As the global health community grapples with the alarming spread of antimicrobial resistance, Kingdom of Saudi Arabia is confronting its own burgeoning healthcare crisis: the rise of Carbapenem-Resistant Enterobacteriaceae (CRE). The surge in CRE cases presents an urgent public health challenge, one that demands immediate attention and action.
A recent narrative review published in the Journal of Infection and Public Health brings to light the pressing issue of CRE in Saudi Arabia. Authored by Fawzia Alotaibi from the Department of Pathology (Microbiology Section) at King Saud University Medical City, the review synthesizes data on the prevalence, epidemiology, and microbiological characteristics of CRE reported from Saudi Arabia, signifying a clear threat to the nation’s healthcare system.
CRE refers to a family of bacteria that have evolved to resist carbapenem antibiotics, which are typically considered among the last resorts for treating multidrug-resistant infections. The implications of CRE’s resistance are profound, as infections with these bacteria significantly limit treatment options and result in higher rates of morbidity and mortality.
The review, titled “Carbapenem-Resistant Enterobacteriaceae: An update narrative review from Saudi Arabia,” was published in the 2019 July-August issue with the digital object identifier (DOI): 10.1016/j.jiph.2019.03.024. The article carries a unique identifier S1876-0341(19)30134-0.
The Prevalence of CRE in Saudi Arabia
The occurrence of CRE infections in Saudi Arabia has mirrored global trends, exhibiting a worrying increase in reported cases over the past years. The narrative review conducted by Alotaibi underscores the gravity of the situation, identifying a spike in the prevalence of CRE across multiple healthcare settings. This rise has been documented not just in adult patients, but alarmingly, in pediatric populations as well.
Epidemiological Factors Contributing to CRE Spread
Several epidemiological factors contribute to the proliferation of CRE in Saudi Arabia. The country’s centralized healthcare system, with patients often referred to tertiary hospitals, may facilitate the spread of these resistant bacteria. In addition, the high rate of international travel and the pilgrimage rituals connected to Hajj and Umrah—which draw millions annually—exacerbate the challenge of containing such infections.
Microbiological Characteristics of CRE
CRE encompasses various species of Enterobacteriaceae, including Klebsiella pneumoniae and Escherichia coli that are resistant to carbapenem antibiotics due to the production of enzymes such as carbapenemases. The review identifies the presence of these resistance mechanisms in isolates tested in Saudi labs, highlighting the adaptability of these bacteria and the difficulties in treating infections they cause.
Public Health Implications and Strategies
The rise of CRE has significant implications for public health and patient outcomes in Saudi Arabia. Infections with CRE are associated with prolonged hospital stays, increased healthcare costs, and higher mortality rates. The article suggests the urgent need for surveillance programs, stewardship initiatives, and reinforcement of infection control policies to mitigate the spread of CRE.
The review suggests several measures that could be undertaken to limit the spread of CRE in Saudi Arabia. These include enhancing antimicrobial stewardship programs that promote the judicious use of antibiotics, strengthening infection control measures, and improving microbiological diagnostic capabilities to detect CRE promptly.
References
1. Alotaibi, F. (2019). Carbapenem-Resistant Enterobacteriaceae: An update narrative review from Saudi Arabia. Journal of Infection and Public Health, 12(4), 465-471. doi: 10.1016/j.jiph.2019.03.024.
2. World Health Organization (WHO). (2017). Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities.
3. Centers for Disease Control and Prevention (CDC). (2019). Antibiotic Resistance Threats in the United States.
4. Tzouvelekis, L. S., Markogiannakis, A., Psichogiou, M., Tassios, P. T., & Daikos, G. L. (2012). Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. Clinical Microbiology Reviews, 25(4), 682-707.
5. Al-Badr, A., & Al-Shaikh, G. (2013). Recurrent urinary tract infections management in women: A review. Sultan Qaboos University Medical Journal, 13(3), 359–367.
Keywords
1. Carbapenem-Resistant Enterobacteriaceae Saudi Arabia
2. CRE Infection Control
3. Antimicrobial Resistance Middle East
4. Saudi Healthcare CRE Challenge
5. Antibiotic Stewardship Programs Saudi
The reported increase in CRE in Saudi Arabia calls for a multifaceted response, integrating advanced scientific methodology and robust public health strategies. Surveillance needs to be beefed up and international collaboration should be encouraged to share insights and best practices in the pursuit of curbing this dire public health threat. As CRE continues to challenge health systems worldwide, Saudi Arabia’s proactive engagement in battling this crisis will not only benefit the nation but will also contribute to the global effort against antibiotic resistance.