Historical Overview of the Evolution of Multidrug-Resistant Gram-Negative Infections in Tunisia from 1999 to 2019

<b>Background/Objectives</b>: As antimicrobial resistance patterns of Gram-negative bacteria change over time, this study aimed to analyze the antimicrobial susceptibility trends of <i>Escherichia coli</i>, <i>Klebsiella pneumoniae</i>, <i>Pseudomonas aerugi...

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Main Authors: Lamia Kanzari, Sana Ferjani, Basma Mnif, Faouzia Mahjoubi, Mariem Zribi, Khaoula Meftah, Asma Ferjani, Emna Mhiri, Yomna Ben Lamine, Yosr Kadri, Habiba Naija, Manel Hamdoun, Yosra Chebbi, Sarra Dhraief, Naglaa Mohamed, Hela Zaghden, Lamia Thabet, Wafa Achour, Olfa Bahri, Farouk Barguellil, Maha Mastouri, Sophia Besbes, Leila Slim, Hanen Smaoui, Adnene Hammami, Ilhem Boutiba-Ben Boubaker
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Language:English
Published: MDPI AG 2025-06-01
Series:Antibiotics
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Online Access:https://www.mdpi.com/2079-6382/14/7/657
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author Lamia Kanzari
Sana Ferjani
Basma Mnif
Faouzia Mahjoubi
Mariem Zribi
Khaoula Meftah
Asma Ferjani
Emna Mhiri
Yomna Ben Lamine
Yosr Kadri
Habiba Naija
Manel Hamdoun
Yosra Chebbi
Sarra Dhraief
Naglaa Mohamed
Hela Zaghden
Lamia Thabet
Wafa Achour
Olfa Bahri
Farouk Barguellil
Maha Mastouri
Sophia Besbes
Leila Slim
Hanen Smaoui
Adnene Hammami
Ilhem Boutiba-Ben Boubaker
author_facet Lamia Kanzari
Sana Ferjani
Basma Mnif
Faouzia Mahjoubi
Mariem Zribi
Khaoula Meftah
Asma Ferjani
Emna Mhiri
Yomna Ben Lamine
Yosr Kadri
Habiba Naija
Manel Hamdoun
Yosra Chebbi
Sarra Dhraief
Naglaa Mohamed
Hela Zaghden
Lamia Thabet
Wafa Achour
Olfa Bahri
Farouk Barguellil
Maha Mastouri
Sophia Besbes
Leila Slim
Hanen Smaoui
Adnene Hammami
Ilhem Boutiba-Ben Boubaker
author_sort Lamia Kanzari
collection DOAJ
description <b>Background/Objectives</b>: As antimicrobial resistance patterns of Gram-negative bacteria change over time, this study aimed to analyze the antimicrobial susceptibility trends of <i>Escherichia coli</i>, <i>Klebsiella pneumoniae</i>, <i>Pseudomonas aeruginosa</i>, and <i>Acinetobacter baumannii</i> isolates in Tunisia. <b>Methods</b>: From 1999 to 2019, non-duplicate isolates of Gram-negative bacteria were collected from 11 Tunisian hospitals as part of an antimicrobial resistance surveillance program. Antimicrobial susceptibility testing was performed using the disk diffusion method according to the European Committee on Antimicrobial Susceptibility Testing guidelines. <b>Results</b>: Out of 213,434 isolates collected during the study period, 58.8% were <i>E. coli</i>, 22% were <i>K. pneumoniae</i>, 14.4% were <i>A. baumannii</i>, and 4.8% were <i>P. aeruginosa</i>, with 67% of the isolates sourced from urine samples. <i>E. coli</i> showed a significant increase in resistance to third-generation cephalosporins (3GC), from 5.4% in 2004 to 16.5% in 2019, but <i>K. pneumoniae</i> displayed a rising trend of resistance to imipenem, from 1% in 2005 to 18.6% in 2019; meanwhile, amikacin remained effective against <i>K. pneumoniae</i> isolates. <i>P. aeruginosa</i> did not exhibit a significant change in resistance to imipenem. <i>A. baumannii</i> had a high resistance rate to imipenem that increased from 34.5% in 2008 to 84.2% in 2019 and had low susceptibility rates to all other antibiotics tested. <b>Conclusions</b>: This study reveals high carbapenem resistance among <i>K. pneumoniae</i> and <i>A. baumannii</i> in Tunisia. <i>A. baumannii</i> shows alarming multidrug resistance that requires urgent control measures.
