Abstract
A few decades after the discovery of the first antibiotic, the widespread overuse and misuse of antibiotics across human and nonhuman sectors have led to the development and spread of antimicrobial resistance (AMR). AMR is now a threat to public health worldwide not only for its effect on population health but also for the significant associated economic burden. Several governments and organizations, including the World Health Organization (WHO), have emphasized the need to control this problem and called for the development and implementation of national policies and strategies to limit its spread.
In this chapter, we will provide a broad overview of the global epidemiology of AMR with emphasis on the current situation in countries of the Arab world. We will also explore the causes behind its evident increase. Finally, we will end with specific recommendations for the implementation of multifaceted strategies and action policies structured around the Global Action Plan launched by the WHO.
References
Abbara A, Rawson TM, Karah N, El-Amin W, Hatcher J, Tajaldin B, Dar O, Dewachi O, Abu Sitta G, Uhlin BE, Sparrow A (2018a) Antimicrobial resistance in the context of the Syrian conflict: drivers before and after the onset of conflict and key recommendations. Int J Infect Dis 73:1–6
Abbara A, Rawson TM, Karah N, El-Amin W, Hatcher J, Tajaldin B, Dar O, Dewachi O, Abu Sitta G, Uhlin BE, Sparrow A (2018b) A summary and appraisal of existing evidence of antimicrobial resistance in the Syrian conflict. Int J Infect Dis 75:26–33
Abdelaziz A, Tawfik A, Rabie K, Omran M, Hussein M, Abou-Ali A, Ahmed A-S (2019) Quality of community pharmacy practice in antibiotic self-medication encounters: a simulated patient study in upper Egypt. Antibiotics 8:35
Al Jarousha AMK, Jadba AHNE, Afifi ASA, Qouqa IAE (2009) Nosocomial multidrug-resistant Acinetobacter baumannii in the neonatal intensive care unit in Gaza City, Palestine. Int J Infect Dis 13:623–628
Al-Ghamdi M (2001) Empirical treatment of uncomplicated urinary tract infection by community pharmacist in the eastern province of Saudi Arabia. Saudi Med J 22:1105–1108
Alghamdi S, Shebl NA, Aslanpour Z, Shibl A, Berrou I (2018) Hospital adoption of antimicrobial stewardship programmes in gulf cooperation council countries: a review of existing evidence. J Glob Antimicrob Resist 15:196–209. https://doi.org/10.1016/j.jgar.2018.07.014
Al-Ghamdi S, Gedebou M, Bilal NE (2002) Nosocomial infections and misuse of antibiotics in a provincial community hospital, Saudi Arabia. J Hosp Infect 50:115–121
Alhomoud F, Aljamea Z, Almahasnah R, Alkhalifah K, Basalelah L, Alhomoud FK (2017) Self-medication and self-prescription with antibiotics in the Middle East—do they really happen? A systematic review of the prevalence, possible reasons, and outcomes. Int J Infect Dis 57:3–12. https://doi.org/10.1016/j.ijid.2017.01.014
Al-Mazeedi HM, Abbas AB, Alomirah HF, Al-Jouhar WY, Al-Mufty SA, Ezzelregal MM, Al-Owaish RA (2010) Screening for tetracycline residues in food products of animal origin in the State of Kuwait using charm II radio-immunoassay and LC/MS/MS methods. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 27:291–301
Almohammed RA, Bird EL (2019) Public knowledge and behaviours relating to antibiotic use in gulf cooperation council countries: a systematic review. J Infect Public Health 12:159–166. https://doi.org/10.1016/j.jiph.2018.09.002
Al-Mustafa ZH, Al-Ghamdi MS (2002) Use of antibiotics in the poultry industry in Saudi Arabia: implications for public health. Ann Saudi Med 22:4–7
