacteria” (n = 77, 12.5%) from diverse sources showed unique species-specific resistance patterns, while sharing a common Gram-negative resistance profile. Among these, Providencia stuartii was reported for the first time in Ha’il. In addition, specimen source, age, and gender differences played significant roles in susceptibility. Overall infection rates were 30% in ICU, 17.5% in medical wards, and 13.5% in COVID-19 zones, mostly in male (59%) senior (54%) patients. In ICU, infections were caused by P. mirabilis (52%), A. baumannii (49%), P. aeruginosa (41%), K. pneumoniae (24%), and E. coli (21%), and most of the respiratory infections were caused by carbapenem-resistant A. baumannii and K. pneumoniae and UTI by K. pneumoniae and E. coli. While impressive IC, hospital performances, and alternative treatment options still exist, the spread of resistant Gram-negative bacteria is concerning especially in geriatric patients. The high selective SARS-CoV2 coinfection by A. baumannii and K. pneumoniae, unlike the low global rates, warrants further vertical studies. Attributes of resistances are multifactorial in Saudi Arabia because of its global partnership as the largest economic and pilgrimage hub with close social and cultural ties in the region, especially during conflicts and political unrests. However, introduction of advanced inter-laboratory networks for genome-based surveillances is expected to reduce nosocomial resistances.

Bacterial Coinfection and Antibiotic Resistance Profiles among Hospitalised COVID-19 Patients

“…Strains isolated from sputum samples from ICU patients were sensitive to colistin. This observation is in line with a previous study conducted in the same region (Hail), which reported resistance of A. baumannii from COVID-19 and non-COVID-19 individuals to all antibiotics except colistin (5% resistance rate) and ertapenem [ 50 ]. Another study showed that A. baumannii isolated from endotracheal aspirate samples of nineteen COVID-19 patients was resistant to all tested antibiotics, except colistin with a resistance rate of 52% [ 36 ].…”

What Doesn’t Kill Them Makes Them Stronger: The Impact of the Resistance Patterns of Urinary Enterobacterales Isolates in Patients from a Tertiary Hospital in Eastern Europe

“…Our results are more dramatic than those reported in most of the studies [35][36][37][38], even though we have found some others with higher resistance rates [19,24,39]. For example, Kot et al identified all E. coli and P. mirabilis isolates as susceptible to carbapenems (vs. 99.1% and 91.1%, respectively, in our study), and an 84.4% susceptibility for K. pneumoniae isolates (vs. 68.4% sensitivity to ertapenem in ours) [17].…”

Antimicrobial and Anti-Inflammatory Activities of MAF-1-Derived Antimicrobial Peptide Mt6 and Its D-Enantiomer D-Mt6 against Acinetobacter baumannii by Targeting Cell Membranes and Lipopolysaccharide Interaction

“…To enhance the cationicity of MAF-1A, the analog Mt6 was designed and synthesized with the positively charged alkaline amino acid Lys substituted for the acidic amino acids Glu ( 5 , 12 , 19 , 24 ) and Asp ( 8 ). These substitutions increased the net charge of Mt6 from +2 (MAF-1A) to +9.…”

“… Acinetobacter baumannii is one of the multidrug-resistant pathogens that causes hospital-acquired infections. Numerous clinical studies are slowly revealing that it is difficult to cure A. baumannii infections due to its serious drug resistance and the side effects of anti- A. baumannii drugs ( 7 – 11 ). As a result, the World Health Organization has designated it as a top priority for novel antibiotic development ( 12 ).…”