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.
Highlights
Before the discovery of penicillin by Alexander Fleming in 1928, infectious diseases accounted for high morbidity and mortality worldwide [1]
Among E. coli and ESKAPE pathogens, this review is mainly focused on E. coli, K. pneumoniae, P. aeruginosa and A. baumannii, as the resistance data against these pathogens is highly variable worldwide and is gathering massive attention owing to the challenges, severity of infections and treatment threats posed by these pathogens
Increasing incidence of antibiotic resistance has been reported in various countries around the world, in the Arab region
Summary
Before the discovery of penicillin by Alexander Fleming in 1928, infectious diseases accounted for high morbidity and mortality worldwide [1]. Β-lactams, aminoglycosides and quinolines were discovered and predominantly used in treatment of infections caused by staphylococci and streptococci Among these three classes of antibiotics, β-lactams were the mainstay of therapy owing to their well-established clinical safety and efficacy. Limited therapeutic options were available for the treatment of these nosocomial infections, compelling clinicians to use available therapeutic options with compromised Gram-negative efficacy. This was the era of selection and dissemination of various β-lactamases including inhibitor resistant β-lactamases in etiologically prevalent organisms such as E. coli, K. pneumoniae and Enterobacter
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