Antimicrobial resistance among GLASS pathogens in conflict and non-conflict affected settings in the Middle East: a systematic review

Truppa, Claudia; Abo-Shehada, Mahmoud N.

doi:10.1186/s12879-020-05503-8

Table 1 Summary of the characteristics of the 132 articles included in the systematic review on antimicrobial resistances among GLASS pathogens in conflict and non-conflict affected settings the Middle East

From: Antimicrobial resistance among GLASS pathogens in conflict and non-conflict affected settings in the Middle East: a systematic review

Study characteristics	Number (%)	References
Year of publication
2012	2 (1.5)	[41, 42]
2013	11 (8.3)	[43,44,45,46,47,48,49,50,51]
2014	17 (12.9)	[54,55,56,57,58,59,60,61,62,63,64,65,66,67,68]
2015	34 (25.8)	[71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102]
2016	28 (21.2)	[105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130]
2017	28 (21.2)	[133,134,135,136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152,153,154,155,156,157,158]
2018	12 (9.1)	[161,162,163,164,165,166,167,168,169,170]
Year of completion of data collection
2011	14 (10.6)	[41, 48, 49, 54, 58, 66, 74, 78, 85, 86]
2012	13 (9.8)	[51, 56, 59, 60, 62, 63, 68, 70, 71, 105, 109]
2013	31 (23.5)	[46, 47, 50, 55, 61, 64, 67, 69, 72, 73, 75, 80, 81, 87,88,89, 91, 92, 94, 99,100,101, 113, 120, 123, 127, 132, 145, 153, 155, 159]
2014	26 (19.7)	[57, 65, 76, 79, 83, 84, 90, 93, 95,96,97,98, 104, 114, 116, 124, 125, 129, 130, 135, 149, 154, 157, 158, 160, 167]
2015	31 (23.5)	[77, 82, 102, 103, 106,107,108, 110,111,112, 115, 117,118,119, 121, 122, 126, 128, 131, 134, 136, 140, 142,143,144, 147, 148, 150, 151, 166, 171]
2016	14 (10.6)	[133, 138, 139, 141, 152, 156, 161, 163,164,165, 168,169,170, 172]
2017	3 (2.3)	[137, 146, 162]
Country of publication
Non-conflict affected	81 (61.4)
Bahrain	0 (0)	NA
Egypt	35 (26.5)	[42, 47, 52, 61, 65, 68, 70,71,72,73, 87, 89, 91, 93, 94, 98, 99, 103, 105, 120, 121, 125, 131, 133, 134, 138, 139, 142, 145, 146, 148, 150, 166, 168, 172]
Jordan	8 (6.1)	[49, 57, 88, 119, 132, 161, 163, 169]
Kingdom of Saudi Arabia (KSA)	25 (18.9)	[41, 46, 51, 62, 69, 76, 77, 80, 81, 83, 85, 90, 92, 102, 107, 108, 111, 115,116,117, 135, 136, 154, 164, 170]
Kuwait	1 (0.8)	[130]
Morocco	7 (5.3)	[63, 64, 86, 100, 143, 153, 155]
Oman	0 (0)	NA
Qatar	0 (0)	NA
Tunisia	1 (0.8)	[152]
United Arab Emirates (UAE)	2 (1.5)	[60, 165]
Multiple countries: Egypt and KSA	2 (1.5)	[74, 97]
Fragile and conflict affected	50 (37.9)
Djibouti	0 (0)	NA
Iraq	24 (18.2)	[53, 56, 58, 67, 78, 79, 82, 84, 95, 96, 109, 110, 112, 114, 118, 126, 129, 137, 140, 151, 156, 158, 162, 171]
Israel and the Occupied Palestinian Territories	7 (5.3)	[43, 44, 50, 54, 113, 144, 147]
