Antimicrobial Resistance in Syria

Background Antimicrobial resistance is one of the important and serious public health problems worldwide. Syria has a severe lack of data regarding this problem, especially after war. We aimed from this study to provide a unique snapshot on antimicrobial resistance in Syria.Methods This is a multi-centric cross-sectional in-vitro study. The results of routine antimicrobial susceptibility tests were collected and analyzes from five major hospitals during the period from 1st March 2018 through 31th October 2018.Results Final analysis included 2861 isolates. We noticed extremely high rates of antimicrobial resistance among all the species studied. Gram negatives have high resistance rates for cephalosporins. 77% of E.coli, 73% of Klebsiella and 82% of pseudomonas are resistant for ceftriaxone. We also noticed minimal effect of macrolides on gram negatives. 25% of Salmonella typhi strains were resistant to ciprofloxacin. High resistance rates to nitrofurantoin is seen among uropathogenic bacteria. Most gram positive bacteria still have a low resistance rate to vancomycin and linezolid. 54% of staphylococcus aureus and 38% of streptococcus pyogens are resistant to amoxicillin-clavulanate. Resistance rates to Colistin are minimal. The comparison with resistance rates before war reveals the great impact of war on antimicrobial resistance problem.Conclusion Antimicrobial resistance rates in Syria are worrying. We recommend that the Syrian health authorities apply a policy to restrict the irrational use of antibiotics, and to increase awareness toward antimicrobials use.