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Antibiotic resistance in Libya-1970 2011
 

Antibiotic resistance in Libya-1970 2011

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    Antibiotic resistance in Libya-1970 2011 Antibiotic resistance in Libya-1970 2011 Presentation Transcript

    • ‫بسم ا الرحمن الرحيم‬ THE STORY OF ANTIBIOTIC RESISTANCE IN LIBYA: 1970-2011 Prof. Khalifa Sifaw Ghenghesh
    • • Resistance to antimicrobial drugs is a major problem that inflicts the whole world. • The problem is still worse in developing countries where lack of antimicrobial-resistance surveys and lack of control policies are the norm.
    • Antimicrobial resistance of Salmonella isolated from diarrheic fecal specimens in Libya % resistant Antibiotic Ampicillin Chloramphenicol Gentamicin Nalidixic acid Ciprofloxacin (or Norfloxacin) Trimethoprimsulphamehtoxazole * 1979-1980 1979-1980 1992-1993 Tripoli Tripoli Tripoli (n=244) (n=238) (n=21) 89 29 52 79 89 52 17 14 43 12 17 0.0 NA* NA 0.0 NA NA=Data not available NA 48 2000-2001 Zliten (n=23) 100 96 78 4 0.0 2008 Tripoli (n=19) 47 5 NA 84 63 4 21
    • Escherichia coli from UTIs in Libya % resistant Antibiotic 1981 1994-1995 Benghazi Tripoli (n=38)1 (n=534)2 Ampicillin Chloramphenicol Gentamicin Nalidixic acid Ciprofloxacin Nitrofurantoin TMP-SMZ 2 2002-2005 Sirte (n=1265)4 2005-2006 Tripoli (n=29)5 2006-2008 Benghazi (n=105)6 22 NA 74 29 75 45 49 23 59 21 57 14 0.0 0.0 7 11 18 10 9 28 10 28 7 23 NA NA NA 2 14 17 0.0 25 7 7 NA 0.0 NA 45 81 36 24 31 Outpatients. Outpatients and inpatients. 1,3,4-6 1996 Benghazi (n=148)3
    • Antimicrobial resistance of Gram-negative bacilli isolated from hospital and community cockroaches (2000-2002) No. (%) resistant Antibiotic Hospital Community Total cockroach cockroach (n=193) (n=246) (n=439) -----------------------------------------------------------------------------------------Ampicillin 141(73) 208(85) 349(80) Augmentin 85(44) 88(36) 173(39) Cephalothin 144(75) 145(59) 289(66) Chloramphenicol 51(26) 39(16) 90(21) Gentamicin 16(8) 0(0) 16(4) Norfloxacin 0(0) 1(0.4) 1(0.2) Tetracycline 59(31) 62(25) 121(28) TMP-SMZ 48(25) 16(7) 64(15) ------------------------------------------------------------------------------------------
    • Resistance of different bacterial pathogens isolated from ice cream in Tripoli (2001-2002). % resistant Antibiotic Gram-negative bacilli Gram-positive cocci (n=48) (n=67) -----------------------------------------------------------------------------------------Ampicillin 83 90 Amoxicillin40 45 clavulanic acid Cefuroxime 25 NT Ciprofloxacin 0.0 6 Gentamicin 0.0 12 Tetracycline 19 24 TMP-SMZ 12.5 25 ------------------------------------------------------------------------------------------
    • Extended Spectrum β-lactamases in Escherichia coli and Klebsiella pneumoniae from Libya E. coli City/Year Source K. pneumoniae No. % No. % Tested ESBL Tested ESBL Tripoli (2002-2003) Clinical specimens 383 8.6 209 15.3 Tripoli (2005-2006) Urine 48 4 - - Benghazi (2006-2008) Urine 105 1.9 42 2.4 Clinical specimens 104 6.7 40 32.5 Libya (2009)
    • Antibiotic Resistance of Gram-Negative Bacilli from Wounds of Combatants of the Libyan Uprising (2011) Antimicrobial agent Amikacin Gentamicin Ertapenem Imipenem Meropenem Cefuroxime Ceftazidime Cefotaxime Cefepime Aztreonam Piperacillin/ tazobactam Trimethoprim/ sulfamethoxazole Ciprofloxacin Colistin 1 Acinetobacter baumannii (n=4) 25 100 100 25 25 100 25 100 25 100 25 Pseudomonas aeruginosa (n=12) 8.3 50 100 8.3 8.3 100 50 100 33.3 50 25 Enteric bacteria1 (n=9) 0.0 88.9 11.1 0.0 0.0 100 100 100 100 100 22.2 100 100 88.9 100 25 58.3 0.0 66.7 NT3 All (100%) isolates are ESBL producers.