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spelling doaj-art-22e3badab8694bd8923015b4a41b7acf2025-08-20T03:13:41ZengMDPI AGAntibiotics2079-63822025-06-0114765710.3390/antibiotics14070657Historical Overview of the Evolution of Multidrug-Resistant Gram-Negative Infections in Tunisia from 1999 to 2019Lamia Kanzari0Sana Ferjani1Basma Mnif2Faouzia Mahjoubi3Mariem Zribi4Khaoula Meftah5Asma Ferjani6Emna Mhiri7Yomna Ben Lamine8Yosr Kadri9Habiba Naija10Manel Hamdoun11Yosra Chebbi12Sarra Dhraief13Naglaa Mohamed14Hela Zaghden15Lamia Thabet16Wafa Achour17Olfa Bahri18Farouk Barguellil19Maha Mastouri20Sophia Besbes21Leila Slim22Hanen Smaoui23Adnene Hammami24Ilhem Boutiba-Ben Boubaker25National Reference Laboratory on Antimicrobial Resistance Surveillance, Tunis 1006, TunisiaNational Reference Laboratory on Antimicrobial Resistance Surveillance, Tunis 1006, TunisiaLaboratory of Microbiology of Sfax University Hospital Center, Sfax 3000, TunisiaLaboratory of Microbiology of Sfax University Hospital Center, Sfax 3000, TunisiaLaboratory of Microbiology, La Rabta Hospital, Tunis 1007, TunisiaLaboratory of Microbiology, Bechir Hamza Children’s Hospital, Tunis 1006, TunisiaNational Reference Laboratory on Antimicrobial Resistance Surveillance, Tunis 1006, TunisiaLaboratory of Microbiology, Abderrahmen Mami Hospital, Ariana 2080, TunisiaLaboratory of Microbiology, Mohamed Kassab Orthopaedics Institute, La Manouba 2010, TunisiaLaboratory of Microbiology, Fatouma Bourguiba Hospital, Monastir 5000, TunisiaLaboratory of Microbiology, Military Hospital, Tunis 1008, TunisiaLaboratory of Clinical Biology, Aziza Othmana Hospital, Tunis 1008, TunisiaLaboratory Department, Bone and Marrow Transplantation Center, Tunis 1006, TunisiaLaboratory of Clinical Biology, Burn and Trauma Center, Ben Arous 2013, TunisiaPfizer Inc., New York, NY 10001-2192, USAPfizer Inc., Tunis 1053, TunisiaLaboratory of Clinical Biology, Burn and Trauma Center, Ben Arous 2013, TunisiaLaboratory Department, Bone and Marrow Transplantation Center, Tunis 1006, TunisiaLaboratory of Clinical Biology, Aziza Othmana Hospital, Tunis 1008, TunisiaLaboratory of Microbiology, Military Hospital, Tunis 1008, TunisiaLaboratory of Microbiology, Fatouma Bourguiba Hospital, Monastir 5000, TunisiaLaboratory of Microbiology, Mohamed Kassab Orthopaedics Institute, La Manouba 2010, TunisiaLaboratory of Microbiology, Abderrahmen Mami Hospital, Ariana 2080, TunisiaLaboratory of Microbiology, Bechir Hamza Children’s Hospital, Tunis 1006, TunisiaLaboratory of Microbiology of Sfax University Hospital Center, Sfax 3000, TunisiaNational Reference Laboratory on Antimicrobial Resistance Surveillance, Tunis 1006, Tunisia<b>Background/Objectives</b>: As antimicrobial resistance patterns of Gram-negative bacteria change over time, this study aimed to analyze the antimicrobial susceptibility trends of <i>Escherichia coli</i>, <i>Klebsiella pneumoniae</i>, <i>Pseudomonas aeruginosa</i>, and <i>Acinetobacter baumannii</i> isolates in Tunisia. <b>Methods</b>: From 1999 to 2019, non-duplicate isolates of Gram-negative