The scope of bacterial resistance to antibiotics in some countries in the middle East and North Africa

Data available on bacterial resistance to antibiotics in the Middle East and some African countries mainly comprised sporadic nosocomial outbreaks. However, some surveillance studies, such as the PEARLS and ARMed have examined resistance determinants and patterns of common nosocomial pathogens in some Middle Eastern and North African countries. But no national surveillance figures have been published in any of these individual countries. In this chapter we will present reported rates of bacterial resistance to antibiotics in clinically important pathogens such as MRSA, Escherichia coli and other selected Enterobacteriaceae in this geographical region. In addition, we will discuss studies on nosocomial pathogens notorious for multidrug resistance such as Acinetobacter baumannii, Pseudomonas aeruginosa, as well as ESBL producers of the Enterobacteriaceae that are prevalent in some Middle Eastern and African countries. These clinically important pathogens were reported to possess various ESBL genes of the TEM-, SHV-, CTX-M-families; as well as the carbapenem hydrolyzing metallo-and OXA-type β-lactamases. Other resistance determinants were also reported and include the integron associated qnr gene, and the aac (6')-Ib-cr gene which codes for aminoglycoside resistance and reduced susceptibility to ciprofloxacin. In addition, community acquired infections caused by MRSA and ESBL producers of the Enterobacteriaceae that have been reported in this geographical region will be covered. Because of the disturbing high rates of bacterial resistance to antibiotics in this geographical region, some countries found it compelling to initiate Infection Control programs to hamper the spread of resistant pathogens.