Government responses to the COVID-19 pandemic of the Gulf Cooperation Council countries: good practices and lessons for future preparedness.

The COVID-19 pandemic has dramatically threatened the Gulf Cooperation Council (GCC) countries which have a large proportion of foreign workers. The governments of GCC countries have proactively implemented a comprehensive set of policy measures, and up to our knowledge, a systematic analysis of qualitative and quantitative evidence on the government response is still lacking. We summarized the GCC countries' government response and quantitatively measured that response using four indexes-the Government Response Index, the Stringency Index, the Vaccine Index, and the Initial Response Index, to analyse their response for future pandemic preparedness. Overall, the government response of all the GCC countries to the COVID-19 pandemic has been comprehensive, stringent, and timely. Notably, the GCC countries have implemented comprehensive vaccine policies. In addition, they have worked actively to protect foreign workers to improve their access to health services and secure their essential living conditions, regardless of their immigrant status. All the GCC countries dynamically adjusted their response to the evolving COVID-19 epidemiological burden and started to relax the stringency of the control policies after the Omicron wave, though the governments had different response magnitudes as measured by the four indexes. These findings have provided several important lessons for future pandemic response and preparedness for countries with similar economic, demographic, and health contexts in (1) prompt actions of containment and closure policies with dynamic adjusting, (2) strengthening health system policies, (3) comprehensive vaccination policies with universal access, (4) equitable and free access to testing, diagnosis, and treatment for all, and (5) strengthening the resilience of health systems.

National surveillance of antimicrobial resistance among Gram-positive bacteria in Saudi Arabia.

BACKGROUND: Antimicrobial-resistant Gram-positive bacteria are important causes of serious infections. METHODS: Between January and December 2009, we examined clinical Gram-positive isolates from 24 hospitals across Saudi Arabia. RESULTS: Among the 13750 isolates, Staphylococcus aureus (62.3%) was the commonest, followed by non-group A beta-haemolytic streptococci (14.8%), group A beta-haemolytic streptococci (7.1%), coagulase-negative staphylococci (6.6%), pneumococci (6.0%), and enterococci (3.1%). Resistance rates were high among S. aureus (methicillin-resistant S. aureus: 32%), coagulase-negative staphylococci (oxacillin: 63%) and pneumococci (penicillin G: 33%; erythromycin: 26%; ceftriaxone: 11%); low among enterococci (vancomycin: 1%) and among beta-haemolytic streptococci. Resistance rates varied between regions, but comparison was complicated by differences in antibiotics tested. Many relevant antibiotics were tested against few isolates (e.g. ampicillin, vancomycin, and high-level gentamicin versus enterococci) while unhelpful tests were widely performed (e.g. cefotaxime, ceftriaxone, and imipenem versus staphylococci. CONCLUSION: Resistance is widespread in staphylococci and pneumococci, but not enterococci and beta-haemolytic streptococci in Saudi Arabia. Rationalization of antibiotic panels tested is urgently needed.

Antimicrobial resistance among non-fermenting Gram-negative bacteria in Saudi Arabia.

OBJECTIVES: Non-fermentative Gram-negative bacilli (non-fermenters) can cause serious healthcare-associated infections and are often resistant to multiple antibiotics. We examined resistance rates among these bacteria from different regions of Saudi Arabia. METHODS: A cross-sectional study between January and December 2009 examined 8908 clinical non-fermenters from 24 hospitals across Saudi Arabia. Susceptibility testing was monitored to ensure compliance with CLSI guidelines, but the antibiotics tested were at the hospitals' discretion. RESULTS: Out of the 8908 non-fermenters, most were Pseudomonas aeruginosa (72.9%), followed by Acinetobacter baumannii (25.3%) and Stenotrophomonas maltophilia (1.8%). Resistance rates among P. aeruginosa were: polymyxin B, 2.2%; imipenem, 15.9%; ciprofloxacin, 22.0%; amikacin, 22.9%; and gentamicin, 31.2%. Resistance rates among A. baumannii were: imipenem, 5.4%; polymyxin B, 13.2%; ciprofloxacin, 64.0%; trimethoprim/sulfamethoxazole, 73.8%; amikacin, 76.9%; and gentamicin, 77.8%. Resistance rates among S. maltophilia were: polymyxin B, 6.9%; trimethoprim/sulfamethoxazole, 20.5%; and ciprofloxacin, 38.9%. There was major variation in resistance rates between geographical regions. CONCLUSIONS: Resistance rates among non-fermenters were high in Saudi Arabia and were variable among regions.