Alnemri AR, Almaghrabi RH, Alonazi N, Alfrayh AR (2016) Misuse of antibiotic: a systemic review of Saudi published studies. Curr Pediatr Res 20:169–173
Aly NY, Omar AA, Badawy DA, Al-Mousa HH, Sadek AA (2012) Audit of physicians’ adherence to the antibiotic policy guidelines in Kuwait. Med Princ Pract 21:310–317
Arzanlou M, Chai WC, Venter H (2017) Intrinsic, adaptive and acquired antimicrobial resistance in Gram-negative bacteria. Essays Biochem 61:49–59
Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, Nisar MA, Alvi RF, Aslam MA, Qamar MU, Salamat MKF, Baloch Z (2018) Antibiotic resistance: a rundown of a global crisis. Infect Drug Resist 11:1645–1658
Ayyad S, Al-Owaisheer A, Al-Banwan F, Al-Mejalli A, Shukkur M, Thalib L (2010) Evidence-based practice in the use of antibiotics for respiratory tract infections in primary health centers in Kuwait. Med Princ Pract 19:339–343
Barlam TF, Cosgrove SE, Abbo LM, Macdougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK (2016) Implementing an antibiotic stewardship program: guidelines by the infectious diseases society of America and the society for healthcare epidemiology of America. Clin Infect Dis 62:1197–1202
Blair JMA, Webber MA, Baylay AJ, Ogbolu DO, Piddock LJV (2015) Molecular mechanisms of antibiotic resistance. Nat Rev Microbiol 13:42–51. https://doi.org/10.1038/nrmicro3380
Camacho A, Bouhenia M, Alyusfi R, Alkohlani A, Naji MAM, de Radiguès X, Abubakar AM, Almoalmi A, Seguin C, Sagrado MJ, Poncin M, McRae M, Musoke M, Rakesh A, Porten K, Haskew C, Atkins KE, Eggo RM, Azman AS, Broekhuijsen M, Saatcioglu MA, Pezzoli L, Quilici ML, Al-Mesbahy AR, Zagaria N, Luquero FJ (2018) Cholera epidemic in Yemen, 2016–18: an analysis of surveillance data. Lancet Glob Heal 6:e680–e690
Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, Colomb-Cotinat M, Kretzschmar ME, Devleesschauwer B, Cecchini M, Ouakrim DA, Oliveira TC, Struelens MJ, Suetens C, Monnet DL, Strauss R, Mertens K, Struyf T, Catry B, Latour K, Ivanov IN, Dobreva EG, Tambic Andraševic A, Soprek S, Budimir A, Paphitou N, Žemlicková H, Schytte Olsen S, Wolff Sönksen U, Märtin P, Ivanova M, Lyytikäinen O, Jalava J, Coignard B, Eckmanns T, Abu Sin M, Haller S, Daikos GL, Gikas A, Tsiodras S, Kontopidou F, Tóth Á, Hajdu Á, Guólaugsson Ó, Kristinsson KG, Murchan S, Burns K, Pezzotti P, Gagliotti C, Dumpis U, Liuimiene A, Perrin M, Borg MA, de Greeff SC, Monen JC, Koek MB, Elstrøm P, Zabicka D, Deptula A, Hryniewicz W, Caniça M, Nogueira PJ, Fernandes PA, Manageiro V, Popescu GA, Serban RI, Schréterová E, Litvová S, Štefkovicová M, Kolman J, Klavs I, Korošec A, Aracil B, Asensio A, Pérez-Vázquez M, Billström H, Larsson S, Reilly JS, Johnson A, Hopkins S (2019) Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis 19:56–66
Centers for Disease Control and Prevention (2014) Core elements of hospital antibiotic stewardship programs. US Department of Health and Human Services, CDC, Atlanta
Centers for Disease Prevention and Control (2019) Antibiotic Prescribing and Use. https://www.cdc.gov/antibiotic-use/index.html. Accessed 15 Aug 2019
CLSI (2019) CLSI M100-ED29: 2019 performance standards for antimicrobial susceptibility testing, 29th edn. http://em100.edaptivedocs.net/GetDoc.aspx?doc=CLSI M100 ED29:2019&scope=user
Cooke J, Butler C, Hopstaken R, Dryden MS, McNulty C, Hurding S, Moore M, Livermore DM (2015) Narrative review of primary care point of- care testing (POCT) and antibacterial use in respiratory tract infection (RTI). BMJ Open Respir Res 2:1–10. https://doi.org/10.1136/bmjresp-2015-000086