bacteria were collected from 11 Tunisian hospitals as part of an antimicrobial resistance surveillance program. Antimicrobial susceptibility testing was performed using the disk diffusion method according to the European Committee on Antimicrobial Susceptibility Testing guidelines. <b>Results</b>: Out of 213,434 isolates collected during the study period, 58.8% were <i>E. coli</i>, 22% were <i>K. pneumoniae</i>, 14.4% were <i>A. baumannii</i>, and 4.8% were <i>P. aeruginosa</i>, with 67% of the isolates sourced from urine samples. <i>E. coli</i> showed a significant increase in resistance to third-generation cephalosporins (3GC), from 5.4% in 2004 to 16.5% in 2019, but <i>K. pneumoniae</i> displayed a rising trend of resistance to imipenem, from 1% in 2005 to 18.6% in 2019; meanwhile, amikacin remained effective against <i>K. pneumoniae</i> isolates. <i>P. aeruginosa</i> did not exhibit a significant change in resistance to imipenem. <i>A. baumannii</i> had a high resistance rate to imipenem that increased from 34.5% in 2008 to 84.2% in 2019 and had low susceptibility rates to all other antibiotics tested. <b>Conclusions</b>: This study reveals high carbapenem resistance among <i>K. pneumoniae</i> and <i>A. baumannii</i> in Tunisia. <i>A. baumannii</i> shows alarming multidrug resistance that requires urgent control measures.https://www.mdpi.com/2079-6382/14/7/657Gram-negative bacteriaantibioticsantimicrobial resistancedisk diffusion methodTunisian hospitalsevolution
spellingShingle Lamia Kanzari
Sana Ferjani
Basma Mnif
Faouzia Mahjoubi
Mariem Zribi
Khaoula Meftah
Asma Ferjani
Emna Mhiri
Yomna Ben Lamine
Yosr Kadri
Habiba Naija
Manel Hamdoun
Yosra Chebbi
Sarra Dhraief
Naglaa Mohamed
Hela Zaghden
Lamia Thabet
Wafa Achour
Olfa Bahri
Farouk Barguellil
Maha Mastouri
Sophia Besbes
Leila Slim
Hanen Smaoui
Adnene Hammami
Ilhem Boutiba-Ben Boubaker
Historical Overview of the Evolution of Multidrug-Resistant Gram-Negative Infections in Tunisia from 1999 to 2019
Antibiotics
Gram-negative bacteria
antibiotics
antimicrobial resistance
disk diffusion method
Tunisian hospitals
evolution
title Historical Overview of the Evolution of Multidrug-Resistant Gram-Negative Infections in Tunisia from 1999 to 2019
title_full Historical Overview of the Evolution of Multidrug-Resistant Gram-Negative Infections in Tunisia from 1999 to 2019
title_fullStr Historical Overview of the Evolution of Multidrug-Resistant Gram-Negative Infections in Tunisia from 1999 to 2019
title_full_unstemmed Historical Overview of the Evolution of Multidrug-Resistant Gram-Negative Infections in Tunisia from 1999 to 2019
title_short Historical Overview of the Evolution of Multidrug-Resistant Gram-Negative Infections in Tunisia from 1999 to 2019
title_sort historical overview of the evolution of multidrug resistant gram negative infections in tunisia from 1999 to 2019
topic Gram-negative bacteria
antibiotics
antimicrobial resistance
disk diffusion method
Tunisian hospitals
evolution
url https://www.mdpi.com/2079-6382/14/7/657
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