Three Years of Evaluation to Determine Reduction of Antibiotic Resistance in Gram-Negative Bacteria by the Saudi National Action Plan

Abstract

Background

Bacterial antibiotic resistance (AR) is a primary public health concern. In 2017, the Saudi National Action Plan (SNAP) implemented several strategies to overcome AR. Here, to better understand the effectiveness of that plan, we evaluated the rates of AR, extended-spectrum beta-lactamase (ESBL) positivity, and multi-drug resistance (MDR) among gram-negative bacteria in a private Saudi hospital.

Methods

This retrospective study included all patients with a confirmed diagnosis of gram-negative bacterial infection from January 2017 to December 2019. Identification of bacterial strains was performed using VITEK 2 ID-GNB cards, while AR, ESBL, and MDR were determined using AST-No. 12 cards, both used as recommended by the manufacturer. Cards were loaded into a VITEK 2 system for examination.

Results

A total of 4760 isolated gram-negative bacteria were collected. The most isolated organism was Escherichia coli, with 2585/4760 (54.30%) strains, and the least was Providencia stuartii, with 55/4760 (1.16%) strains. A total of 1328/4760 (27.90%) clinical isolates were ESBL-positive, and 851/4760 (17.88%) possessed MDR. Escherichia coli was also the most frequently isolated as having ESBL activity and MDR, with 772/1328 (58.13%) and 292/851 (34.31%) isolates, respectively. Between 2017 and 2019, the rates of ESBL and MDR were significantly reduced (p < 0.05) for most bacteria, except for Salmonella species, which showed increased resistance to antibiotics.

Conclusion

Our findings revealed that the rates of AR, ESBL, and MDR reduced over time, which suggests the SNAP is effective at overcoming AR risk.

Keywords:

• antibiotic resistance
• multi-drug resistance
• gram-negative bacteria
• VITEK
• Saudi Arabi

Acknowledgments

We are grateful to all hospital laboratory members for their support and give especial thanks to Meshari Almaliky for gathering and providing some missing data needed in our study. Also, we thank Imam Mohammad Ibn Saud Islamic University and SmartLab for supplying the funding.

Ethics Statement

The study was approved by the Ethics Review Committee (ERC) of College of Medicine, Imam Mohammad Ibn Saud Islamic University. The ethics committee approved the waiver of patient’s informed consent, with the justification that this was a retrospective and analytical study whose information was obtained from medical records. Also, the data were de-identified and anonymously analyzed. The study was conducted in accordance with the ethical guidelines of the Declaration of Helsinki. Privacy statement: the authors guarantee patient data confidentiality.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest for this work.