Landscape of Multidrug-Resistant Gram-Negative Infections in Egypt: Survey and Literature Review

• Published in: Infection and drug resistance 2021-01, Vol.14, p.1905-1920
• Main Authors: El-Kholy, Amani, El-Mahallawy, Hadir A, Elsharnouby, Noha, Abdel Aziz, Mohamed, Helmy, Ahmed Mohamed, Kotb, Ramy
• Format: Article
• Language: English
• Subjects: Antibacterial agents; Antibiotics; Antimicrobial agents; Antimicrobial resistance; Bacteria; Bacterial pneumonia; Beta lactamases; Chronic diseases; Chronic illnesses; Decision making; Drug resistance; Drug resistance in microorganisms; E coli; egypt; Enterobacteriaceae; Enzymes; Epidemiology; Gram-negative bacteria; Health aspects; hospital-acquired pneumonia; Hospitals; Infectious diseases; intra-abdominal infections; Laboratories; Literature reviews; Multidrug resistance; Multidrug resistant organisms; Nosocomial infections; Original Research; Pathogens; Physicians; Pneumonia; Questionnaires; Risk factors; Surveillance; Surveys; Urinary tract infections; β Lactamase
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S298920

This article is the first to review published reports on the prevalence of multidrug-resistant (MDR) gram-negative infections in Egypt and gain insights into antimicrobial resistance (AMR) surveillance and susceptibility testing capabilities of Egyptian medical centers. A literature review and online survey were conducted. The online survey and literature review reported high prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (19-85.24% of , and 10-87% of ), carbapenem-resistant Enterobacteriaceae (35-100% of and 13.8-100% of ), carbapenem-resistant (10-100%), and carbapenem-resistant (15-70%) in Egypt. Risk factors for MDR Gram-negative infections were ventilated patients (67.4%), prolonged hospitalization (53.5%) and chronic disease (34.9%). Although antimicrobial surveillance capabilities were deemed at least moderate in most centers, lack of access to rapid AMR diagnostics, lack of use of local epidemiological data in treatment decision-making, lack of antimicrobial stewardship (AMS) programs, and lack of risk prediction tools were commonly reported by respondents. This survey has highlighted the presence of knowledge gaps as well as limitations in the surveillance and monitoring capabilities of AMR in Egypt, with most laboratories lacking rapid diagnostics and molecular testing. Future efforts in Egypt should focus on tackling these issues via nationwide initiatives, including understanding the AMR trends in the country, capacity building of laboratories and their staff to correctly and timely identify AMR, and introducing newer antimicrobials for targeting emerging resistance mechanisms in Gram-negative species.