Antimicrobial Resistance of Gram-Negative Bacteria in Saudi Arabia

Much of the focus of today's media is directed on multidrug-resistant gram-positive bacteria. However, resistance within gram-negative bacilli continues to rise, occasionally creating situations in which few or no antibiotics that retain activity are available. Gram-negative bacteria are important causes of urinary tract infections, bloodstream infections, hospital- and healthcare-associated pneumonias, and various intra-abdominal infections. In Saudi Arabia, among Escherichia coli isolates from outpatients, 50% are resistant to ampicillin, 33% are resistant to trimethoprim-sulfamethoxazole (TMP-SMZ), and 14% are resistant to ciprofloxacin. Among isolates from inpatients, 63% of E. coli are resistant to ampicillin, 44% are resistant to TMP-SMZ, and 33% are resistant to ciprofloxacin. Multidrug resistance is detected in 2-28% of outpatient isolates and 7.4-39.6% of inpatient isolates. For Pseudomonas aeruginosa, the resistance rates of outpatient and inpatient isolates to piperacillin, ceftazidime, imipenem, and ciprofloxacin are 4.6% and 11.5%, 2.4% and 10%, 2.6% and 5.8%, and 3% and 6%, respectively. Multi-drug resistance is observed in 1-2% of inpatient isolates. Acinetobacter calcoaceticus-baumannii has high rates of resistance to ampicillin (86%), cefoxitin (89%), and nitrofurantoin (89%). The rate of resistance to imipenem is 3%; to ticarcillin-clavulanic acid, 16.5%; to gentamicin, 26%; and to ceftazidime, 38%. Multidrug resistance is observed in 14%-35.8%. Acinetobacter calcoaceticus-baumannii complex were recovered. The organism showed high rates of resistance to ampicillin (86%), cefoxitin (89%), and nitrofurantoin (89%). The rate of resistance to imipenem was 3%; to ticarcillin-clavulanic acid, 16.5%; to gentamicin, 26%; and to ceftazidime, 38%. Multidrug resistance is observed in 14%-35.8%.

Keywords: Aramco Medical Services Organization, Dhahran and Preventive Medicine Directorate, Saudi Ministry of Health, Trimethoprim-sulfamethoxazole, multidrug-resistant gram-positive bacteria, Pseudomonas aeruginosa, Gram-negative bacteria, ampicillin, cefoxitin, nitrofurantoin, ticarcillin-clavulanic acid, gentamicin, ceftazidime, Multidrug resistance