Daoud Z, Farah J, Sokhn ES, El Kfoury K, Dahdouh E, Masri K, Afif C, Abdel-Massih RM, Matar GM (2017) Multidrug-resistant Enterobacteriaceae in Lebanese hospital wastewater: implication in the. One Health Concept Microb Drug Resist 24:166–174
Davey P, Marwick C, Scott C, Charani E, McNeil K, Brown E, Gould M, Ramsay C, Michie S (2017) Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2:CD003543
Davies J, Davies D (2010) Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev 74:417–433
Diab M, Hamze M, Bonnet R, Saras E, Madec JY, Haenni M (2018) Extended-spectrum beta-lactamase (ESBL)- and carbapenemase-producing Enterobacteriaceae in water sources in Lebanon. Vet Microbiol 217:97–103
Dib JG, Al-Tawfiq JA, Al Abdulmohsin S, Mohammed K, Jenden PD (2009) Improvement in vancomycin utilization in adults in a Saudi Arabian medical center using the hospital infection control practices advisory committee guidelines and simple educational activity. J Infect Public Health 2:141–146
EUCAST (2019) Clinical breakpoints and dosing of antibiotics. http://www.eucast.org/clinical_breakpoints/
European Centre for Disease Prevention and Control (2018) Surveillance of antimicrobial resistance in Europe (2017)
European Commission Directorate-General for Health and Food Safety (2017) EU Guidelines for the prudent use of antimicrobials in human health
Fleming A (1945) Penicillin. https://www.nobelprize.org/uploads/2018/06/fleming-lecture.pdf
Forsberg KJ, Reyes A, Wang B, Selleck EM, Sommer MOA, Dantas G (2012) The shared antibiotic resistome of soil bacteria and human pathogens. Science 337:1107–1111. (80- )
Gayer M, Legros D, Formenty P, Connolly MA (2007) Conflict and emerging infectious diseases. Emerg Infect Dis 13:1625–1631
Haddad N, Kanj SS, Awad LS, Abdallah DI, Moghnieh RA (2019) The 2018 Lebanese Society of Infectious Diseases and Clinical Microbiology Guidelines for the use of antimicrobial therapy in complicated intra-abdominal infections in the era of antimicrobial resistance. BMC Infect Dis 19:293
Holmes AH, Moore LSP, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, Guerin PJ, Piddock LJV (2016) Understanding the mechanisms and drivers of antimicrobial resistance. Lancet 387:176–187
Husni R, Atoui R, Choucair J, Moghnieh R, Mokhbat J, Tabbarah Z, Bizri AE, Tayyar R, Jradeh M, Yared N, Musharrafieh U, Al-Awar G, Helou Z, Dakdouki G, Farra A, Hammoud J, Aoun N, Kanj SS (2017) The Lebanese society of infectious diseases and clinical microbiology guidelines for the treatment of urinary tract infections. Leban Med J 65:208–219
Khalifeh MM, Moore ND, Salameh PR (2017) Self-medication misuse in the Middle East: a systematic literature review. Pharmacol Res Perspect 5:1–13
Klein EY, Van Boeckel TP, Martinez EM, Pant S, Gandra S, Levin SA, Goossens H, Laxminarayan R (2018) Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci U S A 115:E3463–E3470
KPMG (2014) The global economic impact of anti-microbial resistance. KPMG, London
Laxminarayan R, Sridhar D, Blaser M, Wang M, Woolhouse M (2016) Achieving global targets for antimicrobial resistance. Science 353:874–875. (80- )
Leangapichart T, Dia NM, Olaitan AO, Gautret P, Brouqui P, Rolain J-M (2016a) Acquisition of Extended-Spectrum -lactamases by Escherichia coli and Klebsiella pneumoniae in gut microbiota of pilgrims during the hajj pilgrimage of 2013. Antimicrob Agents Chemother 60:3222–3226
Leangapichart T, Gautret P, Griffiths K, Belhouchat K, Memish Z, Raoult D, Rolain J-M (2016b) Acquisition of a High Diversity of Bacteria during the hajj pilgrimage, including Acinetobacter baumannii with Bla OXA-72 and Escherichia coli with Bla NDM-5 Carbapenemase genes. Antimicrob Agents Chemother 60:5942–5948
