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A Narrative Review of Healthcare-Associated Gram-Negative Infections Among Pediatric Patients in Middle Eastern
Mona Al Dabbagh1,2,3, Mohammad Alghounaim4, Rana H Almaghrabi5
1King Abdulaziz Medical City, Jeddah, Saudi Arabia.
Insights
Antimicrobial-resistant Gram-negative bacteria (GNB) are a growing threat in Middle Eastern pediatric healthcare settings. High rates of resistance, particularly carbapenem resistance, necessitate improved infection control and antimicrobial stewardship programs.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health
Background:
- Gram-negative bacteria (GNB) pose significant challenges in healthcare due to rising antimicrobial resistance (AMR).
- Lack of effective infection control and prevention (ICP) and antimicrobial stewardship programs (ASPs) exacerbate GNB infections.
- This review focuses on healthcare-associated infections (HAIs) caused by GNB in pediatric populations within the Middle East.
Purpose of the Study:
- To review and summarize the available literature on GNB-causing HAIs in pediatric patients in Middle Eastern countries.
- To identify common GNB pathogens and their antimicrobial resistance patterns in this demographic.
- To highlight gaps in data regarding infection control and antimicrobial stewardship.
Main Methods:
- Literature searches were conducted using PubMed and Embase databases.
- Studies were included if they reported data on GNB, HAIs, pediatric patients, and specific Middle Eastern countries.
- Exclusion criteria were applied to studies not meeting these core parameters.
Main Results:
- A total of 50 studies met the inclusion criteria.
- Klebsiella species/K. pneumoniae and Escherichia coli were the most frequent GNB isolates in pediatric HAIs across Egypt, Saudi Arabia, Kuwait, Oman, Qatar, Jordan, and Lebanon.
- High rates of carbapenem resistance (up to 100%) and multidrug resistance (MDR) (up to 100%) were reported in multiple countries.
- Extended-spectrum beta-lactamase (ESBL)-producing K. pneumoniae and E. coli were prevalent.
Conclusions:
- GNB are a significant cause of HAIs in Middle Eastern pediatric patients, with substantial AMR.
- There is a notable lack of comprehensive data on ASPs in the region.
- Enhanced implementation of ICP, ASPs, and AMR surveillance is crucial for managing GNB-associated HAIs.
Introduction:
Gram-negative bacteria (GNB) have become prominent across healthcare and community settings due to factors including lack of effective infection control and prevention (ICP) and antimicrobial stewardship programs (ASPs), GNB developing antimicrobial resistance (AMR), and difficulty treating infections. This review summarizes available literature on healthcare-associated infections (HAIs) in Middle Eastern pediatric patients.
Methods:
Literature searches were performed with PubMed and Embase databases. Articles not reporting data on GNB, HAIs, pediatric patients, and countries of interest were excluded.
Results:
The searches resulted in 220 publications, of which 49 met the inclusion criteria and 1 additional study was identified manually. Among 19 studies across Egypt reporting GNB prevalence among pediatric patients, Klebsiella species/K. pneumoniae and Escherichia coli were typically the most common GNB infections; among studies reporting carbapenem resistance and multidrug resistance (MDR), rates reached 86% and 100%, respectively. Similarly, in Saudi Arabia, Klebsiella spp./K. pneumoniae and E. coli were the GNB most consistently associated with infections, and carbapenem resistance (up to 100%) and MDR (up to 75%) were frequently observed. In other Gulf Cooperation Council countries, including Kuwait, Oman, and Qatar, carbapenem resistance and MDR were also commonly reported. In Jordan and Lebanon, E. coli and Klebsiella spp./K. pneumoniae were the most common GNB isolates, and AMR rates reached 100%.
Discussion:
This review indicated the prevalence of GNB-causing HAIs among pediatric patients in Middle Eastern countries, with studies varying in reporting GNB and AMR. Most publications reported antimicrobial susceptibility of isolated GNB strains, with high prevalence of extended-spectrum beta-lactamase-producing K. pneumoniae and E. coli isolates. A review of ASPs highlighted the lack of data available in the region.
Conclusions:
Enhanced implementation of ICP, ASPs, and AMR surveillance is necessary to better understand the widespread burden of antimicrobial-resistant GNB and to better manage GNB-associated HAIs across Middle Eastern countries.
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