Dramatic increase in antimicrobial resistance in ESKAPE clinical isolates over the 2010-2020 decade in India.

RATIONALE AND OBJECTIVES: ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) constitute a threat to humans worldwide. India is now the most populous country. The goal was to investigate the evolution of the rates of antimicrobial resistance in ESKAPE pathogens across India over the 2010-20 decade. METHODS: The data (89 studies) were retrieved from the Medline PubMed repository using specific keywords. RESULTS: The study of 20 177 ESKAPE isolates showed that A. baumannii isolates were the most represented (35.9%, n = 7238), followed by P. aeruginosa (25.3%, n = 5113), K. pneumoniae (19.5%, n = 3934), S. aureus (16.3%, n = 3286), E. faecium (2.6%, n = 517) and Enterobacter spp. (0.4%, n = 89). A notable increase in the resistance rates to antimicrobial agents occurred over the 2010-20 decade. The most important levels of resistance were observed in 2016-20 for A. baumannii (90% of resistance to the amoxicillin-clavulanate combination) and K. pneumoniae (81.6% of resistance to gentamycin). The rise in ß-lactamase activities was correlated with an increase in the positivity of Gram-negative isolates for ß-lactamase genes. CONCLUSIONS: This review highlighted that, in contrast to developed countries that kept resistance levels under control, a considerable increase in resistance to various classes of antibiotics occurred in ESKAPE pathogens in India over the 2010-2020 decade.

Retrospective Analysis on Antimicrobial Resistance Trends and Prevalence of ß-lactamases in Escherichia coli and ESKAPE Pathogens Isolated from Arabian Patients during 2000-2020.

The production of diverse and extended spectrum ß-lactamases among Escherichia coli and ESKAPE pathogens is a growing threat to clinicians and public health. We aim to provide a comprehensive analysis of evolving trends of antimicrobial resistance and ß-lactamases among E. coli and ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acine to bacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) in the Arabian region. A systematic review was conducted in Medline PubMed on papers published between January 2000 and February 2020 on countries in the Arab region showing different antibiotic resistance among E. coli and ESKAPE pathogens. A total of n = 119,144 clinical isolates were evaluated for antimicrobial resistance in 19 Arab countries. Among these clinical isolates, 74,039 belonged to E. coli and ESKAPE pathogen. Distribution of antibiotic resistance among E. coli and ESKAPE pathogens indicated that E. coli (n = 32,038) was the predominant pathogen followed by K. pneumoniae (n = 17,128), P. aeruginosa (n = 11,074), methicillin-resistant S. aureus (MRSA, n = 4370), A. baumannii (n = 3485) and Enterobacter spp. (n = 1574). There were no reports demonstrating Enterococcus faecium producing ß-lactamase. Analyses revealed 19 out of 22 countries reported occurrence of ESBL (Extended-Spectrum ß-Lactamase) producing E. coli and ESKAPE pathogens. The present study showed significantly increased resistance rates to various antimicrobial agents over the last 20 years; for instance, cephalosporin resistance increased from 37 to 89.5%, fluoroquinolones from 46.8 to 70.3%, aminoglycosides from 40.2 to 64.4%, mono-bactams from 30.6 to 73.6% and carbapenems from 30.5 to 64.4%. An average of 36.9% of the total isolates were reported to have ESBL phenotype during 2000 to 2020. Molecular analyses showed that among ESBLs and Class A and Class D ß-lactamases, blaCTX-M and blaOXA have higher prevalence rates of 57% and 52.7%, respectively. Among Class B ß-lactamases, few incidences of blaVIM 27.7% and blaNDM 26.3% were encountered in the Arab region. Conclusion: This review highlights a significant increase in resistance to various classes of antibiotics, including cephalosporins, ß-lactam and ß-lactamase inhibitor combinations, carbapenems, aminoglycosides and quinolones among E. coli and ESKAPE pathogens in the Arab region.

Prevalence of ß-lactamase and antibiotic-resistant Pseudomonas aeruginosa in the Arab region.

BACKGROUND: Several studies in the Arab region have recognised the rate of nosocomial infections caused by Pseudomonas aeruginosa (P. aeruginosa), which produce ß-lactamase, and identified their emergence and prevalence in the region. This article reviewed molecular studies on these ß-lactamase-producing P. aeruginosa during 2010-2018 in several countries of the Arab region in order to analyse the trend of rising prevalence of disease causing drug-resistant P. aeruginosa in the Arab region. METHODS: Data from selected clinical studies during 2010-2018 on ß-lactamase-producing P. aeruginosa in the Arab region were obtained from reliable scientific databases for analysis and evaluation. RESULTS: Significant changes were found in resistance of P. aeruginosa towards certain antibiotics of the ß-lactam class. There was an increasing trend in the occurrence of resistance genes in ß-lactamase-producing P. aeruginosa. CONCLUSION: This review showed that there is an increasing prevalence of ß-lactamase-producing P. aeruginosa in some countries in the Arab region. This is a major cause of concern as this implies that more and more instances of multidrug resistance are emerging in this area. This leads to an overall negative impact on health concerns and amounts to increasing difficulty in combating disease. It is recommended that awareness about antibiotic use and abuse be made a priority and measures to curb unchecked use of prescription antibiotics be put into place. Effective screening methods to detect cases of resistance at their onset may be developed.