Prevalence and Etiology of Community- and Hospital-Acquired Pneumonia in Saudi Arabia and Their Antimicrobial Susceptibility Patterns: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Protocol Design
2.2. Identification of the Research Question
2.3. Eligibility Criteria
2.4. Information Sources
2.5. Search Strategy
2.6. Study Selection
2.7. Data Extraction
2.8. Quality Assessment
2.9. Data Synthesis and Reporting
3. Results
3.1. Study Selection
3.2. Characteristics of Included Studies
3.3. Antimicrobial Susceptibility/Resistance Pattern
3.4. Quality Assessment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Author and Year | Study Setting | Study Period | Sample Size | Population Type | Study Design | Prevalence of Infection | Top 3 Isolated Pathogens | ||
---|---|---|---|---|---|---|---|---|---|
Batool et al., 2021 [23] | 1 hospital | May 2019–October 2019 | 165 | Adults | Cross-sectional study | CAP (46.6%) | S. pneumoniae (34%) | H. influenzae (16%) | S. aureus (30%) |
Balkhy et al., 2014 [24] | ICU | October 2004–June 2009 | 248 | Adults | Retrospective study | VAP (100%) | Acinetobacter spp. (35.1%) | P. aeruginosa (25.4%) | S. aureus (17.3%) |
Farahat et al., 2021 [25] | 1 hospital | 2016 -2019 | 218 | Adults | Retrospective study | CAP (100%) | S. aureus (2.5%) | MRSA (2.3%) | Klebsiella spp. (1.3%) |
Rahman et al., 2000 [26] | 5 medical centers | January–July | 129 | - | Retrospective study | LRTIs (100%) | H. influenzae (100%) | - | - |
Memish et al., 2004 [27] | 3 hospitals | January 2000–December 2000 | 154 | Mixed | Cross-sectional study | CAP (100%) | S. pneumoniae (100%) | - | - |
Alshahwan et al., 2019 [28] | Pulmonary department | 2010–2017 | 800 | Adults | Retrospective study | CAP (80%) | - | - | - |
HAP (20%) | |||||||||
Akbar et al., 2001 [29] | 1 hospital | January 1998–December 1999 | 354 | Adults | Prospective study | CAP (24%) | H. influenzae (51.7%) | S. aureus (14.1%) | M. catarrhalis (11.7%) |
HAP (76%) | Pseudomonas spp. (27.1%) | S. aureus (15.2%) | H. influenzae (14.4%) | ||||||
Babay et al., 2000 [30] | 1 hospital | July 1998–December 1999 | 32 | Mixed | Retrospective study | Pneumonia (21.8%) | M. catarrhalis (100%) | - | - |
Albarak et al., 2018 [31] | 13 hospitals | August 2016–September 2016 | 266 | Adults | Prospective case series | CAP (100%) | S. pneumoniae (18%) | - | - |
Obeid et al., 2015 [32] | 1 hospital | 2006, 2009 and 2012 | 1952 | - | Retrospective study | VAP (100%) | A. Baumannii (100%) | - | - |
Almuneef et al., 2004 [33] | ICU | May 2000–December 2002 | 361 | Children | Prospective study | VAP (10.2%) | P. aeruginosa (56.8%) | S. aureus (18.9%) | K. pneumoniae (10.8%) |
Saleem et al., 2022 [34] | ICU | 2019–2022 | 591 | Adults | Prospective study | VAP (27.5%) | A. baumannii (21.4%) | - | - |
El-Saed et al., 2013 [35] | ICU | August 2003–June 2009 | 457 | Adults | Prospective study | VAP (100%) | Acinetobacter spp. (26.5%) | P. aeruginosa (21.7%) | S. aureus (15.3%) |
