这项研究的目的是评估埃及的抗菌素耐药性(AMR)状况以及COVID-19对AMR的影响,伊拉克,乔丹,黎巴嫩,并就该地区实施抗菌药物管理(AMS)计划的障碍收集专家意见。
使用横断面问卷调查来评估当前的AMR景观,现有的AMS计划,实施AMS计划的障碍,以及COVID-19对四个国家AMR的影响。
这项调查由来自埃及的204名医生(n=82)完成,黎巴嫩(n=49),伊拉克(n=43),和约旦(n=30)。先前的抗生素使用和先前的细菌定植被认为是AMR增加的最常见的风险因素。根据调查,多药耐药(MDR)革兰阴性菌最常见于下呼吸道感染,肺炎克雷伯菌和大肠杆菌是医院感染中最常见的革兰氏阴性菌。只有14.8%的儿科医师和28.6%的成年医师报告说,目标病原体基因分型和表型分型是在医院进行的,缺乏测试的最常见原因是技术和资源限制。这些限制,再加上新型抗生素的稀缺性和高成本,已被确定为该地区成功管理MDR革兰氏阴性细菌感染的最重要障碍。据报道,抗生素的活性和安全性,感染部位,合并症的存在,和已出版的指南和当地抗生素确定了该地区患者经验性抗生素治疗的选择。由于COVID-19大流行期间的几个因素,这四个国家的AMR显着上升,包括医院占用率的增加,优先事项从AMR监控转移,和AMR流行病学的变化。此外,COVID-19大流行期间大量不必要且未经证实的抗生素处方导致该地区随后的抗生素短缺和AMR显著增加.医生还指出,大多数COVID-19患者在访问医疗机构之前已经使用了抗生素。在重症监护病房收治的大多数COVID-19患者中发现了MDR革兰氏阴性菌。尽管已经实施了各种AMS倡议,它们在整个地区都没有标准化。该地区实施AMS的一些主要障碍是缺乏训练有素的AMS人员,缺乏医疗专业人员的AMS知识和培训,财政限制,缺乏AMR监测系统。
这些调查结果为该地区现有的AMR和AMS景观提供了宝贵的见解,以及阻碍高效AMS和AMR管理的障碍。基于这些发现,作者提出了一项行动呼吁,为该地区的每个国家提出了应对这些挑战的方法。
The objective of this
study was to assess the antimicrobial resistance (AMR) landscape and the impact of COVID-19 on AMR in Egypt, Iraq, Jordan, and Lebanon, and to gather expert opinions on the barriers to the implementation of antimicrobial stewardship (AMS) initiatives in the region.
A cross-sectional questionnaire survey was used to assess the current AMR landscape, existing AMS initiatives, barriers to implementing AMS initiatives, and the impact of COVID-19 on AMR in the four countries.
The survey was completed by 204 physicians from Egypt (n = 82), Lebanon (n = 49), Iraq (n = 43), and Jordan (n = 30). Previous antibiotic use and previous bacterial colonization were perceived as the most common risk factors for an increase in AMR. According to the survey, multidrug-resistant (MDR) gram-negative bacteria were most common in lower respiratory tract infections, and Klebsiella pneumoniae and Escherichia coli were the most commonly identified gram-negative bacteria in hospital-acquired infections. Only 14.8% of pediatric physicians and 28.6% of adult physicians reported that target pathogen genotyping and phenotyping were done in hospitals, and the most commonly reported reasons for the lack of testing were technological and resource constraints. These constraints, coupled with the scarcity and high cost of newer antibiotics, have been identified as the most significant barriers to the successful management of MDR gram-negative bacterial infections in the region. It was reported that the spectrum of activity and safety of the antibiotic, the site of infection, the presence of comorbidities, and published guidelines and local antibiograms determined the choice of empirical antibiotic therapy for patients in the region. The four countries experienced a significant rise in AMR due to several factors during the COVID-19 pandemic, including an increase in hospital occupancy, a shift in priorities away from AMR surveillance, and changes in AMR epidemiology. Additionally, the large volumes of unnecessary and unsubstantiated antibiotic prescriptions during the COVID-19 pandemic has led to subsequent antibiotic shortages and significant increases in AMR in the region. Physicians also noted that the majority of COVID-19 patients were already on antibiotics before visiting the healthcare facility. MDR gram-negative bacteria were found in the majority of COVID-19 patients admitted to the intensive care unit. Despite the fact that various AMS initiatives have been implemented, they are not standardized across the region. Some of the main barriers to AMS implementation in the region are a lack of adequately trained AMS staff, lack of AMS knowledge and training among healthcare professionals, financial constraints, and the lack of AMR surveillance systems.
These survey results provide valuable insights into the existing AMR and AMS landscape in the region, as well as the barriers that impede efficient AMS and AMR management. Based on these findings, the authors developed a call to action that suggests ways for each country in the region to address these challenges.