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Review
. 2023 May;12(5):1217-1235.
doi: 10.1007/s40121-023-00799-w. Epub 2023 Apr 18.

A Narrative Review of Healthcare-Associated Gram-Negative Infections Among Pediatric Patients in Middle Eastern Countries

Mona Al Dabbagh  1   2   3 , Mohammad Alghounaim  4 , Rana H Almaghrabi  5 , Ghassan Dbaibo  6 , Ghassan Ghatasheh  7 , Hanan M Ibrahim  8 , Mohamed Abdel Aziz  9 , Ashraf Hassanien  10 , Naglaa Mohamed  11
Affiliations
Review

A Narrative Review of Healthcare-Associated Gram-Negative Infections Among Pediatric Patients in Middle Eastern Countries

Mona Al Dabbagh et al. Infect Dis Ther. 2023 May.

Abstract

Introduction: Gram-negative bacteria (GNB) have become prominent across healthcare and community settings due to factors including lack of effective infection control and prevention (ICP) and antimicrobial stewardship programs (ASPs), GNB developing antimicrobial resistance (AMR), and difficulty treating infections. This review summarizes available literature on healthcare-associated infections (HAIs) in Middle Eastern pediatric patients.

Methods: Literature searches were performed with PubMed and Embase databases. Articles not reporting data on GNB, HAIs, pediatric patients, and countries of interest were excluded.

Results: The searches resulted in 220 publications, of which 49 met the inclusion criteria and 1 additional study was identified manually. Among 19 studies across Egypt reporting GNB prevalence among pediatric patients, Klebsiella species/K. pneumoniae and Escherichia coli were typically the most common GNB infections; among studies reporting carbapenem resistance and multidrug resistance (MDR), rates reached 86% and 100%, respectively. Similarly, in Saudi Arabia, Klebsiella spp./K. pneumoniae and E. coli were the GNB most consistently associated with infections, and carbapenem resistance (up to 100%) and MDR (up to 75%) were frequently observed. In other Gulf Cooperation Council countries, including Kuwait, Oman, and Qatar, carbapenem resistance and MDR were also commonly reported. In Jordan and Lebanon, E. coli and Klebsiella spp./K. pneumoniae were the most common GNB isolates, and AMR rates reached 100%.

Discussion: This review indicated the prevalence of GNB-causing HAIs among pediatric patients in Middle Eastern countries, with studies varying in reporting GNB and AMR. Most publications reported antimicrobial susceptibility of isolated GNB strains, with high prevalence of extended-spectrum beta-lactamase-producing K. pneumoniae and E. coli isolates. A review of ASPs highlighted the lack of data available in the region.

Conclusions: Enhanced implementation of ICP, ASPs, and AMR surveillance is necessary to better understand the widespread burden of antimicrobial-resistant GNB and to better manage GNB-associated HAIs across Middle Eastern countries.

Keywords: Antimicrobial resistance; Gram-negative bacteria; Healthcare-associated infections; Middle East; Multidrug resistance; Pediatrics.

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Conflict of interest statement

Mohamed Abdel Aziz, Ashraf Hassanien, and Naglaa Mohamed are employees of Pfizer Inc and may hold stock or stock options. Ghassan Dbaibo has received institution grants and honoraria for presentations and advisory boards from Pfizer Inc, MSD, Sanofi Pasteur, and Abbott Laboratories. Mona Al Dabbagh has received honoraria for presentations from MSD and Sanofi Pasteur. Rana H. Almaghrabi, Ghassan Ghatasheh, and Hanan M. Ibrahim declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart summarizing the publications identified by database searching and author hand searches and the subsequent selection of studies for inclusion in the review. GCC Gulf Cooperation Council
Fig. 2
Fig. 2
Publications identified by database searches and included in the review. n-Values represent the number of publications selected for each country included in the search string. *Includes 1 paper identified from author files. UAE United Arab Emirates
See this image and copyright information in PMC

References

    1. Kaye KS, Pogue JM. Infections caused by resistant Gram-negative bacteria: epidemiology and management. Pharmacotherapy. 2015;35:949–962. doi: 10.1002/phar.1636. - DOI - PubMed
    1. Dandachi I, Chaddad A, Hanna J, Matta J, Daoud Z. Understanding the epidemiology of multi-drug resistant Gram-negative bacilli in the Middle East using a One Health Approach. Front Microbiol. 2019;10:1941. doi: 10.3389/fmicb.2019.01941. - DOI - PMC - PubMed
    1. World Health Organization. Global action plan on antimicrobial resistance. Geneva, Switzerland, 2015. https://www.who.int/publications/i/item/9789241509763. Accessed 29 Aug 2022.
    1. Breijyeh Z, Jubeh B, Karaman R. Resistance of Gram-negative bacteria to current antibacterial agents and approaches to resolve it. Molecules. 2020;25:1340. doi: 10.3390/molecules25061340. - DOI - PMC - PubMed
    1. World Health Organization. WHO publishes list of bacteria for which new antibiotics are urgently needed. News release. February 27, 2017. https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-.... Accessed 29 Aug 2022.

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