Antimicrobial Resistance Profiles of Pseudomonas aeruginosa in the Arabian Gulf Region Over a 12-Year Period (2010-2021)

Abstract

Objectives: To evaluate literature from a 12-year period (2010-2021) on the antimicrobial resistance profile of Pseudomonas aeruginosa from the Arabian Gulf countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates).

Methods: An electronic literature search was conducted for articles on antimicrobial resistance in P. aeruginosa and associated phenotypes, covering the period of 1st January 2010 to 1st December 2021.

Results: Antimicrobial resistance in the Arabian Gulf was highest to meropenem (10.3-45.7%) and lowest to colistin (0.0-0.8%), among the agents tested. Annual data showed that ceftazidime resistance (Kuwait), piperacillin-tazobactam non-susceptibility (Qatar), and aztreonam, imipenem, and meropenem resistance (Saudi Arabia) increased by 12-17%. Multiple mechanisms of carbapenem resistance were identified and multiple clones were detected, including high-risk clones such as ST235. The most common carbapenemases detected were the VIM-type metallo-β-lactamases.

Conclusions: Among P. aeruginosa in the Arabian Gulf countries, resistance to meropenem was higher than to the other agents tested, and meropenem resistance increased in Saudi Arabia during the study period. Resistance to colistin, a classic antibiotic used to treat Pseudomonas spp. infections, remained low. The VIM-type β-lactamase genes were dominant. We recommend local and regional antimicrobial resistance surveillance programs to detect the emergence of resistance genes and to monitor antimicrobial resistance trends in P. aeruginosa.

Keywords: Pseudomonas aeruginosa; Antimicrobial resistance; Arabian Gulf region; Resistance mechanisms; Resistance phenotypes.

Fig. 1

Flow chart for selection of publications on P. aeruginosa from the Arabian Gulf countries and other countries/regions (2010–2021)

Fig. 2

Rates of antimicrobial resistance (resistance data from the ATLAS database [53], except for the UAE [57]) or nonsusceptibility (non-susceptibility data from Oman presented to 1 decimal place but presented to the nearest whole number in the publication [20]) and difficult-to-treat resistance (DTR data from the ATLAS database [53]) among P. aeruginosa (2016–2021). Rates of antimicrobial resistance or non-susceptibility were presented as the percentage of resistant or non-susceptible P. aeruginosa (determined using CLSI breakpoints [64]) of the total isolates collected. DTR was defined as resistance to >1 antimicrobial in each of the following classes: cephalosporins (ceftazidime, cefepime or ceftriaxone), carbapenems (imipenem, meropenem, doripenem or ertapenem), and quinolones (ciprofloxacin or levofloxacin). Total isolate numbers [years of collection] were: KW, 757 (CZA, CST: 721) [2016–2021]; OM, 2362 [2016 and 2017]; QA, 116 [2019–2021]; SA, 160 (CZA, CST: 140) [2016, 2018–2021]; UAE, 9402 [2020]; IN, 1405 (CZA and CST: 1365) [2016, 2018–2021]; PK, 36 [2016 and 2017]; EMR incl Greece (Greece, Jordan, Israel, and Turkey), 2561 (CZA and CST: 2413) [2016–2021]; S. Europe excl Greece (Croatia, Italy, Portugal, Serbia and Spain), 6185 (CZA and CST: 5063) [2016–2021]; North America (Canada and United States), 5601 (CZA and CST: 4876) [2016–2021]; Latin America (Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Mexico, Panama and Venezuela), 6380 (CZA and CST: 5808) [2016–2021]; and Southeast Asia (Malaysia, Philippines, Singapore, Thailand and Vietnam), 2126 (CZA and CST: 2027) [2016–2021]). AMK, amikacin; CZA, ceftazidime-avibactam; CST, colistin; DTR, difficult-to-treat resistance; EMR, Eastern Mediterranean region; excl, excluding; IN, India; incl, including; KW, Kuwait; MEM, meropenem; OM, Oman; PK, Pakistan; QA, Qatar; S., Southern; SA, Saudi Arabia; TZP, piperacillin-tazobactam; and UAE, United Arab Emirates. -, no data collected for these antimicrobial agents in the selected countries

Fig. 3

Distribution of β-lactamase genes among P. aeruginosa from the Arabian Gulf countries and other countries/regions (2010–2021) (genotype data from each country/region are shown in Supplementary Table 4). Circles show the genotype number of each β-lactamase gene detected in a country or region and ‘type’ represents an identified β-lactamase gene that has not been sub-typed. EMR, Eastern Mediterranean Region; inc, including; excl, excluding; NDM, New Delhi metallo-β-lactamase; VIM, Verona integron-encoded metallo-β-lactamase; IMP, imipenemase; GES, Guiana extended-spectrum; KPC, Klebsiella pneumoniae carbapenemase; and UAE, United Arab Emirates