    • Methicillin-resistance (MR) among Staphylococcus aureus (SA) from Libya City/Year Tripoli (1995-1996) Tripoli (1995-1996) Tripoli (1998) Tripoli (2004) Tripoli (2005-2006) Benghazi (2007) Tripoli (2007) Tripoli (2008) Source Foods samples Clinical specimens Used bank notes DVDs UTIs Clinical specimens Burn patients HCW No Tested 23 40 50 35 24 200 120 643 % MRSA 0.0 0.0 4 11 21 31 54 37
    • Tuberculosis • • Mycobacterium tuberculosis A serious health problem in Libya. – Estimated incidence rate per 100,000 population (1990-2010) = 40 • First line drugs: – Isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA) and ethambutol (EMB). • Second line drugs: – Fluoroquinolones, aminoglycosides, ethionamide, D-cycloserine and peptides (viomycin and capreomycin). • Isoniazid and rifampicin – keystone drugs in the management of TB – Resistance to either isoniazid or rifampicin may be managed with other firstline drugs • Multidrug-resistant TB (MDR-TB): – Resistance to both isoniazid and rifampicin with or without resistance to other drugs. – MDR-TB demands treatment with second-line drugs that have limited sterilizing capacity, and are less effective and more toxic.
    • Primary, Acquired and Multidrug Resistance among TB Cases in Libya Type of resistance Primary Acquired MDR-New TB cases1 MDRRetreatment cases1 1970-1980 1984-1986 % 2002-2007 13 (9-17) 28 (15-33) NA 11 (4-20) 22 (12-34) NA NA NA 2.6 (0.4-14) NA NA 3 (0.0-8.0) NA NA 3.4 (1.9-5.0) NA NA 39 (10-77) 35 (0.0-75) 20 (14-25) NA NA 3 (0.8-15) NA NA MDR-Total TB cases1 Estimated by WHO. 1 2008 2011
    • Resistance of Neisseria gonorrhoea isolated in Tripoli in 1988/1989 to antibiotics Antibiotic Penicillin Erythromycin Tetracycline Kanamycin Spectinomycin % resistant (n=42) 45.2 11.9 11.9 2.4 2.4
    • In Libya • Lack of trained microbiologists. • Antibiotic Susceptibility testing: – Standard methods are not used. – No control organisms. – Data reporting is not reliable. • Medical doctors: – Lack of interest in infectious diseases. – Misuse of antimicrobial agents in the treatment of infectious diseases. – Lack of interest in educating their patients regarding proper use of antibiotics. •
    • • The community: – Lack of knowledge of the proper use of antibiotics. – No knowledge of the antimicrobial resistance problem. – Misuse and abuse of antimicrobial agents. • The Government: – Lack of control over importation and quality of antibiotics. – Lack of surveys of antibiotic resistance in the country. – Lack of control of antibiotic use in animal husbandry. – Infection prevention and control programs not implemented – No support for research on antibiotic resistance.
    • THE PROBLEM • The high prevalence of resistant bacteria in Libya seems to be related to antibiotic usage – Easy availability without prescription at drug stores, – Injudicious use in hospitals, and – Uncontrolled use in animal husbandry.
    • CONCLUSION • The problem of antibiotic resistance is very serious in Libya, as it appears to be on the increase, particularly with the emergence of resistance to newer drugs that include the fluoroquinolones (e.g. ciprofloxacin) among the clinically important bacterial species.
    • RECOMMENDATIONS • It is urgently required: – To ban the sale of antibiotics without prescription, – To use antibiotics more judiciously in hospitals by intensive teaching of the principles of the use of antibiotics, and – To establish better control measures of nosocomial infections. • Regulation of antimicrobials for other than human use is also required. • These issues are not easy to address and require the collective action of health authorities, the pharmaceutical community, health care providers, and consumers
    • e-mail: ghenghesh_micro@yahoo.com ghenghesh@yahoo.com