Background There is a lack of official national antimicrobial resistance (AMR) data in Lebanon. Individual hospitals generate their own antibiotic susceptibility data in the form of yearly pamphlets. Methods In this study, antibiotic susceptibility data from 13 hospitals distributed across different governorates of Lebanon were collected to conduct a compilation-based surveillance of AMR in Lebanon for the years 2015–2016. The findings were compared with those of a previous nationwide study in this country conducted between 2011 and 2013 as well as with similar data obtained from the 2015 and 2016 European surveillance reports of AMR. To provide a clear presentation of the AMR situation, mean percent susceptibility of different antibiotic–microbe combinations was calculated. Results During 2015–2016, the percent susceptibility of Enterobacteriaceae to third-generation cephalosporins and to carbapenems was 59 and 97%, respectively. Among Pseudomonas aeruginosa and Acinetobacter spp., carbapenem susceptibility reached 70 and 12%, respectively. Among Gram positive organisms, the percent susceptibility to methicillin in Staphylococcus aureus was 72%, that to vancomycin in Enterococcus spp. was 98% and that to penicillin in Streptococcus pneumoniae was 75%. Compared with results of 2011–2013, there was an overall trend of decreased susceptibility of bacteria to the tested antibiotics, with a variation of 5 to 10%. The antibiotic susceptibility data from Lebanon were found to be comparable with those from Eastern and South-eastern European countries. Conclusion This study highlights the need to establish a robust national AMR surveillance system that enables data from Lebanon to be included in global AMR maps. Electronic supplementary material The online version of this article (10.1186/s13756-019-0487-5) contains supplementary material, which is available to authorized users.

The treatment of infections caused by multidrug-resistant Gram-negative bacteria is challenging given the limited options for effective therapy. Combination therapy has garnered great interest recently, with the goals of ensuring appropriate therapy with at least one active agent, and achieving synergistic activity among the anti-microbials used. In this review, we evaluate the data supporting the use of combination therapy against Pseudomonas aeruginosa, carbapenem-resistant Enterobacteriaceae, Acinetobacter species and Stenotrophomonas maltophilia. Various regimens have been tried with promising results; however, the data are mostly derived from in vitro synergy studies. While these reports suggest an advantage of combination therapy over monotherapy, clinical data are scarce, and are comprised of retrospective and a few prospective observational studies. Well-designed randomized trials are needed to better elucidate the efficacy of the various combination regimens. Until then, this review offers a critical appraisal of the published literature and provides recommendations based on the available evidence.

Aspergillus mastoiditis usually occurs in immunocompromised patients. There are a few isolated reports in the literature involving immunocompetent patients. We hereby describe the case of an immunocompetent patient diagnosed with invasive Aspergillus mastoiditis, which was treated successfully, and review the literature pertaining to this condition. The common clinical presentations, putative pathophysiology, and recommended therapy are discussed.

Lebanon yearly witnesses a high flux of expatriates and workers from Dengue virus (DENV) endemic regions. Multiple cases of Dengue fever have been documented at the American University of Beirut Medical Center (AUBMC) in travellers to endemic regions. Given the presence of the Aedes aegypti mosquito in Lebanon, introduction of DENV to the country is highly likely. We report a case of DENV infection in Lebanon diagnosed in April 2012 in a patient with no prior travel history. The patient presented with fever (39°C) and lower urinary tract symptoms and was initially diagnosed with culture negative prostatitis. He was started on empiric antibiotics but continued to have severe headache, diffuse myalgias, bone pain, and fatigue. He later developed a faint rash with leukopenia and thrombocytopenia. Extensive work-up was unrevealing. DENV IgM and IgG were positive suggesting acute infection. This is the first reported case since 1945 from Lebanon in a patient with no prior travel history.