Osman et al., 2020 [36] | PICU | January 2015–March 2018 | 141 | Children | Prospective study | VAP (100%) | P. aeruginosa (34.0%) | K. pneumoniae (18.1%) | S. maltophilia (13.6%) |
Kabrah et al., 2021 [37] | ICU | November 2020–January 2021 | 96 | Adults | Retrospective study | LRTIs (53.1%) | P. aeruginosa (66.7%) | A. baumannii (13.7%) | K. oxytica (4.0%) |
Ibrahim et al., 2018 [38] | ICU | December 2016–January 2018 | 3736 | Adults | Retrospective study | 9.6% | Acinetobacter spp. (34.6%) | P. aeruginosa (24.5%) | K. pneumoniae (14.9%) |
Al-Dorzi et al., 2012 [39] | ICU | August 2003–June 2009 | 2812 | Adults | Prospective study | VAP (15.4%) | - | - | - |
Saleem et al., 2023 [40] | ICU | January 2019–December 2019 | 591 | - | Prospective study | VAP (43%) | K. pneumoniae (24%) | A. baumannii (21.5%) | P. aeruginosa (15.3%) |
Othman et al., 2017 [41] | ICU | September 2012–August 2013 | 48 | Adults | Prospective study | VAP (35.4%) | P. aeruginosa (41.1%) | S. aureus (17.6%) | K. pneumoniae (11.7%) |
Balkhy et al., 2006 [42] | 1 hospital | May 2003 | 562 | Adults | PPS | CAP (34.9%) | P. aeruginosa (21.3%) | Klebsiella spp. (10.1%) | Pseudomonas spp. (7.9%) |
Al-Johani et al., 2010 [43] | ICU | January 2004–June 2009 | 4192 | Adults | Retrospective study | VAP (43%) | Acinetobacter spp. (31.7%) | P. aeruginosa (30.6%) | E. coli (14.0%) |
Mwanri et al., 2014 [44] | ICU | 2010–2012 | 496 | Mixed | Retrospective study | VAP (14.8%) | Acinetobacter spp. (57.4%) | Klebsiella ESBL (13.2%) | MRSA (9.8%) |
Bshabshe et al., 2016 [45] | ICU | 2014–2015 | 105 | Adults | Observational study | 100% | A. baumannii (46.6%) | A. haemolyticus (30.4%) | A. complex (18.0%) |
Zaki et al., 2021 [46] | 1 hospital | January 2017–December 2019 | 163 | Children | Retrospective study | CAP (26.4%) | S. aureus (37.2%) | K. pneumoniae (30.2%) | Streptococcus spp. (14%) |
Hakami et al., 2022 [47] | 1 hospital | May 2016–December 2019 | 1151 | Mixed | Cross-sectional study | 49.3% | P. aeruginosa (28.5%) | K. pneumoniae (17.6%) | A. baumannii (15.1%) |
Walid et al., 2016 [48] | 1 hospital | January 2019–Jan 2015 | 122 | Children | Retrospective study | Pneumonia (26.2%) | P. aeruginosa (11.5%) | S. pneumoniae (7.6%) | S. aureus (7.6%) |
Al-Munjem et al., 2022 [49] | 1 medical center | January 2016–December 2017 | 405 | Mixed | Retrospective study | Pneumonia (47.4%) | S. pneumoniae (90.9%) | P. aeruginosa (84.1%) | K. pneumoniae (84.1%) |
Marie et al., 2010 [50] | 1 hospital | - | 552 | Mixed | Retrospective study | Pneumonia (49.4%) | M. pneumoniae (42.2%) | - | - |
Author and Year | Isolated Organism | Top 3 Most Sensitive Antibitoics | Top 3 Most Resistant Antibiotic | ||||
---|---|---|---|---|---|---|---|
Batool et al., 2021 [23] | S. pneumoniae | Amoxicillin/Sulbactam (96%) | Ceftriaxone (92%) | Amikacin (92%) | Co-trimoxazole (43%) | Ampicillin (39%) | Ciprofloxacin (39%) |
H. influenzae | Levofloxacin (91%) | Ciprofloxacin (83%) | Amikacin (83%) | Doxycycline (59%) | Clarithromycin (59%) | Azithromycin (59%) | |
