Increasing Antimicrobial Resistance in World Health Organization Eastern Mediterranean Region, 2017-2019

Abstract

To better guide the regional response to antimicrobial resistance (AMR), we report the burden of AMR over time in countries in the World Health Organization Eastern Mediterranean Region. To assess the capacities of national infection prevention and control and antimicrobial stewardship programs, we analyzed data on bloodstream infections reported to the Global Antimicrobial Resistance Surveillance System during 2017-2019, data from 7 countries on nationally representative surveys of antimicrobial prescriptions, and data from 2 regional surveys. The median proportion of bloodstream infections was highest for carbapenem-resistant Acinetobacter spp. (70.3%) and lowest for carbapenem-resistant Escherichia coli (4.6%). Results of the regional assessments indicate that few countries have capacities for infection prevention and control and antimicrobial stewardship programs to prevent emergence and spread of AMR. Overall, the magnitude of the problem and the limited capacity to respond emphasize the need for regional political leadership in addressing AMR.

Keywords: AMR; Eastern Mediterranean Region; World Health Organization; antimicrobial drug resistance; antimicrobial resistance; antimicrobial stewardship; bacteria; bloodstream infections; infection prevention and control.

Figure 1

Proportion of patients with bloodstream infections caused by antimicrobial resistant pathogens in 14 World Health Organization Eastern Mediterranean Region countries. Data from the Global Antimicrobial Resistance Surveillance System (https://www.who.int/glass) for 2019. Each dot represents the percentage of patients with resistant organisms in a country. Horizontal lines within boxes indicate medians, box tops and bottoms indicate interquartile ranges (middle 50% of data), and error bars (upper and lower whiskers) represent scores outside the middle 50%. CRAsp, carbapenem-resistant Acinetobacter spp., CREC, carbapenem-resistant Escherichia coli; CRKP, carbapenem-resistant K. pneumoniae; E. coli, Escherichia coli; K. pneumoniae, Klebsiella pneumoniae; MRSA, methicillin-resistant Staphylococcus aureus; 3CG, third-generation cephalosporins.

Figure 2

Proportion of patients with bloodstream infections caused by antimicrobial resistant pathogens in 11–14 World Health Organization Eastern Mediterranean Region countries. Data from the Global Antimicrobial Resistance Surveillance System (https://www.who.int/glass) for 2017–2019. CRAsp, carbapenem-resistant Acinetobacter spp.; CREC, carbapenem-resistant Escherichia coli; CRKP, carbapenem-resistant K. pneumoniae; E. coli, Escherichia coli; K. pneumoniae, Klebsiella pneumoniae; MRSA, methicillin-resistant Staphylococcus aureus; 3CG, third-generation cephalosporins.

Figure 3

Proportion of patients with bloodstream infections caused by antimicrobial resistant pathogens in World Health Organization Eastern Mediterranean Region countries. Data from the Global Antimicrobial Resistance Surveillance System (https://www.who.int/glass) for 2019. A) Caused by 3GC-resistant Escherichia coli, 14 countries. B) Caused by K. pneumoniae resistant to 3GC, 12 countries. C) Caused by carbapenem-resistant E. coli, 14 countries. D) Caused by carbapenem-resistant Klebsiella pneumoniae, 13 countries. E) Caused by carbapenem-resistant Acinetobacter spp., 12 countries. F) Caused by methicillin-resistant Staphylococcus aureus, 12 countries.