The Increasing Burden of Antimicrobial Resistance in the Who Eastern Mediterranean Region: Can We Reduce Emergence and Spread to Revert the Trend?

Abstract

The rapid rise in antimicrobial resistance (AMR) is a global crisis that threatens major health gains made since antibiotics were discovered and will significantly delay progress towards sustainable development goals. To better guide the regional response to AMR, we described the burden and trends of AMR in the Eastern Mediterranean region, assessed the challenges to address and identified opportunities for control.We analyzed data reported from countries in the region to the global antimicrobial resistance surveillance system on bloodstream infections (BSIs) caused by resistant pathogens from 2017-2019; data from seven nationally representative prevalence surveys on antimicrobial prescriptions among hospitalized patients, and two regional surveys to assess the capacities of the national infection prevention and control (IPC) and antimicrobial stewardship (AMS) programmes.Among 14 reporting countries in 2019, the median proportion of BSIs caused by resistant pathogens was highest for carbapenem resistant Acinetobacter spp (CRAsp) at 70.3% (IQR 62.4%-80.8%), and lowest for carbapenem resistant E.coli (CREC) at 4.6% (IQR 1.8%-18.2%). There was an increasing trend in the median proportion of BSIs caused by CRAsp from 71.4% in 2017 to 74.5% in 2019, from 55.3% in 2017 to 65.4% in 2019 for K. pneumoniae resistant to third generation cephalosporins (3GC), from 36.6% in 2017 to 45.8%.2% in 2019 for Methicillin- resistant staph aureus (MRSA), and from 24.2% in 2017 to 37.5% in 2019 for carbapenem resistant K. pneumoniae (CRKP). A smaller increase was noticed for E.coli resistant to 3GC from 58% in 2017 to 59.5% in 2019, and CREC from 6.1% in 2017 to 7.1% in 2019. Ten of 20 (50%) countries had a prescription only sale policy for antibiotics and 13 of 22 countries (60%) had a national IPC programme structure. The burden of resistant pathogens causing BSIs is dangerously high and increasing in the region. However, few countries have capacities of AMS and IPC programmes to prevent emergence and spread. Enhanced surveillance, IPC and AMS are more critical than ever to slow down the deadly spread of AMR that threatens health security in the region. Political commitment, leadership, and high-level coordination are urgently needed to combat AMR. Funding Information: 1. BMG funds (Bundesministerium fuer Gesundheit) Federal Ministry of Health in Germany 2. US CDC 3. Korea International Cooperation Agency 4. Robert Koch Institute, Germany Declaration of Interests: None declared. Ethics Approval Statement: The data reported in this article was reported to WHO by national surveillance systems that comply to their national requirements in terms of ethical clearance. Countries shared anonymous aggregated data without identifiers collected through routine surveillance and provided formal approval to WHO to utilize the reported data.