S. aureus | Amikacin (90%) | Ceftriaxone (80%) | Ampicillin (80%) | Co-trimoxazole (60%) | Clarithromycin (40%) | Doxycycline (40%) | |
Balkhy et al., 2014 [24] | Acinetobacter spp. | Meropenem (25%) | Piperacillin/Tazobactam (17%) | Amikacin (11%) | Imipenem (95%) | Ciprofloxacin (98%) | Gentamicin (97%) |
P. aeruginosa | Amikacin (68%) | Meropenem (43%) | Piperacillin/Tazobactam (8%) | Gentamicin (100%) | Cefepime (98%) | Ciprofloxacin (97%) | |
S. aureus | Gentamicin (56%) | Ciprofloxacin (35%) | Penicillin (37%) | Oxacillin (100%) | Vancomycin (100%) | Erythromycin (88%) | |
Farahat et al., 2021 [25] | - | - | - | - | - | - | - |
Rahman et al., 2000 [26] | H. influenzae | Ciprofloxacin (100%) | Ceftazidime (100%) | Amoxiclav (98%) | Ampicillin (13.2%) | Tetracycline (7%) | Chloramphenicol (5%) |
Memish et al., 2004 [27] | S. pneumoniae | Vancomycin (100%) | Levofloxacin (98%) | Ceftriaxone (85%) | Erythromycin (15%) | Penicillin (14%) | Sulfamethoxazole/trimethoprim (9%) |
Alshahwan et al., 2019 [28] | - | - | - | - | - | - | - |
Akbar et al., 2001 For CAP [29] | H. influenzae | Cefuroxime (97%) | Ciprofloxacin (84%) | Ceftriaxone (87%) | Vancomycin (97%) | Gentamicin (97%) | Imipenem (94%) |
S. pneumoniae | Co-amoxiclav (100%) | Cefuroxime (100%) | Erythromycin (100%) | Penicillin (67%) | Gentamicin (67%) | Aztreonam (67%) | |
M. Catarrhalis | Co-amoxiclav (100%) | Cefuroxime (100%) | Erythromycin (100%) | Penicillin (87%) | Ceftriaxone (87%) | Erythromycin (14%) | |
Akbar et al., 2001 For HAP [29] | Pseudomonas spp. | Amikacin (85%) | Gentamicin (84%) | Piperacillin (70%) | Erythromycin (98%) | Co-amoxiclav (93%) | Ampicillin (93%) |
S. aureus | Vancomycin (86%) | Oxacillin (81%) | Erythromycin (67%) | Ampicillin (86%) | Co-amoxiclav (86%) | Ciprofloxacin (86%) | |
Enterobacter spp. | Imipenem (100%) | Amikacin (100%) | Ciprofloxacin (79%) | Ampicillin (93%) | Co-amoxiclav (93%) | Cefuroxime (86%) | |
Babay et al., 2000 [30] | M. catarrhalis | Ciprofloxacin (-) | Gentamicin (-) | Tetracycline (-) | - | - | - |
Albarrak et al., 2018 [31] | - | - | - | - | - | - | - |
Obeid et al., 2015 [32] | A. baumannii | Colistin (-) | Gentamicin (-) | Tigecycline (-) | Amikacin (-) | Ceftazidime (-) | Ciprofloxacin (-) |
Almuneef et al., 2004 [33] | - | - | - | - | - | - | - |
Saleem et al., 2022 [34] | A. baumannii | Colistin (100%) | Amikacin (48%) | Gentamicin (17%) | Co-amoxiclav (-) | Ciprofloxacin (-) | Ampicillin (-) |
Al-Saed et al., 2013 [35] | - | - | - | - | - | - | - |
Osman et al., 2020 [36] | - | - | - | - | - | - | - |
Kabrah et al., 2018 [37] | Overall | Teicoplanin (100%) | Vancomycin (100%) | Synercid (100%) | Penicillin (100%) | Aztreonam (96%) | Cefotaxime (88%) |
Ibrahim et al., 2018 [38] | Acinetobacter spp. | Colistin (96%) | Sulfamethoxazole/Trimethoprim (7%) | Gentamicin (4%) | Aztreonam (97%) | Cefepime (97%) | Ceftazidime (97%) |
P. aeruginosa | Amikacin (82%) | Tobramycin (80%) | Gentamicin (69%) | Cefuroxime (66%) | Cefotaxime (63%) | Cefepime (53%) | |
