A systematic review of Antimicrobial Stewardship Program implementation in Middle Eastern countries

Abstract

Background: Antimicrobial resistance is a serious threat to global health. Antimicrobial Stewardship Programs (ASPs) are adopted by healthcare systems worldwide. This review aimed to evaluate the published practices of ASPs in Middle Eastern countries. Methods: Searches were carried out in PubMed/MEDLINE, Embase, EBSCO, Cochrane Library, Google, and Google Scholar electronic databases for studies published from January 2005 to December 2020 that assessed ASP practices in Middle Eastern countries, following PRISMA guidelines. Results: Of the 422 titles identified, 20 studies met the inclusion criteria. Eight studies were conducted in the Kingdom of Saudi Arabia, five in Qatar, two each in Lebanon and Jordan, and one each in Palestine and UAE; there was also one multinational study. Different ASP practices, including prospective auditing and feedback, pre-authorization, tracking, antibiotic restriction, education, de-escalation, and intravenousto-oral switch, were reported. ASP practices correlated with improved susceptibility rates and decreases in antimicrobial use. Conclusion:The outcomes of this review reveal the scarcity of data on ASP practices. The introduction of ASPs in hospitals in Middle Eastern countries has led to favorable clinical effects. Policymakers and stakeholders should promote and invest in implementing these programs as an essential component of their healthcare systems.

Exploring Information Available to and Used by Physicians on Antibiotic Use and Antibiotic Resistance in Jordan

“…Therefore, it has been recommended to tailor efforts toward the implementation of antibiotic stewardship broadly in Jordan in order to enhance antibiotic utilization. This was also supported in several studies conducted in the Middle East that suggested more effective awareness strategies [ 63 , 64 ].…”

Challenges to Antimicrobial Stewardship in the Countries of the Arab League: Concerns of Worsening Resistance during the COVID-19 Pandemic and Proposed Solutions

“…Yet, the majority of the AMR data is generated by hospital laboratories and therefore may be more biased towards AMR in nosocomial organisms [ 30 , 31 , 32 ]. Several reports describe the AMS efforts in the Arab world [ 29 , 40 , 41 ] showing the successful implementation of stewardship programs to promote appropriate antibiotic use.…”

“…Though AMS efforts and results are limited, major efforts ensued to improve surveillance (as evidenced by the reporting through GLASS); and some countries in the GCC have had a good start with AMS (though results of AMS interventions are not published yet). Despite the absence of a pan-Arab AMS network, several initiatives on various fronts have culminated in establishing point prevalence surveys of infections, developing regional guidelines for the management of MDR infections [ 28 ], creating national action plans [ 29 , 30 ], strengthening regional networks and promoting AMS awareness and education among healthcare workers [ 42 ]. Experts from the Arab countries are also contributing to global AMS efforts as members of international organizations such as the WHO, the Alliance for Prudent Use of Antibiotics (APUA), the Surveillance and Epidemiology of Drug-Resistant Infections Consortium (SEDRIC), and other global networks [ 28 ].…”

“…The possible solutions needed in this area of the world to overcome the aforementioned obstacles include interventions such as strengthening AMR governance efforts at all levels, starting from the highest decision-making political level to the hospital administrative level reaching the individual practitioner. This can be achieved by prioritizing this issue in the ministries of health and the hospital organograms, and by creating independent entities on AMS and Infection Prevention and Control (IPC) with dedicated personnel and budget, along with clear road maps and key quality performance indicators [ 19 , 29 ]. At the healthcare facility and academic levels, improving targeted AMR education of healthcare workers in general is of utmost importance.…”

“…GCC countries have established national AMR surveillance plans in collaboration with the WHO[27]. In contrast, some of the Arab countries in North Africa and the Levant suffer from political instability and conflicts that have weakened their health infrastructures and displaced millions of people, hence hindering AMR surveillance[14,28,29].From the pre-COVID-19 era, AMR figures were alarming in the Arab world. High proportions of carbapenem resistance in Acinetobacter spp.…”