Lebanon	8 (6.1)	[66, 101, 106, 123, 124, 149, 157, 167]
Libya	6 (4.5)	[48, 59, 75, 104, 159, 160]
Syrian Arab Republic	4 (3.0)	[45, 55, 128, 141]
Yemen	1 (0.8)	[122]
Mixed conflict and non-conflict affected	1 (0.7)
Bahrain, Oman, UAE and Lebanon	1 (0.7)	[127]
Study design
Cross-sectional	16 (12.1)	[45, 50, 74, 78, 91, 93, 95, 96, 102, 107, 122, 138, 144, 146, 163, 164]
Case-control	2 (1.5)	[57, 165]
Cohort	2 (1.5)	[131, 161]
Surveillance	9 (6.8)	[52, 109, 116, 123, 127, 135, 149, 159, 160]
Not specified	103 (78.1)	[41, 42, 46,47,48,49, 51, 53,54,55,56, 58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73, 75,76,77, 80,81,82,83,84,85,86,87,88,89,90, 92, 94, 97,98,99,100,101, 103,104,105,106, 108, 110,111,112,113,114,115, 117,118,119,120,121, 124,125,126, 128,129,130, 132,133,134, 136, 137, 139,140,141,142,143, 145, 147, 148, 150,151,152,153,154,155,156,157,158, 162, 166,167,168,169,170,171,172]
Study setting
Hospital	66 (50.0)	[46, 51,52,53, 55, 56, 59, 61, 62, 64, 65, 67, 68, 71, 72, 75,76,77, 81,82,83,84, 86, 87, 89,90,91,92,93, 96, 99,100,101, 103, 104, 107,108,109, 111, 114, 115, 119, 121, 131,132,133, 136, 142, 144, 146,147,148, 150, 155,156,157,158, 161, 162, 164, 168, 170, 172]
Laboratory	55 (41.7)	[41, 45, 49, 54, 58, 60, 63, 66, 69, 70, 73, 78,79,80, 85, 88, 94, 97, 98, 106, 110, 112, 113, 116,117,118, 120, 123,124,125,126,127,128,129, 134, 135, 137,138,139,140,141, 143, 145, 149, 151,152,153,154, 159, 160, 165,166,167, 169, 171]
Primary care	4 (3.0)	[50, 74, 122, 130]
Community	3 (2.3)	[95, 102, 163]
Mixed	4 (4.0)	[43, 44, 57, 105]
Source of data
Inpatients	66 (50.0)	[41, 42, 46,47,48, 51,52,53,54,55,56, 60,61,62,63, 65, 68, 69, 71,72,73, 82, 83, 85, 86, 89,90,91,92, 96, 99,100,101, 103, 104, 106,107,108,109,110,111, 115,116,117,118, 121, 124, 126, 131, 133, 134, 136, 138,139,140, 147, 150, 151, 153, 156, 159, 161, 162, 167, 168, 172]
Outpatients	12 (9.1)	[50, 57, 59, 74, 77, 84, 97, 114, 122, 130, 132, 155]
Healthcare workers	5 (3.8)	[81, 87, 144, 148, 170]
Students	4 (3.0)	[44, 95, 102, 163]
Of which medical students	2 (1.5)	[102, 163]
Mixed	17 (12.9)	[43, 45, 66, 70, 75, 76, 105, 119, 137, 141, 145, 146, 154, 164,165,166, 169]
Not specified	28 (21.2)	[49, 58, 64, 67, 78,79,80, 88, 93, 94, 98, 112, 113, 120, 123, 125, 127,128,129, 135, 142, 143, 149, 152, 157, 158, 160, 171]
Age groups*
Neonates	6 (4.5)	[55, 71, 92, 119, 133, 156]
Infants	15 (11.4)	[55, 64, 86, 93, 101, 103, 108, 109, 114, 119, 127, 132, 145, 146, 156]
Children	33 (25.0)	[50, 55, 62, 64, 67, 77, 79, 84, 86, 90, 93, 95, 100, 101, 103, 107,108,109, 114, 115, 122, 127, 132, 136, 139, 145, 146, 153, 155, 156, 159, 169, 172]
Adults	44 (33.3)	[53, 56, 61, 62, 65, 76, 81, 84, 86, 87, 89, 90, 95, 99, 101, 102, 107,108,109, 111, 114, 115, 130, 131, 136, 144, 145, 147, 148, 153, 155, 159, 161,162,163, 168,169,170, 172]