K. pneumoniae | Colistin (100%) | Imipenem (59%) | Amikacin (54%) | Cefuroxime (71%) | Sulfamethoxazole/Trimethoprim (71%) | Ceftazidime (67%) | |
Al-Dorzi et al., 2012 [39] | - | - | - | - | - | - | - |
Saleem et al., 2023 [40] | K. pneumoniae | Colistin (59%) | Piperacillin/Tazobactam (52%) | Gentamicin (52%) | Ampicillin (92%) | Levofloxacin (92%) | Amoxiclav (89%) |
A. baumannii | Tigecycline (40%) | Piperacillin/Tazobactam (26%) | Gentamicin (20%) | Amoxiclav (100%) | Ciprofloxacin (100%) | Meropenem (100%) | |
P. aeruginosa | Tigecycline (96%) | Colistin (72%) | Amikacin (72%) | Amoxiclav (84%) | Cefuroxime (84%) | Cephalothin (84%) | |
Othman et al., 2017 [41] | - | - | - | - | - | - | - |
Balkhy et al., 2006 [42] | - | - | - | - | - | - | - |
Al-Johani et al., 2010 [43] | Acinetobacter spp. | Imipenem (10%) | Meropenem (10%) | Ciprofloxacin (10%) | Cefepime (-) | Ciprofloxacin (-) | Ceftazidime (-) |
P. aeruginosa | Ciprofloxacin (49%) | Ceftazidime (44%) | Carbapenems (26%) | Meropenem (-) | Meropenem (-) | Cefepime (-) | |
E.coli | Cefepime (50%) | Ceftazidime (46%) | Cefotaxime (46%) | Ampicillin (-) | Sulfamethoxazole/Trimethoprim (-) | Ciprofloxacin (-) | |
Mwanri et al., 2014 [44] | - | - | - | - | - | - | - |
Bshabshe et al., 2016 [45] | A. baumannii | Colistin (100%) | Sulfamethoxazole/Trimethoprim (74%) | Amikacin (16%) | Moxifloxacin (100%) | Meropenem (100%) | Fosfomycin (100%) |
A. haemolyticus | Colistin (100%) | Sulfamethoxazole/Trimethoprim (68%) | Amikacin (18%) | Ampicillin (100%) | Moxifloxacin (100%) | Fosfomycin (100%) | |
A. complex | Colistin (100%) | Rifampicin (100%) | Sulfamethoxazole/Trimethoprim (78%) | Amikacin (100%) | Ciprofloxacin (100%) | Imipenem (100%) | |
Zaki et al., 2021 [46] | - | - | - | - | - | - | - |
Hakami et al., 2022 [47] | P. aeruginosa | Cefepime (99%) | Tigecycline (99%) | Imipenem (98%) | Piperacillin/Tazobactam (51%) | Ciprofloxacin (25%) | Ampicillin (10%) |
K. pneumoniae | Amoxicillin (99%) | - | - | Ampicillin (82%) | Ceftriaxone (9%) | Piperacillin/Tazobactam (7%) | |
A. baumannii | Meropenem (99%) | Ceftriaxone (99%) | Amoxiclav (98%) | Piperacillin/Tazobactam (52%) | Ampicillin (38%) | Ciprofloxacin (5%) | |
Walid et al., 2016 [48] | Overall | - | - | - | Ceftriaxone (24%) | Cefuroxime (21%) | Cefotaxime (3%) |
Al Munjem et al., 2022 [49] | S. pneumoniae | Levofloxacin (67%) | Oxacillin (52%) | Ciprofloxacin (32%) | Azithromycin (100%) | Amoxicillin (98%) | Co-amoxiclav (98%) |
P. aeruginosa | Levofloxacin (70%) | Ciprofloxacin (29%) | - | - | - | - | |
K. pneumoniae | Levofloxacin (67%) | Ciprofloxacin (35%) | Amoxicillin (2%) | Co-amoxiclav (100%) | Amoxicillin (98%) | Azithromycin (98%) | |
Marie et al., 2010 [50] | - | - | - | - | - | - | - |
Selection | Comparability | Outcomes | ||||||
---|---|---|---|---|---|---|---|---|
Reference | Representative of Sample A | Sample Size B | Non-Respondents C | Ascertainment of Exposure D | Comparability of Cohort Studies on Basis of Design E | Assessment of Outcomes F | Statistical Analysis G | Quality Score |
