Antimicrobial resistance among GLASS pathogens in Morocco: an epidemiological scoping review

Abstract

Background Monitoring of antimicrobial resistance (AMR) is of great importance due to the frequency of strains becoming increasingly resistant to antibiotics. This review, using a public health focused approach, which aims to understand and describe the current status of AMR in Morocco in relation to WHO priority pathogens and treatment guidelines. Methods PubMed, ScienceDirect and Google Scholar Databases and grey literature are searched published articles on antimicrobial drug resistance data for GLASS priority pathogens isolated from Morocco between January 2011 and December 2021. Articles are screened using strict inclusion/exclusion criteria. AMR data is extracted with medians and IQR of resistance rates. Results Forty-nine articles are included in the final analysis. The most reported bacterium is Escherichia coli with median resistance rates of 90.9%, 64.0%, and 56.0%, for amoxicillin, amoxicillin-clavulanic acid, and co-trimoxazole, respectively. Colistin had the lowest median resistance with 0.1%. A median resistance of 63.0% is calculated for amoxicillin-clavulanic acid in Klebsiella pneumonia. Imipenem resistance with a median of 74.5% is reported for Acinetobacter baumannii. AMR data for Streptococcus pneumonie does not exceed 50.0% as a median. Conclusions Whilst resistance rates are high for most of GLASS pathogens, there are deficient data to draw vigorous conclusions about the current status AMR in Morocco. The recently join to the GLASS system surveillance will begin to address this data gap.

The Public health problem and resistant bacteria in lowand middle-income countries

“…However, there are also studies showing higher rates of resistance to other classes of antimicrobials -Fluoroquinolones and Cephalosporins (9,32). Regarding K. pneumoniae, this study had similar results to those from Mexico and Tanzania, where the isolates had the second highest proportion of MDR profiles, and Morocco, where in addition to MDR status an alarming rate of carbapenemase-producing strains was detected (2,29,32). The results obtained on carbapenemase production by ord.…”

“…However, many studies focus on various aspects of AMR occurrence and "frequency" in the health system, society, and the environment. Three studies conducted in Cameroon, Morocco, and Vietnam showed Enterobacteriaceae as the most frequently isolated microorganisms, followed by S. aureus, as we determined, but Camara N. and Haeeb A. determined an opposite situation in Tanzania and Saudi Arabia (2,9,27,28,29). When analyzing isolates according to the source (biosubstrate), studies focusing on uropathogens showed that E. coli is the most frequent uropathogen followed by K. pneumoniae (in Ethiopia and USA), compared to 2 studies from Romania showing 2 distinct situations -one study showed a similar situation as in Ethiopia, and the second one showed a distinct situation -with P. aeruginosa on the first place similar to the one in Mexico (14, 25, 30 31, 32).…”

“…If we look at the Gram-negative microorganisms as a whole, part of the ESKAPE group, the trend of MDR strains (either XDR or PDR) circulation is constantly increasing, even reaching 100% in some LMICs. This phenomenon will inevitably create huge treatment costs, potentially amounting to tens of millions of dollars, as estimated by Australian epidemiologists (26,29,32,36), calculated for a one-year period in Australia. LMICs do not have sufficient financial resources to treat pa-2020 tients and combat the long-term effects of reduced work capacities of the ill population, as well as the environmental damage and impacts on other economic sectors.…”