Retrospective Analysis on Antimicrobial Resistance Trends and Prevalence of β-lactamases in Escherichia coli and ESKAPE Pathogens Isolated from Arabian Patients during 2000–2020

Abstract

The production of diverse and extended spectrum β-lactamases among Escherichia coli and ESKAPE pathogens is a growing threat to clinicians and public health. We aim to provide a comprehensive analysis of evolving trends of antimicrobial resistance and β-lactamases among E. coli and ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acine to bacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) in the Arabian region. A systematic review was conducted in Medline PubMed on papers published between January 2000 and February 2020 on countries in the Arab region showing different antibiotic resistance among E. coli and ESKAPE pathogens. A total of n = 119,144 clinical isolates were evaluated for antimicrobial resistance in 19 Arab countries. Among these clinical isolates, 74,039 belonged to E. coli and ESKAPE pathogen. Distribution of antibiotic resistance among E. coli and ESKAPE pathogens indicated that E. coli (n = 32,038) was the predominant pathogen followed by K. pneumoniae (n = 17,128), P. aeruginosa (n = 11,074), methicillin-resistant S. aureus (MRSA, n = 4370), A. baumannii (n = 3485) and Enterobacter spp. (n = 1574). There were no reports demonstrating Enterococcus faecium producing β-lactamase. Analyses revealed 19 out of 22 countries reported occurrence of ESBL (Extended-Spectrum β-Lactamase) producing E. coli and ESKAPE pathogens. The present study showed significantly increased resistance rates to various antimicrobial agents over the last 20 years; for instance, cephalosporin resistance increased from 37 to 89.5%, fluoroquinolones from 46.8 to 70.3%, aminoglycosides from 40.2 to 64.4%, mono-bactams from 30.6 to 73.6% and carbapenems from 30.5 to 64.4%. An average of 36.9% of the total isolates were reported to have ESBL phenotype during 2000 to 2020. Molecular analyses showed that among ESBLs and Class A and Class D β-lactamases, blaCTX-M and blaOXA have higher prevalence rates of 57% and 52.7%, respectively. Among Class B β-lactamases, few incidences of blaVIM 27.7% and blaNDM 26.3% were encountered in the Arab region. Conclusion: This review highlights a significant increase in resistance to various classes of antibiotics, including cephalosporins, β-lactam and β-lactamase inhibitor combinations, carbapenems, aminoglycosides and quinolones among E. coli and ESKAPE pathogens in the Arab region.

Antibiotic Resistance Pattern of Acinetobacter baumannii Strains

“…[ 21 22 ] In addition, previous studies from Oman have indicated high level increase in resistance to piperacillin-tazobactam in the past 20 years, while relatively lower resistance was reported against aminoglycosides (gentamicin and amikacin) and quinolones. [ 23 ] However, resistance rate of A. baumannii to aminoglycosides, quinolones, and trimethoprim-sulfamethoxazole was also significantly high in our study. This is congruent with previous studies conducted worldwide.…”

Prevalence of Antibiotic Resistance Over Time in a Third-Level University Hospital

“…In contrast, many recent studies have shown an increase in AMR, particularly for Gram-negative bacteria. 22 , 23 Since this work aimed to further explore the possible impact of interventions on controlling the spread of MDR bacteria at our setting, as an update of a previous study, 13 the continuing decrease over time in the relative prevalence of MDR bacteria suggests that greater attention to the AMR issue has a positive impact. Consistently, the antibiotic consumption at our institute was lower than that at other hospitals in the Calabria Region, especially for ceftriaxone, meropenem, and piperacillin/tazobactam, 12 even if the effect of reduction in antimicrobial consumption on AMR has been demonstrated to be inconsistent for all drugs and limited in time.…”

Animal Models in the Evaluation of the Effectiveness of Phage Therapy for Infections Caused by Gram-Negative Bacteria from the ESKAPE Group and the Reliability of Its Use in Humans

“…The acronym ESKAPE refers precisely to the "escape" of these bacteria from the action of antibiotics [4]. Infections with these bacteria are especially common in hospitalized and/or immunocompromised patients and in those with intestinal flora dysbiosis [7,8] and pose a serious threat to the life and health of these patients.…”