Abstract
Background
 To study resistance rates of multidrug-resistant bacteria (MDR) for new Cephalosporines before their widespread use in Jordan.
 Methods
 During September 2019 - May 2020, MDR-bacteria were prospectively collected from microbiology laboratories of three hospitals, susceptibility of the extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL), K. pneumoniae-carbapenemases strains (KPC), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant P. aeruginosa (CRPa), carbapenem-resistant A. baumannii (CRAb), and Methicillin-resistant Staphylococcus aureus (MRSA) were tested. Demographic details for patients were identified. Antimicrobials evaluated were ceftazidime-avibactam, ceftolozane-tazobactam, and ceftobiprole medocaril.
 Results
 Non-duplicate 263 MDR clinical isolates were collected from sterile sites; ESBL (128), P. aeruginosa (57), MRSA (37), KPC (22), A. baumannii (11), and CRE (n = 8). The age was dominated by the older age group (Age > 64, Pearson R = 0.985, R2 = 0.969, P = 0.000). Males were 143 and females 107 (P < 0.000). There were (194) isolate from the wards and (55) were from the ICUs. Sources were urine (96), blood (36), soft tissues (49), abdomen (24), URT (14), and osteo-skeletal (12). Clinical diagnoses were: UTI (90). Bacteremia (36), SSTI (45), IAI (23), pneumonia (17), URTI (13), osteomyelitis (11), and diabetic foot (6). The susceptibility of the ESBL-producing bacteria was 100% for meropenem, 99% for ceftazidime-avibactam, and 90% for ceftolozane/tazobactam. P. aeruginosa was, 73% for ceftazidime-avibactam, 62% susceptible to ceftolozane/tazobactam, 62% for meropenem, and 45% to ceftobiprole. CRE was 38% susceptible to ceftazidime-avibactam and KPC 15%, while ceftolozane-tazobactam susceptibility was zero, and 14% for CRE, and 0% for Ceftobiprole Medocaril. A. baumannii was 13% susceptible to ceftazidime-avibactam, meropenem 9%, and 2% for ceftolozane/tazobactam
 Conclusion
 Ceftazidime-avibactam and ceftolozane/tazobactam may be useful alternatives for the treatment of ESBL-producers and P. aeruginosa, though the MDR-bacteria demonstrated some resistance to the newly introduced agents before their widespread use in the country.
Highlights
Our region is plagued with multidrug-resistant bacteria (MDR), especially those carrying the acronym “ESKAPE pathogens” including Enterobacter spp., Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterococci spp., they comprise the largest burden of the hospitalrelated infections [1]
Non-duplicate 263 MDR clinical isolates were collected from sterile sites; ESBL (128), P. aeruginosa (57), Methicillin-resistant Staphylococcus aureus (MRSA) (37), K. pneumoniaecarbapenemases strains (KPC) (22), A. baumannii (11), and carbapenem-resistant Enterobacteriaceae (CRE) (n = 8)
Collection of data The study has evaluated the susceptibility of the MDR bacteria isolates including the extended-spectrum β-lactamases producing Enterobacteriaceae (ESBL), K. pneumoniae carbapenemases (KPC), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant P. aeruginosa (CRPa), and carbapenem-resistant A. baumannii (CRAb) to the relatively new antimicrobials: ceftazidime-avibactam (CAZAVI), ceftolozane-tazobactam, and ceftobiprole in Jordan
Summary
Our region is plagued with multidrug-resistant bacteria (MDR), especially those carrying the acronym “ESKAPE pathogens” including Enterobacter spp., Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterococci spp., they comprise the largest burden of the hospitalrelated infections [1]. Another study demonstrated from the same hospital showed high occurrence of MDR P. aeruginosa isolates carrying blaCTX-M genes, but no specific associations were found between antibiotic resistance, virulence genes and genotypes among the isolates [7, 8]. Other Studies from Jordan evaluating the resistance pattern of the nosocomial Acinetobater baummannii infections demonstrated high resistant rates (> 94%) for the third and fourth generations cephalosporines, pipracillin-tazobactam, carbapenems and quinolones, reliable antimicrobials pointed at minocycline and colistin.
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