All age groups	13 (9.8)	[41, 43, 45, 46, 51, 52, 68, 75, 107, 127, 142, 152, 164]
Not specified	58 (43.9)	[49, 54, 57,58,59,60, 63, 66, 69, 70, 72,73,74, 78, 80, 82, 83, 85, 88, 91, 94, 96,97,98, 104,105,106, 110, 112, 113, 117, 118, 120, 121, 123,124,125,126, 128, 129, 134, 135, 137, 140, 141, 143, 149,150,151, 154, 157, 158, 160, 165,166,167, 171]
Gender
Male	1 (0.7)	[48]
Female	0 (0)	NA
Both	67 (50.8)	[41,42,43,44, 49,50,51,52,53, 61, 62, 65, 66, 71, 74,75,76,77, 81, 86, 88,89,90, 95, 98,99,100,101,102, 107,108,109, 111, 114,115,116, 119, 122, 127, 130,131,132,133, 136, 141, 142, 145,146,147,148, 152,153,154,155,156,157, 160,161,162,163,164,165, 168, 169, 172]
Not specified	64 (48.5)	[47, 54,55,56,57,58,59,60, 63, 64, 67,68,69,70, 72, 73, 78,79,80, 82,83,84,85, 87, 91,92,93,94, 96, 97, 103,104,105,106, 110, 112, 113, 117, 118, 120, 121, 123,124,125,126, 128, 129, 134, 135, 137,138,139,140, 143, 144, 149,150,151, 158, 159, 166, 167, 170, 171]
Clinical syndrome
Colonization	21 (15.9)	[41, 44, 50, 51, 57, 74, 77, 81, 83, 87, 92, 93, 95, 102, 111, 119, 132, 144, 148, 163, 170]
Urinary tract infections	20 (15.2)	[45, 49, 54, 59, 75, 84, 100, 107, 109, 114, 130, 146, 147, 154, 155, 159, 164,165,166, 169]
Skin and soft tissue infections	10 (7.6)	[42, 48, 61, 82, 96, 121, 125, 126, 140, 161]
Of which war-related	2 (1.5)	[48, 161]
Bloodstream infections	10 (7.6)	[65, 71, 72, 103, 115, 133, 137, 150, 153, 172]
Respiratory tract infections	6 (4.5)	[62, 64, 89, 99, 122, 162]
Gastroenteritis	5 (3.8)	[58, 67, 79, 98, 149]
Meningitis	2 (1.5)	[134, 156]
Keratitis	1 (0.7)	[142]
Miscellanea	43 (32.6)	[43, 46, 47, 52, 53, 55, 56, 60, 63, 66, 68,69,70, 73, 76, 78, 86, 88, 90, 91, 94, 101, 104, 106, 108, 112, 116,117,118, 120, 124, 127, 129, 131, 136, 138, 139, 141, 145, 151, 152, 157, 168]
Type of specimen
Urine	20 (15.2)	[45, 49, 54, 59, 75, 84, 100, 107, 109, 114, 130, 146, 147, 154, 155, 159, 164,165,166, 169]
Nasal/nasopharyngeal swab	18 (13.6)	[41, 44, 50, 51, 56, 57, 74, 77, 81, 93, 95, 102, 111, 132, 144, 148, 163, 170]
Blood	10 (7.6)	[65, 71, 72, 103, 115, 133, 137, 150, 153, 172]
Tissue swab/biopsy	9 (6.8)	[42, 48, 61, 82, 121, 125, 126, 140, 161]
Faeces	8 (6.1)	[58, 67, 79, 87, 92, 98, 119, 149]
Sputum or other respiratory	4 (3.0)	[62, 89, 99, 162]
Other	7 (5.3)	[64, 83, 104, 122, 134, 142, 156]
Miscellanea	52 (39.4)	[43, 46, 47, 52, 53, 55, 60, 63, 66, 68,69,70, 73, 76, 78, 86, 88, 90, 91, 94, 97, 101, 105, 106, 108, 110, 112, 113, 116,117,118, 120, 123, 124, 127,128,129, 131, 135, 136, 138, 139, 141, 143, 145, 151, 152, 157, 158, 167, 168, 171]
Not specified	4 (3.0)	[80, 85, 96, 160]
Laboratory methods
Identification of microorganism
Morphology	53 (40.2)	[41,42,43,44, 47, 48, 50, 51, 54,55,56,57,58, 61,62,63, 66, 67, 73, 74, 78, 79, 81, 87, 91, 93,94,95,96, 99, 100, 102, 105, 109, 111, 113, 114, 119, 122, 125, 127,128,129, 132, 136, 142, 144, 146, 148, 150, 152, 156, 169]
VITEK™	21 (15.9)	[46, 72, 75, 76, 80, 82,83,84,85, 88, 101, 106, 108, 117, 118, 140, 151, 154, 158, 162, 171]
API	15 (11.4)	[45, 59, 68, 70, 86, 90, 124, 131, 143, 145, 149, 153, 155, 157, 167]
Others	12 (9.1)	[69, 77, 104, 107, 115, 116, 130, 133, 159, 160, 164, 170]
Multiple	25 (17.4)	[53, 60, 64, 65, 92, 97, 98, 103, 110, 112, 120, 121, 123, 126, 135, 137,138,139, 147, 161, 163, 165, 166, 168, 172]
Not specified	6 (4.5)	[49, 52, 71, 89, 134, 141]
Antibiotic susceptibility testing
Disk diffusion	64 (48.5)	[42, 43, 47,48,49,50,51,52, 54, 57,58,59, 64, 65, 67, 68, 70, 71, 74, 76, 79, 81, 82, 86, 87, 91, 94, 96, 98,99,100, 105, 106, 109, 110, 112, 113, 119,120,121, 124,125,126, 128, 130, 136, 137, 141,142,143,144,145,146, 148, 149, 152, 153, 155, 156, 162, 166, 169]
VITEK™	12 (9.1)	[83, 88, 92, 108, 117, 118, 135, 151, 154, 158, 168, 171]
PCR	7 (5.3)	[55, 62, 66, 78, 101, 102, 129]
E-test™	4 (3.0)	[97, 127, 131, 160]
MIC	4 (3.0)	[46, 53, 90, 134]
Others	3 (2.3)	[77, 104, 115]
Multiple	35 (26.5)	[41, 56, 60, 61, 63, 69, 72, 73, 75, 80, 84, 85, 93, 95, 103, 107, 111, 114, 116, 123, 132, 138,139,140, 147, 150, 157, 159, 161, 163,164,165, 167, 170, 172]
Not specified	3 (2.3)	[89, 122, 133]
Standard for interpretation of results
CLSI	103 (78.0)	[41,42,43,44,45,46, 50,51,52, 54,55,56,57, 59,60,61, 63,64,65,66,67, 69,70,71, 74,75,76, 79,80,81,82, 84, 86, 88, 90,91,92, 94,95,96, 98,99,100, 102, 103, 105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121, 124,125,126, 130, 132,133,134, 136,137,138,139,140,141,142,143,144,145,146,147,148,149,150, 155,156,157,158,159, 161,162,163,164,165,166,167,168,169, 172]
BSAC	3 (2.3)	[85, 97, 122]
EUCAST	2 (1.5)	[72, 160]
CA-SFM	2 (1.5)	[152, 153]
Multiple methods	4 (3.0)	[53, 68, 124, 127]
Not specified	18 (13.6)	[49, 58, 62, 73, 77, 78, 87, 89, 101, 104, 128, 129, 131, 135, 151, 154, 170, 171]

* Articles can report data on more than one age group, and therefore the sum of all age groups can differ from the total number of articles
GLASS Global Antimicrobial Resistance Surveillance System
NA Not Applicable
API Analytical Profile Index
PCR Polymerase Chain Reaction
MIC Minimum inhibitory concentration
CLSI Clinical & Laboratory Standards Institute
BSAC British Society for Antimicrobial Chemotherapy
EUCAST European Committee on Antimicrobial Susceptibility Testing
CA-SFM Comité de l’Antibiogramme de la Societé Française de Microbiologie

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