Batool et al., 2021 [23] | * | * | - | ** | * | ** | - | 7 |
Balkhy et al., 2014 [24] | * | * | - | ** | * | ** | * | 8 |
Farahat et al., 2021 [25] | * | * | - | * | * | ** | * | 7 |
Rahman et al., 2000 [26] | * | * | - | ** | * | ** | * | 8 |
Memish et al., 2004 [27] | * | * | - | ** | * | ** | * | 8 |
Alshahwan et al., 2019 [28] | * | * | - | * | * | ** | * | 7 |
Akbar et al., 2001 For CAP [29] | * | * | - | ** | * | ** | * | 8 |
Babay et al., 2000 [30] | * | * | - | ** | * | ** | - | 7 |
Albarrak et al., 2018 [31] | * | * | - | * | * | ** | * | 7 |
Obeid et al., 2015 [32] | * | * | - | ** | * | ** | - | 7 |
Almuneef et al., 2004 [33] | * | * | - | * | * | ** | * | 7 |
Saleem et al., 2022 [34] | * | * | - | ** | * | ** | * | 8 |
Al-Saed et al., 2013 [35] | * | * | - | * | * | ** | * | 7 |
Osman et al., 2020 [36] | * | * | - | * | * | ** | * | 7 |
Kabrah et al., 2018 [37] | * | * | - | ** | * | ** | * | 8 |
Ibrahim et al., 2018 [38] | * | * | - | ** | * | ** | * | 8 |
Al-Dorzi et al., 2012 [39] | * | * | - | * | * | ** | * | 7 |
Saleem et al., 2023 [40] | * | * | - | ** | * | ** | * | 8 |
Othman et al., 2017 [41] | * | * | - | * | * | ** | * | 7 |
Balkhy et al., 2006 [42] | * | * | - | * | * | ** | * | 7 |
Al-Johani et al., 2010 [43] | * | * | - | ** | * | ** | * | 8 |
Mwanri et al., 2014 [44] | * | * | - | * | * | ** | * | 7 |
Bshabshe et al., 2016 [45] | * | * | - | ** | * | ** | * | 8 |
Zaki at al., 2021 [46] | * | * | - | * | * | ** | * | 7 |
Hakami et al., 2022 [47] | * | * | - | ** | * | ** | * | 8 |
Walid et al., 2016 [48] | * | * | - | ** | * | ** | * | 8 |
Al Munjem et al., 2022 [49] | * | * | - | ** | * | ** | * | 8 |
Marie et al., 2010 [50] | * | * | - | * | * | ** | - | 6 |
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Alshammari, M.K.; Alotaibi, M.A.; AlOtaibi, A.S.; Alosaime, H.T.; Aljuaid, M.A.; Alshehri, B.M.; AlOtaibi, Y.B.; Alasmari, A.A.; Alasmari, G.A.; Mohammed, M.H.; et al. Prevalence and Etiology of Community- and Hospital-Acquired Pneumonia in Saudi Arabia and Their Antimicrobial Susceptibility Patterns: A Systematic Review. Medicina 2023, 59, 760. https://doi.org/10.3390/medicina59040760
Alshammari MK, Alotaibi MA, AlOtaibi AS, Alosaime HT, Aljuaid MA, Alshehri BM, AlOtaibi YB, Alasmari AA, Alasmari GA, Mohammed MH, et al. Prevalence and Etiology of Community- and Hospital-Acquired Pneumonia in Saudi Arabia and Their Antimicrobial Susceptibility Patterns: A Systematic Review. Medicina. 2023; 59(4):760. https://doi.org/10.3390/medicina59040760
Chicago/Turabian StyleAlshammari, Mohammed Kanan, Mzoun Abdulaziz Alotaibi, Ahad Sanad AlOtaibi, Hanan Tareq Alosaime, Mona Awadh Aljuaid, Budur Mohammed Alshehri, Yasmen Bejad AlOtaibi, Asma Ali Alasmari, Ghadi Ali Alasmari, Maram Hussain Mohammed, and et al. 2023. "Prevalence and Etiology of Community- and Hospital-Acquired Pneumonia in Saudi Arabia and Their Antimicrobial Susceptibility Patterns: A Systematic Review" Medicina 59, no. 4: 760. https://doi.org/10.3390/medicina59040760