Prevalence of antibiotic-resistant organisms among hospitalized patients at a tertiary care center in Lebanon, 2010-2018

Moustafa Moussally; Nada Zahreddine; Jamil Kazma; Rihab Ahmadieh; Souha S Kan; Zeina A Kanafan

doi:10.1016/j.jiph.2020.11.006

Prevalence of antibiotic-resistant organisms among hospitalized patients at a tertiary care center in Lebanon, 2010-2018

J Infect Public Health. 2021 Jan;14(1):12-16. doi: 10.1016/j.jiph.2020.11.006. Epub 2020 Dec 17.

Authors

Moustafa Moussally¹, Nada Zahreddine², Jamil Kazma¹, Rihab Ahmadieh², Souha S Kan³, Zeina A Kanafan⁴

Affiliations

¹ Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
² Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon.
³ Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon.
⁴ Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: zk10@aub.edu.lb.

PMID: 33341479
DOI: 10.1016/j.jiph.2020.11.006

Abstract

Background: Infections due to antibiotic resistant organisms (ARO) among hospitalized patients are associated with increased morbidity, mortality, and healthcare costs. Longitudinal data about antimicrobial resistance are scarce in Lebanon and the region. The objective of this study is to describe the temporal trends of resistance of selected pathogens among hospitalized patients at a tertiary care center in Lebanon.

Methods: We conducted a retrospective review of surveillance data from 2010 until 2018. Six target organisms isolated from hospitalized patients were included: carbapenem-resistant Escherichia coli (CREC), carbapenem-resistant Klebsiella spp. (CRKP), multi-drug resistant Pseudomonas aeruginosa (MDRPA), carbapenem-resistant Acinetobacter baumannii (CRAB), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus spp. (VRE). Correlation analysis was performed to evaluate for temporal trends.

Results: A total of 15,901 isolates were examined, most of which were obtained from urinary specimens. Among Gram-negative organisms, the highest resistance was found among CRAB (81.7%), followed by CRKP (6.5%) and CREC (3.3%). MDRPA overall prevalence was 0.8%. Among Gram-positive organisms, the prevalence of MRSA and VRE was 26.2% and 2.6%, respectively. CREC, MRSA, and VRE showed statistically significant increasing temporal trends, while CRAB decreased significantly from 2013 to 2018.

Conclusion: These data are helpful in characterizing the epidemiology of antimicrobial resistance in Lebanon and show that controlling emerging resistance is achievable with concerted infection control and antimicrobial stewardship efforts. Caution should be exercised to contain early on the spread of CREC and of resistant Gram-positive pathogens.

Keywords: Antimicrobial resistance; Infection control; Infection prevention; Multidrug-Resistant organism; Surveillance.

MeSH terms

Anti-Bacterial Agents* / pharmacology
Anti-Bacterial Agents* / therapeutic use
Drug Resistance, Bacterial
Humans
Lebanon / epidemiology
Methicillin-Resistant Staphylococcus aureus*
Microbial Sensitivity Tests
Prevalence
Retrospective Studies
Tertiary Care Centers

Substances

Anti-Bacterial Agents