title: A reflection on bacterial resistance to antimicrobial agents at a major tertiary care center in Lebanon over a decade.
abstract: BACKGROUND
  Antimicrobial resistance has been inflecting deleterious health and economic consequences locally and globally. This study addresses the patterns and trends of bacterial resistance to antimicrobial agents over a decade, at a major tertiary care center in Beirut.
  
  
  METHODS
  Data on bacterial susceptibility patterns at the CAP accredited Clinical Microbiology Laboratory is analyzed from January 2000 to November 2011, along with related different studies conducted during this period.
  
  
  RESULTS
  Increasing rates of ESBL-producing isolates were noted for Escherichia coli, Klebsiella pneumoniae, Salmonella spp. and Shigella spp. Resistance to carbapenems remains problematic in Acinetobacter spp, and Pseudomonas aeruginosa, and started emerging in E. coli and K. pneumoniae. Tigecycline and colistin maintained excellent activity against most ESBL and carbapenem resistant bacteria relevant to the treatment by these agents. Resistance to quinolones is being encountered in Streptococcus pneumoniae, Haemophilus influenzae, Salmonella spp. and Shigella spp. Methicillin resistant Staphylococcus aureus (MRSA), though remaining relatively high, showed decreasing trends of resistance, while vancomycin maintain uniform activity. Rare and sporadic vancomycin resistant strains in enterococci are encountered. Macrolide and clindamycin increasing rates of resistance is noted in S. pneumoniae, group A streptococci, S. aureus, viridans streptococci and some others.
  
  
  CONCLUSIONS
  Physicians should be aware of the local epidemiology of antimicrobial resistance to properly guide the initial therapy. These resistance problems can be attributed to uncontrolled use of antimicrobial agents, thus, highlighting the need for antimicrobial stewardship to curb this threat.
authors.affiliation: Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon. garaj@aub.edu.lb
authors.forename: George F
authors.initials: GF
authors.lastname: Araj
authors.forename: Aline Z
authors.initials: AZ
authors.lastname: Avedissian
authors.forename: Nadia S
authors.initials: NS
authors.lastname: Ayyash
authors.forename: Hassan A
authors.initials: HA
authors.lastname: Bey
authors.forename: Rima G
authors.initials: RG
authors.lastname: El Asmar
authors.forename: Rania Z
authors.initials: RZ
authors.lastname: Hammoud
authors.forename: Lina Y
authors.initials: LY
authors.lastname: Itani
authors.forename: Maguy R
authors.initials: MR
authors.lastname: Malak
authors.forename: Sohair A
authors.initials: SA
authors.lastname: Sabai
mesh_terms: D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects*; D006801:Humans; D007709:Klebsiella / Q000187:drug effects*; D007861:Lebanon; D013210:Staphylococcus / Q000187:drug effects*; D013291:Streptococcus / Q000187:drug effects*; D062606:Tertiary Care Centers; D013997:Time Factors