Prevalence of Carbapenem-Resistant Enterobacteriaceae in Western Saudi Arabia and Increasing Trends in the Antimicrobial Resistance of Enterobacteriaceae

Taha, Rbab; Mowallad, Abdulfattah; Mufti, Areej; Althaqafi, Abdulhakeem; Fatani, Asif A; El-Hossary, Dalia; Ossenkopp, John; AlhajHussein, Baraa; Kaaki, M; Jawi, Noha; Hassanien, Ashraf; Alsaedi, Asim

doi:10.7759/cureus.35050

Cited by 4 publications

(11 citation statements)

References 29 publications

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“…There was a notable increase in resistance rates for imipenem, escalating from 18.18% to 67.74%, and for meropenem, escalating from 18.18% to 64.51% [ 41 ]. Another local study in Jeddah showed an increase in resistance among Enterobacteriaceae from 8% to 13% [ 42 ]. In contrast to previous studies, a Romanian study highlighted a stable sensitivity to carbapenems among E. coli , K. pneumoniae , and P. aeruginosa over the observation period of 2018–2022 [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Decline in ESBL Production and Carbapenem Resistance in Urinary Tract Infections among Key Bacterial Species during the COVID-19 Pandemic

Altamimi,

Binkhamis,

Alhumimidi

et al. 2024

Antibiotics

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The COVID-19 pandemic has led to significant changes in healthcare practices, including increased antibiotic usage. This study aimed to investigate the impact of the pandemic on the prevalence of extended-spectrum β-lactamase (ESBL) production and carbapenem resistance among key bacterial species causing urinary tract infections (UTIs). Conducted at King Fahad Medical City in Riyadh from January 2018 to December 2022, the study analyzed urine samples from 9697 UTI patients. Patients were categorized into ‘pre-COVID-19’ and ‘during COVID-19’ groups. Bacterial isolates were identified, and antimicrobial susceptibility testing was performed following guidelines. ESBL production was detected using the Double-Disc Synergy Test. Escherichia coli and Klebsiella pneumoniae were the main pathogens. During the pandemic, ESBL production decreased in E. coli by 1.9% and in K. pneumoniae by 6.0%. Carbapenem resistance also declined, with E. coli displaying a 1.2% reduction and K. pneumoniae and Pseudomonas aeruginosa displaying 10.7% and 7.9% reductions, respectively. Notably, logistic regression analysis revealed that the odds of ESBL presence were 10% lower during the COVID-19 pandemic (OR 0.91; 95% CI 0.83–0.99; p = 0.040), and there was a significant reduction in the odds of carbapenem resistance (OR 0.43; 95% CI 0.37–0.51; p < 0.001). This study reveals a significant decrease in ESBL production and carbapenem resistance among UTI pathogens during the COVID-19 pandemic, hinting at the impact of modified antibiotic and healthcare approaches. It emphasizes the need for persistent antimicrobial resistance surveillance and policy adaptation to address resistance challenges, offering key directions for future public health actions.

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Section: Discussionmentioning

confidence: 99%

Decline in ESBL Production and Carbapenem Resistance in Urinary Tract Infections among Key Bacterial Species during the COVID-19 Pandemic

Altamimi,

Binkhamis,

Alhumimidi

et al. 2024

Antibiotics

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“…. Other bacterial species were also isolated and identified, such as Enterobacter [18,22,30,32,36,39], Proteus spp. [21,24,[28][29][30]36], C. freundii [22,30,37], Citrobacter spp.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Resistance Trends Among Enterobacteriaceae in Saudi Arabia: A Systematic Review

Arafah

2024

Cureus

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Antibiotic resistance is a global public health concern that poses a significant threat to the effective treatment of bacterial infections. Enterobacteriaceae, a family of gram-negative bacteria, are associated with a wide range of infections, including urinary tract infections, bloodstream infections, and respiratory tract infections. This systematic review aimed to examine the antibiotic resistance trend among Enterobacteriaceae in Saudi Arabia in the period between 2003 and 2023. Five databases (PubMed, Medline, Ovid, Scopus, and Cochrane) were searched using the keywords "Resistance AND Enterobacteriaceae AND Saudi Arabia" in the title and abstract. All papers assessing the prevalence of resistance among Enterobacteriaceae in Saudi Arabia were included in the systematic review. Out of 97 papers that were extracted through the database search, 22 articles were considered suitable for the systematic review. The articles included 17027 Enterobacteriaceae isolates, out of which 7592 isolates were identified as resistant bacteria. The studies included various resistant strains, such as Escherichia coli and Klebsiella pneumoniae, that were responsible for various clinical conditions, including urinary tract infections, blood infections, surgical site infections, and pneumonia. In addition, the review highlighted the dynamic nature of antibiotic resistance, with the identification of new resistant bacterial species and the emergence of resistance to newer antibiotic classes over the last decade. Continued surveillance, rational antibiotic use, and the development of alternative treatment options are crucial to address the evolving landscape of antibiotic resistance among Enterobacteriaceae bacteria in the country.

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“…From the literature search, 17 studies were conducted in Saudi Arabia assessing the prevalence of CRE [ 39 , 54 , 55 , 56 , 57 , 59 , 63 , 69 , 70 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ], and two of those evaluated urine samples only [ 55 , 75 ]. One study evaluating Gram-negative isolates from the urine found that 55.7%, 35.8%, and 12.4% of K. pneumoniae , P. mirabilis , and E. coli isolates were potential CREs, respectively.…”

Section: Resistant Gram-negative Pathogensmentioning

confidence: 99%

“…As for CRE phenotypic testing, five studies utilized automated AST systems as the only method [ 39 , 54 , 55 , 73 , 76 ]. Five studies used the E test in addition to automated AST systems [ 69 , 77 , 78 , 79 , 80 ]. Three studies applied the Modified Hodge test (MHT) which is no longer recommended for CRE production testing according to CLSI [ 56 , 59 , 79 ].…”

Section: Resistant Gram-negative Pathogensmentioning

confidence: 99%

“…It is important to note that some studies have shown that the E. test may fail to detect all OXA producers since some OXA isolates show susceptibility or low resistance toward carbapenems [ 80 ]. Ten studies utilized PCR for genotypic testing [ 56 , 59 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ]. In spite of the era of genotypic testing, current assays contain a limited number of genes they can capture, and organisms may exhibit other resistance mechanisms that are not detected with the current susceptibility testing methods.…”

Section: Resistant Gram-negative Pathogensmentioning

confidence: 99%

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An Overview of Antimicrobial Resistance in Saudi Arabia (2013–2023) and the Need for National Surveillance

Thabit,

Alabbasi,

Alnezary

et al. 2023

Microorganisms

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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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Prevalence of Carbapenem-Resistant Enterobacteriaceae in Western Saudi Arabia and Increasing Trends in the Antimicrobial Resistance of Enterobacteriaceae

Cited by 4 publications

References 29 publications

Decline in ESBL Production and Carbapenem Resistance in Urinary Tract Infections among Key Bacterial Species during the COVID-19 Pandemic

Decline in ESBL Production and Carbapenem Resistance in Urinary Tract Infections among Key Bacterial Species during the COVID-19 Pandemic

Antibiotic Resistance Trends Among Enterobacteriaceae in Saudi Arabia: A Systematic Review

An Overview of Antimicrobial Resistance in Saudi Arabia (2013–2023) and the Need for National Surveillance

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