title: Results from the Survey of Antibiotic Resistance (SOAR) 2011-13 in the Gulf States.
abstract: OBJECTIVE
  To provide surveillance data on the susceptibility of community-acquired respiratory tract isolates from four Gulf and Near East countries from 2011 to 2013.
  
  
  METHODS
  MICs were determined using Etests(®) for all antibiotics evaluated except erythromycin, where testing was by disc diffusion. Susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints.
  
  
  RESULTS
  Seven hundred and twenty-six respiratory isolates comprising 265 isolates of Streptococcus pneumoniae, 125 isolates of Streptococcus pyogenes and 336 isolates of Haemophilus influenzae were collected from Bahrain, Lebanon, Oman and the United Arab Emirates (UAE). Among S. pneumoniae, susceptibility to penicillin was low in the UAE and Bahrain. Macrolide susceptibility was ∼45%-60% in the UAE and Oman but higher in Lebanon (73.7%) and Bahrain (84%-85%). Penicillin susceptibility using CLSI intravenous breakpoints was >85% in all countries. Antibiotic susceptibility of S. pneumoniae was lower in UAE and Oman. Among S. pyogenes isolates, resistance to erythromycin was highest in Oman (31.6%) but <20% in the other countries. In H. influenzae, susceptibility to most antibiotics was high, except for ampicillin in Lebanon (70.2%) and amoxicillin in Oman (95.4%). Lebanon also had a high percentage (14.9%) of β-lactamase-positive isolates with non-susceptibility to ampicillin. Amoxicillin/clavulanic acid susceptibility was >95% in all countries. Use of EUCAST versus CLSI breakpoints demonstrated profound differences for cefaclor and cefuroxime in S. pneumoniae and H. influenzae, with EUCAST showing lower susceptibility.
  
  
  CONCLUSIONS
  There was considerable variability in susceptibility among countries in the same region. Thus, continued surveillance is necessary to track future changes in antibiotic resistance.
authors.affiliation: Salmaniya Medical Complex, P.O. Box 12, Manama, Bahrain.
authors.forename: A
authors.initials: A
authors.lastname: Jamsheer
authors.affiliation: Sultan Qaboos University Hospital, P.O. Box 38, Post code 123, Muscat, Oman.
authors.forename: A M
authors.initials: AM
authors.lastname: Rafay
authors.affiliation: University of Balamand, Faculty of Medicine and Medical Sciences, Clinical Microbiology, Department of Biomedical Sciences, P.O. Box 100, Tripoli, Lebanon.
authors.forename: Z
authors.initials: Z
authors.lastname: Daoud
authors.affiliation: IHMA Europe Sàrl, 9A route de la Corniche, Epalinges 1066, Switzerland.
authors.forename: I
authors.initials: I
authors.lastname: Morrissey
authors.affiliation: GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK didem.x.torumkuney@gsk.com.
authors.forename: D
authors.initials: D
authors.lastname: Torumkuney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D062665:Epidemiological Monitoring; D005260:Female; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D013297:Streptococcus pyogenes / Q000187:drug effects* / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents