|
1
|
Alshehri AA, Aldali JA, Abdelhamid MA, Alanazi AA, Alhuraiz RB, Alanazi LZ, Alshmrani MA, Alqahtani AM, Alrshoud MI, Alharbi RF. Implementation of Antimicrobial Stewardship Programs in Saudi Arabia: A Systematic Review. Microorganisms 2025; 13:440. [PMID: 40005805 PMCID: PMC11858812 DOI: 10.3390/microorganisms13020440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2025] [Revised: 02/10/2025] [Accepted: 02/13/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND Antimicrobial resistance has highlighted the need for effective infectious disease strategies. Antimicrobial stewardship programs (ASPs) may reduce antibiotic resistance, adverse reactions, and treatment failures. This systematic review examines ASPs in Saudi Arabia, assessing their efficacy, challenges, and outcomes to improve antimicrobial use and patient care. METHODS Searches were carried out in the Ovid, MEDLINE, Embase, PsycInfo, Scopus, and Web of Science Core Collection databases for studies published from 2007 to July 2024, in Saudi Arabia, following the PRISMA guidelines. Studies that assessed ASPs' implementation, effectiveness, and outcomes in hospital settings were included. RESULTS Out of the 6080 titles identified, 14 studies met the inclusion criteria, covering different regions of the country, including Riyadh, Jeddah, Dhahran, Makkah, Al-Kharj, and a multi-regional study in Qassim and Riyadh. Various interventions were implemented by the ASPs, such as educational programs, audit and feedback, switching from intravenous to oral administration, and enhanced policies. These interventions collectively led to a decrease in the overall antimicrobial consumption and cost, and a reduction in cases with multidrug-resistant bacteria. CONCLUSIONS The findings of this review highlight the positive impact of ASPs in Saudi Arabia. However, addressing challenges such as data limitations and training gaps is essential to enhance their effectiveness. Expanding education and refining implementation strategies are crucial for ensuring their long-term success.
Collapse
Affiliation(s)
- Abdullah A. Alshehri
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Al Huwaya, Taif 21944, Saudi Arabia;
| | - Jehad A. Aldali
- Department of Pathology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Maysoon A. Abdelhamid
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia; (M.A.A.); (A.A.A.); (R.B.A.); (L.Z.A.); (M.A.A.); (A.M.A.); (M.I.A.); (R.F.A.)
| | - Alaa A. Alanazi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia; (M.A.A.); (A.A.A.); (R.B.A.); (L.Z.A.); (M.A.A.); (A.M.A.); (M.I.A.); (R.F.A.)
| | - Ratal B. Alhuraiz
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia; (M.A.A.); (A.A.A.); (R.B.A.); (L.Z.A.); (M.A.A.); (A.M.A.); (M.I.A.); (R.F.A.)
| | - Lamya Z. Alanazi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia; (M.A.A.); (A.A.A.); (R.B.A.); (L.Z.A.); (M.A.A.); (A.M.A.); (M.I.A.); (R.F.A.)
| | - Meaad A. Alshmrani
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia; (M.A.A.); (A.A.A.); (R.B.A.); (L.Z.A.); (M.A.A.); (A.M.A.); (M.I.A.); (R.F.A.)
| | - Alhanouf M. Alqahtani
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia; (M.A.A.); (A.A.A.); (R.B.A.); (L.Z.A.); (M.A.A.); (A.M.A.); (M.I.A.); (R.F.A.)
| | - Maha I. Alrshoud
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia; (M.A.A.); (A.A.A.); (R.B.A.); (L.Z.A.); (M.A.A.); (A.M.A.); (M.I.A.); (R.F.A.)
| | - Reema F. Alharbi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia; (M.A.A.); (A.A.A.); (R.B.A.); (L.Z.A.); (M.A.A.); (A.M.A.); (M.I.A.); (R.F.A.)
| |
Collapse
|
|
2
|
Elgazzar D, Aboubakr M, Bayoumi H, Ibrahim AN, Sorour SM, El-Hewaity M, Elsayed AM, Shehata SA, Bayoumi KA, Alsieni M, Behery M, Abdelrahaman D, Ibrahim SF, Abdeen A. Tigecycline and Gentamicin-Combined Treatment Enhances Renal Damage: Oxidative Stress, Inflammatory Reaction, and Apoptosis Interplay. Pharmaceuticals (Basel) 2022; 15:ph15060736. [PMID: 35745655 PMCID: PMC9228782 DOI: 10.3390/ph15060736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
Although the combination of antibiotics is generally well-tolerated, they may have nephrotoxic effects. This study investigated whether tigecycline (TG) and gentamicin (GM) co-administration could accelerate renal damage. Male Wistar rats were randomly divided into six experimental groups: the control, TG7 (tigecycline, 7 mg/kg), TG14 (tigecycline, 14 mg/kg), GM (gentamicin, 80 mg/kg), TG7+GM, and TG14+GM groups. The combination of TG and GM evoked renal damage seen by the disruption of kidney function tests. The perturbation of renal tissue was mainly confounded to the TG and GM-induced oxidative damage, which was exhibited by marked increases in renal MDA (malondialdehyde) along with a drastic reduction in GSH (reduced-glutathione) content and CAT (catalase) activity compared to their individual treatments. More obvious apoptotic events and inflammation were also revealed by elevating the annexin-V and interleukin-6 (IL-6) levels, aside from the upregulation of renal PCNA (proliferating cell nuclear antigen) expression in the TG and GM concurrent treatment. The principal component analysis indicated that creatinine, urea, annexin-V, IL-6, and MDA all played a role in discriminating the TG and GM combined toxicity. Oxidative stress, inflammatory response, and apoptosis were the key mechanisms involved in this potentiated toxicity.
