Antibiotic resistance in the south-eastern Mediterranean: preliminary results from the ARMed Project
Abstract number: 1134_04_200
Borg M.A., Scicluna E.A., Tiemersma E., on behalf of ARMed Steering Group
Few standardised studies have looked at the prevalence of antibiotic resistance in the south-east Mediterranean. The Antibiotic Resistance Surveillance & Control in the Mediterranean Region project (Acronym: ARMed) was initialised in January 2003 and is financed by the European Commission under INCOMED-FP5. This project extends European surveillance studies EARSS, ESAC and HARMONY to southern and eastern Mediterranean partner countries to improve epidemiological analysis of antimicrobial resistance and antibiotic consumption and to identify infection control practices in participating centres [http://www.slh.gov.mt/armed].
A total of 29 laboratories from Cyprus, Egypt, Jordan, Malta, Morocco, Tunisia and Turkey are taking part. Targeted surveillance of antibiotic resistance is being undertaken by means of collection of comparable antimicrobial susceptibility results through the use of a standardised protocol and selection of specific medically important bacteria isolated from blood cultures and cerebrospinal fluid. A methodology conformant with that adopted by the European Antimicrobial Resistance Surveillance System (EARSS) [http://www.earss.rivm.nl] has been agreed. Results are validated by a concurrent quality assurance and proficiency testing programme.
Methicillin resistance in Staphylococcus aureus appears to be the major challenge of the region with rates ranging from 17.8% to 66.1%. In four of the participating countries, methicillin resistance was detected in more than 40% of isolates. Resistance in other nosocomial isolates was significantly more heterogenous. Third generation cephalosporin resistance in Escherichia coli varied widely from 3.7% in Malta up to 76.6% in participating Egyptian hospitals. There was less variation in quinolone resistance within the same species with a range of 12.539.6%. Vancomycin resistance in enterococci is relative rare with only Turkey reporting 1.1% of strains showing glycopeptide non-susceptibility. Penicillin resistance in Streptococcus pneumoniae is on the whole low, with Jordan and Egypt being the only two countries where levels exceed 15%, although macrolide resistance is more common.
This initial antimicrobial susceptibility data indicates that the epidemiology of resistance in the south-eastern Mediterranean shows a significant heterogeneity but is on the whole equal or at times higher than identified in northern countries of the same region by the EARSS network.
|Session name:||XXIst ISTH Congress|
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