Llewelyn MJ, Fitzpatrick JM, Darwin E, SarahTonkin-Crine GC, Paul J, Peto TEA, Yardley L, Hopkins S, Walker AS (2017) The antibiotic course has had its day. BMJ 358:j3418. https://doi.org/10.1136/bmj.j3418
MacGowan AP (2008) Clinical implications of antimicrobial resistance for therapy. J Antimicrob Chemother 62:ii105–ii114
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18:268–281
McEwen SA, Collignon PJ (2017) Antimicrobial resistance: a one health colloquium. Microbiol Spectr 6:1–26
Memish ZA, Venkatesh S, Shibl AM (2003) Impact of travel on international spread of antimicrobial resistance. Int J Antimicrob Agents 21:135–142
Moghnieh R, Yared Sakr N, Kanj SS, Musharrafieh U, Husni R, Jradeh M, Al-Awar G, Matar M, Jureij W, Saad A, Azar E, Abi Hanna P, Minari A, Hammoud J, Kfoury J, Mahfouz T, Abou Chakra D, Zaatari M, Tabbarah ZA (2014) The Lebanese Society for Infectious Diseases and Clinical Microbiology (LSIDCM) guidelines for adult Community-Acquired Pneumonia (CAP) in Lebanon. Leban Med J 62:40–47. https://doi.org/10.12816/0002626
Moghnieh R, Kanafani Z, Abi Hanna P, Matar MJ, Mokhbat J, Jradeh M, Yared N, Husni R, Abdallah D, Atoui R, Choucair J, Al-Awar G, Dakdouki G, Farra A, El Helou G, Hammoud J, Aoun N, Kanj SS (2017) 2016 Lebanese Society of Infectious Diseases & clinical microbiology guidelines on the management of febrile neutropenia in adult cancer patients in the era of growing antimicrobial resistance. Leban Med J 65:63–82. https://doi.org/10.12816/0038540
Moghnieh RA, Kanafani ZA, Tabaja HZ, Sharara SL, Awad LS, Kanj SS (2018) Epidemiology of common resistant bacterial pathogens in the countries of the Arab League. Lancet Infect Dis 18:e379–e394
Levy S, (2012) Molecular Biology Pathogenicity and Ecology of Bacterial Plasmids. Springer, Boston, p 679-682
Mouhieddine TH, Olleik Z, Itani MM, Kawtharani S, Nassar H, Hassoun R, Houmani Z, El ZZ, Fakih R, Mortada IK, Mohsen Y, Kanafani Z, Tamim H (2015) Assessing the Lebanese population for their knowledge, attitudes and practices of antibiotic usage. J Infect Public Health 8:20–31
Mund MD, Khan UH, Tahir U, Mustafa BE, Fayyaz A (2017) Antimicrobial drug residues in poultry products and implications on public health: a review. Int J Food Prop 20:1433–1446
Nasr Z, Paravattil B, Wilby KJ (2017) The impact of antimicrobial stewardship strategies on antibiotic appropriateness and prescribing behaviours in selected countries in the Middle East: a systematic review. East Mediterr Heal J 23:430–440
National Quality Forum, National Quality Partners, Antibiotic Stewardship Action Team (2018) National Quality Partners Playbook: Antibiotic Stewardship in Acute Care
Nazer LH, Kharabsheh A, Rimawi D, Mubarak S, Hawari F (2015) Characteristics and outcomes of Acinetobacter baumannii infections in critically ill patients with Cancer: a matched case–control study. Microb Drug Resist 21:556–561. https://doi.org/10.1089/mdr.2015.0032
Nhung N, Cuong N, Thwaites G, Carrique-Mas J (2016) Antimicrobial usage and antimicrobial resistance in animal production in Southeast Asia: a review. Antibiotics 5:37
Nixon J, Ulmann P (2006) The relationship between health care expenditure and health outcomes: evidence and caveats for a causal link. Eur J Health Econ 7:7–18
OECD (2018) Stemming the superbug tide: just a few dollars more. OECD Publishing, Paris
Pehrsson E, Tsukayama P, Patel S, Mejia-Bautista M, Sosa-Soto G, Navarrete K, Calderon M, Cabrera L, Hoyos-Arango W, Bertoli MT, Berg DE, Gilman RH, Dantas G (2016) Interconnected microbiomes and resistomes in low-income human habitats. Nature 533:212–2016
