Antimicrobial resistance in Cairo, Egypt 1999-2000: a survey of five hospitals.

Antimicrobial resistance among bacterial pathogens is a global problem, but in Egypt data are sparse. We reviewed the antimicrobial susceptibility patterns of bloodstream isolates of Gram-positive cocci and Gram-negative bacilli in five hospitals in Cairo, Egypt, from 1999 to 2000. In addition, susceptibilities of non-bloodstream isolates of Streptococcus pneumoniae and Enterococcus spp. were analysed. High rates of resistance were found in most of the bacteria studied. In the hospitals, a variety of methods were used for identification and susceptibility testing, but in the laboratories quality controlled strains were utilized routinely, to ensure accurate performance of the assays. Only 29% of Staphylococcus aureus isolates and 23% of coagulase-negative staphylococcal isolates were oxacillin susceptible. Both groups of staphylococci were also highly resistant to erythromycin, co-trimoxazole, clindamycin and doxycycline; all isolates were susceptible to vancomycin. Susceptibility of S. pneumoniae isolates to penicillin, ceftriaxone and fluoroquinolones was 63%, 84% and 82%, respectively. Vancomycin susceptibility of the enterococci was 96%; susceptibility to high-level gentamicin and streptomycin was 54% and 48%, respectively. Resistance to most relevant antimicrobials was commonplace among the Gram-negative bacilli; however, most remained susceptible to imipenem. The percentage of bloodstream isolates of Escherichia coli susceptible to common antimicrobial agents was as follows: ampicillin (6%), ampicillin-sulbactam (38%), co-trimoxazole (38%) and aminoglycosides (52%). The susceptibility of isolates of E. coli, Klebsiella and Enterobacter spp. to ceftazidime was 62%, 40% and 46%, respectively. This suggests a potentially high rate of extended-spectrum beta-lactamase (ESBL) and/or Amp-C enzyme production. These results call for a nationwide surveillance programme to monitor microbial trends and antimicrobial resistance patterns in Egypt.