Susceptibility trends and molecular characterization of Gram-negative bacilli associated with urinary tract and intra-abdominal infections in Jordan and Lebanon: SMART 2011-2013.
OBJECTIVE
To investigate phenotypic and genotypic patterns of antimicrobial resistance among Gram-negative bacilli associated with urinary tract infection (UTI) and intra-abdominal infection (IAI) in medical centres of Jordan and Lebanon.


METHODS
Gram-negative bacilli from the SMART study, collected between the years 2011 and 2013, were first identified at local laboratories. These isolates were shipped to a central laboratory where re-identification, susceptibility testing, and molecular characterization were performed using standard methods.


RESULTS
Among the 523 UTI-associated isolates, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis were the most frequent (70%, 14%, and 5%, respectively). E. coli, K. pneumoniae, and Pseudomonas aeruginosa were the most frequent species among the 527 IAI-associated isolates (46%, 14%, and 12%, respectively). Incidence rates of extended-spectrum beta-lactamase (ESBL) producers among UTI-associated E. coli, K. pneumoniae, and P. mirabilis were 43%, 54%, and 4%, respectively. Corresponding rates among IAI-associated isolates were 49%, 56%, and 12%, respectively. Acinetobacter baumannii and P. aeruginosa isolates showed very disturbing low susceptibility patterns. CTX-M-15 was the most prevalent ESBL produced. Seventeen isolates were non-susceptible to carbapenems (estimated prevalence of 1.6%).


CONCLUSIONS
The alarmingly high rates of ESBL production and emergence of carbapenemases emphasize the urgent need to develop antimicrobial stewardship initiatives and to maintain antimicrobial resistance surveillance systems.
Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan. Electronic address: wailh@just.edu.jo.
Wail A
WA
Hayajneh
Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Faculté de Pharmacie, Saint-Joseph University of Beirut, Beirut, Lebanon; Laboratoire Rodolphe Mérieux, Faculté de Pharmacie, Saint-Joseph University of Beirut, Beirut, Lebanon.
Aline
A
Hajj
Microbiology Department, Jordan Hospital, Amman, Jordan.
Fawzi
F
Hulliel
Laboratoire Rodolphe Mérieux, Faculté de Pharmacie, Saint-Joseph University of Beirut, Beirut, Lebanon.
Dolla Karam
DK
Sarkis
Laboratory Medicine and Blood Bank Department, Saint George University Hospital, University of Balamand, Beirut, Lebanon.
Noha
N
Irani-Hakimeh
Levant and Developing Markets, Merck Sharpe and Dohme, Beirut, Lebanon.
Lama
L
Kazan
International Health Management Associates, Inc., Schaumburg, Illinois, USA.
Robert E
RE
Badal
D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005838:Genotype; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology*; D006801:Humans; D059413:Intraabdominal Infections / Q000382:microbiology*; D007597:Jordan; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D007861:Lebanon; D010641:Phenotype; D011513:Proteus mirabilis / Q000187:drug effects / Q000302:isolation & purification; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D014552:Urinary Tract Infections / Q000382:microbiology*
Beta-lactamases; Intra-abdominal infection; Molecular characterization; Resistance; SMART; Urinary tract infection