Bloodstream infections have been a major public health concern, placing strain on patients, healthcare systems, and economies worldwide, particularly with the preponderance of drug-resistant bacteria. Middle Eastern countries are especially vulnerable to the spread of these pathogens due to the unchecked overuse of antibiotics, political unrest and conflict.

A recently published study by faculty from the Department of Internal Medicine–Division of Infectious Diseases at the Gilbert and Rose-Marie Chagoury School of Medicine has brought to light the prevalence of gram-negative bacteremia—an antibiotic-resistant infection in the bloodstream that can lead to sepsis, a life-threatening medical condition—its resistance patterns, and associated factors in four hospitals in Lebanon.

The pioneering multi-center study, published in the Annals of the Clinical Microbiology and Antimicrobials, significantly contributes to the field of infectious diseases and underscores the need to bolster antimicrobial stewardship and infection control measures in Lebanon.

“Bloodstream infections are one of the most serious in hospitals, causing high morbidity and mortality,” said Chairperson of the Department of Internal Medicine and Clinical Professor in the Division of Infectious Diseases Roula Husni-Samaha. “The type of organisms and the resistance pattern are essential data to guide our treatment protocol and mitigate bad outcomes at the national level.” 

The study, conducted between January 2014 and December 2020, reviewed 2,400 charts of patients with bloodstream infections in all four hospitals. “Collaboration among these hospitals was solely based on their large size, personal contacts efforts and willingness to participate,” remarked Dr. Husni-Samaha. “We all had the same motivation to contribute to national data that improves our patient care.”

The data revealed that in almost 70 percent of the patients (1,668) infections were attributed to gram-negative bacteria, such as Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter.

These organisms had a relatively high rate of third-generation resistance to cephalosporin—a broad-spectrum antibiotic targeting resistant gram-negative bacteria—while resistance to carbapenem—a class of strong antibiotics used to treat severe or high-risk bacterial infections—was seen mainly in the case of in-patients and was usually associated with higher mortality.

The main source of bacteremia in the hospitals was urinary tract infections (UTIs) at 32 percent, followed by pneumonia and intra-abdominal infections. In Lebanon, similar to data from the MENA region, the increased prevalence of UTIs with poor access to proper prevention and treatment measures has exacerbated local bacterial resistance, warranting urgent attention to combat this rising health threat.

“Patients with the right treatment mostly do well,” said Dr. Husni-Samaha. “Guided by such studies, protocols for treatment can be better established.”

Diagnosing, treating, and preventing bacteremia caused by gram-negative bacteria are challenging due to fast disease progression and widespread antibiotic resistance. While new rapid advanced molecular tests of the bacteria can help detect the type of resistance faster than regular antibiotics testing to expedite targeted treatment, these are not available in many hospitals. Hence the importance of this study.

Prevention efforts are hindered by the persistence of these bacteria in healthcare environments, where they can colonize patients and medical equipment, leading to hospital-acquired infections. To that end, the researchers advocate for implementing international procedures for disinfection, sterilization, hand hygiene and standard precautions at all times, and the use of PPEs when needed. They also recommend that the proper narrowest spectrum antibiotics indicated for specific infections be used for the shortest period.

“The findings underscore the need for effective antimicrobial stewardship and infection control practices to combat resistant strains in Lebanon and other countries in the region,” said Dr. Husni-Samaha. “The study also draws attention to the implications for patient care, including more extended hospital stays and increased mortality risk, making it a crucial resource for the region’s healthcare policy and treatment strategies.”

The LAU infectious disease research team will be publishing other ongoing studies on epidemiology and resistant patterns to enhance the understanding of prevalent infectious diseases in Lebanon and beyond.

To browse more scholarly output by the LAU community, visit our open-access digital archive, the Lebanese American University Repository (LAUR).