Collapse
Affiliation(s)
- Dina Elgazzar
- Department of Veterinary Pharmacology, Faculty of Veterinary Medicine, Benha University, Toukh 13736, Egypt;
- Correspondence: (D.E.); (A.A.)
| | - Mohamed Aboubakr
- Department of Veterinary Pharmacology, Faculty of Veterinary Medicine, Benha University, Toukh 13736, Egypt;
| | - Heba Bayoumi
- Histology and Cell Biology Department, Faculty of Medicine, Benha University, Benha 13518, Egypt;
| | - Amany N. Ibrahim
- Department of Pharmacology, Faculty of Medicine, Benha University, Benha 13518, Egypt; (A.N.I.); (S.M.S.)
| | - Safwa M. Sorour
- Department of Pharmacology, Faculty of Medicine, Benha University, Benha 13518, Egypt; (A.N.I.); (S.M.S.)
| | - Mohamed El-Hewaity
- Department of Veterinary Pharmacology, Faculty of Veterinary Medicine, Menoufia University, Shebin Elkoum 32514, Egypt;
| | - Abulmaaty M. Elsayed
- Anatomy and Histology Department, Faculty of Medicine, Mutah University, Mutah 61710, Jordan;
- Department of Anatomy and Embryology, Faculty of Medicine, Benha University, Benha 13518, Egypt;
| | - Shaimaa A. Shehata
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt;
| | - Khaled A. Bayoumi
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Cairo 11956, Egypt;
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah 21442, Saudi Arabia
| | - Mohammed Alsieni
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah 21442, Saudi Arabia;
| | - Maged Behery
- Department of Anatomy and Embryology, Faculty of Medicine, Benha University, Benha 13518, Egypt;
| | - Doaa Abdelrahaman
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (D.A.); (S.F.I.)
| | - Samah F. Ibrahim
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (D.A.); (S.F.I.)
| | - Ahmed Abdeen
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, Benha University, Toukh 13736, Egypt
- Center of Excellence for Screening of Environmental Contaminants (CESEC), Benha University, Toukh 13736, Egypt
- Correspondence: (D.E.); (A.A.)
| |
Collapse
|
|
3
|
Setiawan E, Abdul-Aziz MH, Roberts JA, Cotta MO. Hospital-Based Antimicrobial Stewardship Programs Used in Low- and Middle-Income Countries: A Scoping Review. Microb Drug Resist 2022; 28:566-584. [PMID: 35333607 DOI: 10.1089/mdr.2021.0363] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The burden of antimicrobial resistance (AMR) is considerable in many low- and middle-income countries (LMICs), and it is important to describe the antimicrobial stewardship program (ASP) activities found in these countries and report their impact. Importantly, as these programs target prescribing behavior, the factors influencing prescription of antimicrobials must also be taken into account. This scoping review aimed to (1) describe hospital-based ASP activities, (2) report methods used to measure the impact of ASPs, and (3) explore factors influencing antimicrobial prescribing behavior in LMICs. PubMed was searched from database inception until April 2021. Factors influencing antimicrobial prescribing behavior were canvassed using the Capability-Opportunity-Motivation and Behavior framework. Most of ASP studies in LMICs were predominantly conducted in tertiary care and university-based hospitals. Audit of antimicrobial prescriptions with feedback and restrictive-based strategies was the main reported activity. Total antimicrobial consumption was the main method used to measure the impact of ASPs. Positive outcomes were observed for both clinical and microbiological outcomes; however, these were measured from nonrandomized controlled trials. Dominant factors identified through the behavioral framework were a limited awareness of AMR as a local problem, a perception that overprescription of antimicrobials had limited consequences and was mainly driven by a motivation to help improve patient outcomes. In addition, antimicrobial prescribing practices were largely influenced by existing hierarchy among prescribers. Our scoping review suggests that LMICs need to evaluate antimicrobial appropriateness as an added measure to assess impact. Furthermore, improvements in the access of microbiology and diagnostic facilities and ensuring ASP champions are recruited from senior prescribers will positively influence antimicrobial prescribing behavior, helping improve stewardship of antimicrobials in these countries.
Collapse
Affiliation(s)
- Eko Setiawan
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Clinical and Community Pharmacy; and Center for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya, Surabaya, Indonesia
| | - Mohd-Hafiz Abdul-Aziz
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Menino Osbert Cotta
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|