Employment of Mapping Technology in Antimicrobial Resistance Reporting in Saudi Arabia

Abstract

Although Antimicrobial Resistance (AMR) is a worldwide threat, local AMR databases do not exist. Unlike other health disasters, developing containment strategies for AMR cannot be started without a representative, local, updated AMR data. However, Geographical Information Systems (GIS) mapping technology is capable of visualizing AMR data integrated with geographical regions. Due to the absence of AMR databases in Saudi Arabia, we searched Medline and Embase databases from inception until May 28, 2018, including literature that reported AMR data on the most prevalent gram-negative bacterial strains in Saudi Arabia. These data were extracted into Microsoft Excel file and inserted into STATA software, version 13 and ArcMap 10.6 software platform for mapping. We found particularly high levels of AMR in Makkah (Mecca), possibly due to high antibiotic consumption because of the influx of pilgrims, with Pseudomonas aeruginosa isolates showing the highest resistance rate against amikacin, aztreonam, cefepime, ceftazidime, ciprolfloxacin, gentamicin, imipenem, meropenem and pipracillin/tazobactam, and Enterobacteriaceae isolates against cefuroxime, ciprofloxacin, ampicillin, imipenem and ertapenem. The cause is, however, multifactorial since Acinetobacter baumannii isolates showed a variable resistance rate throughout the country. The employment of mapping technology in displaying AMR data extracted from published literature is a practically useful approach, and advanced GIS analyses should help stakeholders create containment strategies and allocate resources to slow down the emergence of AMR.

Trimethoprim-Sulfamethoxazole (Bactrim) Dose Optimization in Pneumocystis jirovecii Pneumonia (PCP) Management: A Systematic Review

“…However, Ohmura and his colleagues reported that a low-dose treatment regimen of TMP-SMX with <10 mg/kg/day for TMP was as well-tolerated and effective as high-dose therapy [ 26 ]. Similarly, Schild et al reported that the patients received an intermediate-dose TMP-SMX (TMP 10–15 mg/kg/day) but later on, 23% of patients switched to low-dose TMP-SMX due to various AEs and this regimen was deemed to be safe and effective in patients with various immune dysfunctions [ 12 ].…”

“…Although highly recommended by the healthcare community, prophylactic drugs are included in the crucial immunosuppressive regimen, resulting in considerable economic burden for the immunocompromised patients [ 38 ]. Routine PCP prophylaxis is recommended for patients treated in hospitals where the prevalence of PCP is at least 3% to 5% among immunocompromised patients [ 12 , 39 , 40 ]. Moreover, the risk of PCP among transplant recipients is greater in 1–6 month post-transplantation period, during prolonged neutropenia, or in patients receiving steroids, antilymphocyte antibodies, or calcineurin inhibitors [ 41 ].…”

“…As with other antibiotics, TMP-SMX must be administered in an appropriate way to achieve adequate antimicrobial activity while reducing concentration-dependent toxicities, necessitating the avoidance of excessive dosage [ 11 ]. Specifically, in the era of antimicrobial resistance, optimal antibiotics usage is very crucial to ensure effectiveness of therapy [ 12 ]. The TMP-SMX dosing recommendations, on the basis of TMP component, is 320–640 mg/day, administered every 12 h, orally, to treat bacterial infections, and 15–20 mg/kg every 6 to 8 h intravenously then orally for the treatment of PCP infections [ 7 ].…”

Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic

“…The Hajj presents substantial logistic challenges for the protection of both non-residents and residents of KSA as well as the maintenance of local, national and international health security [ 17 , 30 ]. Infectious diseases including Zika virus diseases, extensive drug-resistant tuberculosis, (XDR TB), Middle East Respiratory Syndrome (MERS), seasonal influenza and severe acute respiratory syndrome coronavirus (SARS-CoV) have all surfaced in recent decades [ 31 , 32 , 33 , 34 , 35 ]. New policies by Saudi Ministry of Health have been implemented to try and reduce the transmission of infectious diseases during the Hajj.…”

Pharmacokinetics of meropenem in critically ill patients in Saudi Arabia

“…Optimizing the dosing of antibiotics is crucially important due to the increasing rate of drug resistance, limited number of new antibiotics and high mortality associated with hospital-acquired infections especially with gram-negative bacteria ( Abdul-Aziz et al, 2020a , Abdul-Aziz et al, 2020b ). Several studies in Saudi Arabia have reported over the last 20 years an increased prevalence of multi-drug resistant gram-negative bacteria especially carbapenem-resistant gram-negative bacteria ( Al Johani et al, 2010 , Balkhy et al, 2012 , Yezli et al, 2014 , Al-Obeid et al, 2015 , Elabd et al, 2015 , Zowawi et al, 2015 , Zowawi, 2016 , Zowawi et al, 2018 , Alotaibi, 2019 , Alhifany et al, 2020 , Nasser et al, 2020 ). For example, the susceptibility of Acinetobacter baumannii to meropenem decreased from ∼70% in 2006 to ∼10% in 2012 ( Al-Obeid et al, 2015 ) .…”