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. 2025 Jun 12;10(6):164.
doi: 10.3390/tropicalmed10060164.

Bacterial Pathogens and Antibiotic Resistance in Bloodstream Infections in Tunisia: A 13-Year Trend Analysis

Lamia Kanzari  1   2 , Sana Ferjani  1   2 , Khaoula Meftah  3 , Mariem Zribi  4 , Sonda Mezghani  5   6 , Asma Ferjani  1   2 , Yosra Chebbi  7 , Manel Hamdoun  8 , Hajer Rhim  9   10 , Yosr Kadri  9   10 , Siwar Frigui  7 , Emna Mhiri  11 , Asma Ghariani  11 , Nour Ben Ayed  5   6 , Faouzia Mahjoubi  5   6 , Yomna Ben Lamine  12 , Salma Kaoual  12 , Basma Mnif  5   6 , Habiba Naija  13 , Manel Marzouk  14 , Sarra Dhraief  15 , Hela Karray  5   6 , Jaya Prasad Tripathy  16 , Bobson Derrick Fofanah  17 , Safa Bouwazra  7 , Hajer Battikh  18   19 , Ramzi Ouhichi  20 , Lamia Thabet  15 , Jalel Boukadida  14 , Farouk Barguellil  13   19 , Sophia Besbes  12 , Leila Slim  11 , Maha Mastouri  9   10 , Olfa Bahri  8 , Wafa Achour  7 , Adnene Hammami  5   6 , Hanen Smaoui  3 , Ilhem Boutiba-Ben Boubaker  1   2
Affiliations

Bacterial Pathogens and Antibiotic Resistance in Bloodstream Infections in Tunisia: A 13-Year Trend Analysis

Lamia Kanzari et al. Trop Med Infect Dis. .

Abstract

The antimicrobial resistance (AMR) surveillance network has been monitoring bloodstream bacterial pathogens and their resistance since 1999 in Tunisia. We report the long-term trends in the distribution of bloodstream bacterial pathogens and their resistance patterns from this surveillance database. We analyzed antibiotic resistance rates in 11 tertiary teaching hospital laboratories under the AMR surveillance network during 2011-2023, focusing on six priority bacterial pathogens, using the Cochrane-Armitage test for trend analysis. Of 22,795 isolates, K. pneumoniae (38.5%) was the most common, followed by S. aureus (20.4%), E. coli (13.6%), and A. baumannii (10.3%). Carbapenem resistance was highest in A. baumannii (77%), followed by Pseudomonas aeruginosa (29.3%), K. pneumoniae (19.4%), and Enterobacter cloacae (6.8%). Carbapenem-resistant Enterobacterales and third-generation cephalosporin-resistant Enterobacterales (3GCREB) increased from 10.6% to 26.3% (p-value < 0.001), and from 39% to 50.2%, respectively, during 2011-2023 (p-value < 0.001). Vancomycin resistance (38.3%) and the emergence of linezolid resistance in 2019 (2.4%) were reported in E. faecium isolates. Resistance to carbapenems and 3GC is a major challenge to controlling BSI in Tunisia. The national AMR surveillance network helps monitor annual patterns and guides empirical therapy. An integrated database combining clinical profiles and resistance data via real-time data-sharing platforms could improve clinical decision-making.

Keywords: GLASS; SORT-IT; antimicrobial resistance surveillance; carbapenem resistant Enterobacterales; operational research.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Trends in the number of blood-culture-positive bacterial isolates and the distribution of Gram-positive and Gram-negative isolates from the antimicrobial resistance sentinel surveillance laboratories in Tunisia, 2011–2023.
Figure 2
Figure 2
Trends in the distribution of the type of bacterial pathogens among blood-culture-positive bacterial isolates from the antimicrobial resistance sentinel surveillance laboratories in Tunisia, 2011–2023.
Figure 3
Figure 3
Proportion of blood-culture-positive bacterial isolates resistant to selected antibiotics by the type of pathogen (ESKAPE) from the antimicrobial resistance sentinel surveillance laboratories in Tunisia, 2011–2023. Abbreviation: ampicillin (AMP); amoxicillin-clavulanic acid (AMC); piperacillin–tazobactam (PTZ); cefotaxime (CTX); ceftazidime (CAZ); imipenem (IMP); gentamicin (GEN); gentamicin high-charged 30 µg (GHC); amikacin (AMK); ciprofloxacin (CIP); ofloxacin (OFL); oxacillin (OXA); vancomycin (VAN); teicoplanin (TEI), linezolid (LIN).
Figure 4
Figure 4
Trends in the proportion of positive bacterial isolates resistant to selected antibiotics by the type of pathogen (ESKAPE) from the antimicrobial resistance sentinel surveillance laboratories in Tunisia, 2011–2023. Abbreviation: amoxicillin-clavulanic acid (AMC); cefotaxime (CTX); imipenem (IMP); gentamicin (GEN); amikacin (AMK); ciprofloxacin (CIP); ofloxacin (OFL); oxacillin (OXA); vancomycin (VAN); teicoplanin (TEI); ampicillin (AMP); gentamicin high-charged 30 µg (GHC); linezolid (LIN).
See this image and copyright information in PMC

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