Roy K, Groom K, Knight M (2018) Point of care respiratory viral testing (POCT): a novel service to target appropriate antimicrobial prescription and improve antibiotic stewardship. Eur Respir J 52:PA2032. https://doi.org/10.1183/13993003.congress-2018.PA2032
Saga T, Yamaguchi K (2009) History of antimicrobial agents and resistant bacteria. Japan Med Assoc J 52:103–108
Shehadeh M, Suaifan G, Darwish RM, Wazaify M, Zaru L, Alja’fari S (2012) Knowledge, attitudes and behavior regarding antibiotics use and misuse among adults in the community of Jordan. A pilot study. Saudi Pharm J 20:125–133. https://doi.org/10.1016/j.jsps.2011.11.005
Society for Healthcare Epidemiology of America; Infectious Diseases Society of America; Pediatric Infectious Diseases Society (2012) Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 33:322–327
Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, Pulcini C, Kahlmeter G, Kluytmans J, Carmeli Y, Ouellette M, Outterson K, Patel J, Cavaleri M, Cox EM, Houchens CR, Grayson ML, Hansen P, Singh N, Theuretzbacher U, Magrini N, Aboderin AO, Al-Abri SS, Awang Jalil N, Benzonana N, Bhattacharya S, Brink AJ, Burkert FR, Cars O, Cornaglia G, Dyar OJ, Friedrich AW, Gales AC, Gandra S, Giske CG, Goff DA, Goossens H, Gottlieb T, Guzman Blanco M, Hryniewicz W, Kattula D, Jinks T, Kanj SS, Kerr L, Kieny MP, Kim YS, Kozlov RS, Labarca J, Laxminarayan R, Leder K, Leibovici L, Levy-Hara G, Littman J, Malhotra-Kumar S, Manchanda V, Moja L, Ndoye B, Pan A, Paterson DL, Paul M, Qiu H, Ramon-Pardo P, Rodríguez-Baño J, Sanguinetti M, Sengupta S, Sharland M, Si-Mehand M, Silver LL, Song W, Steinbakk M, Thomsen J, Thwaites GE, van der Meer JW, Van Kinh N, Vega S, Villegas MV, Wechsler-Fördös A, Wertheim HFL, Wesangula E, Woodford N, Yilmaz FO, Zorzet A (2018) Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis 18:318–327. https://doi.org/10.1016/S1473-3099(17)30753-3
Taylor J, Hafner M, Yerushalmi E, Smith R, Bellasio J, Vardavas R, Bienkowska-gibbs T, Rubin J (2014) Estimating the economic costs of antimicrobial resistance: model and results. RAND Eur:1–113
The Review on Antimicrobial Resistance (2016) Tackling drug-resistant infections globally: final report and recommendations. Wellcome Trust, HM Government, London
World Bank (2016) Drug-resistant infections: a threat to our economic future. World Bank Rep 2:1–132
World Health Organisation (2018) Monitoring global Progress on addressing antimicrobial resistance: analysis report of the second round of results of AMR country self-assessment survey 2018
World Health Organization (2001) WHO global strategy for containment of antimicrobial resistance. World Health Organization, Geneva
World Health Organization (2014) Antimicrobial resistance. Global report on surveillance
World Health Organization (2015) Global action plan on antimicrobial resistance
World Health Organization (2017a) Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. World Heal Organ. https://doi.org/10.1590/S0100-15742013000100018
World Health Organization (2017b) Global antimicrobial resistance surveillance system (GLASS) report
Yaacoub SG, Lahoud NA, Francis NJ, Rahme DW, Murr TH, Maison PF, Saleh NG (2019) Antibiotic prescribing rate in Lebanese community pharmacies: a Nationwide patient-simulated study of acute bacterial rhinosinusitis. J Epidemiol Glob Health 9:44
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Ballouz, T., Rizk, N., Kanj, S.S. (2019). Antimicrobial Resistance in the Arab Region. In: Laher, I. (eds) Handbook of Healthcare in the Arab World. Springer, Cham. https://doi.org/10.1007/978-3-319-74365-3_173-1
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