Prevalence of multiple-resistant Escherichia coli strains in southern and eastern Mediterranean countries

Abstract number: 1733_844

Borg M.A., Scicluna E.A., de Kraker M., van de Sande-Bruinsma N., Tiemersma E.W., Monen J., Grundmann H., Collaborators ARMed Project

Objective: Resistance to Escherichia coli is fast becoming a major challenge in many countries. The Antibiotic Resistance Surveillance and Control in the Mediterranean Region (ARMed) project [] provided a first time opportunity for a longitudinal multi-year study of trends of antimicrobial resistance amongst this species within countries of the southern and eastern Mediterranean.

Methods: ARMed collected routine susceptibility test results of more than 4,000 invasive isolates of E. coli from blood cultures tested by laboratories in Algeria, Cyprus, Egypt, Jordan, Lebanon, Malta, Morocco, Tunisia and Turkey. Identical protocols were used as those of the European Antimicrobial Resistance Surveillance System (EARSS), including testing of aminopenicillin, third generation cephalosporins (3GC), fluoroquinolones (Fq) and aminoglycosides.

Results: The proportion of aminopenicillin resistant E. coli in 2005 varied between 49% (Malta) and 83% (Lebanon), with a significant increase observed in Turkey: 68% to 75% between 2003 and 2005. The highest proportion of aminoglycoside resistance was observed in Egypt (57% in 2005), whereas the lowest proportion was reported by Malta (7%). Between 2003 and 2005 a significant increase was seen in Morocco from 12% to 33%, and a significant decrease was reported by Malta from 18% to 7%.

Resistance to 3GC varied widely from 1% in Malta to 70% in Egyptian centres in 2005. Between 2003 and 2005, Morocco and Turkey showed a significant increase in resistance from 2% to 28% and 26% to 31% respectively. Levels of Fq resistance in excess of 40% were reported by Egypt and Turkey where a significant increase was observed.

In excess of 15% of isolates from Turkey, Morocco, Jordan and Egypt were multi-resistant to all 4 classes of antimicrobials. The Egyptian centres, in particular, showed consistent increase in multiresistant E. coli during the 3 years of the project to reach a level in excess of 38% in the final year.

Conclusion: Several southern and eastern countries in the Mediterranean show evidence of significant resistance within E. coli, especially to 3GC and Fq, which are considerably higher than that reported by EARSS in the European counterpart countries of the same region. Of particular importance appear to be strains which are multiresistant to several major antimicrobial groups and which can potentially spread outside of the region due to the heavy human traffic in this area of the world.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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