Increasing Antimicrobial Resistance in World Health Organization Eastern Mediterranean Region, 2017–2019

Maha Talaat; Bassem Zayed; Sara Tolba; Enjy Abdou; Mohamed Gomaa; Dana Itani; Yvan Hutin; Rana Hajjeh


Emerging Infectious Diseases. 2022;28(4):717-724. 

In This Article

Abstract and Introduction


To better guide the regional response to antimicrobial resistance (AMR), we report the burden of AMR over time in countries in the World Health Organization Eastern Mediterranean Region. To assess the capacities of national infection prevention and control and antimicrobial stewardship programs, we analyzed data on bloodstream infections reported to the Global Antimicrobial Resistance Surveillance System during 2017–2019, data from 7 countries on nationally representative surveys of antimicrobial prescriptions, and data from 2 regional surveys. The median proportion of bloodstream infections was highest for carbapenem-resistant Acinetobacter spp. (70.3%) and lowest for carbapenem-resistant Escherichia coli (4.6%). Results of the regional assessments indicate that few countries have capacities for infection prevention and control and antimicrobial stewardship programs to prevent emergence and spread of AMR. Overall, the magnitude of the problem and the limited capacity to respond emphasize the need for regional political leadership in addressing AMR.


Antimicrobial resistance (AMR) is a global crisis and one of the world's most complex challenges, threatening a century of health progress. AMR affects human and animal health and poses a serious threat to reaching sustainable development goals and food security. Drug-resistant infections account for 700,000 deaths globally each year and could cumulate to 10 million by 2050 if no sustained efforts to contain AMR are implemented.[1–3]

The Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) consists of 21 countries and the occupied Palestinian territory (731 million persons in 2021).[4] The region is diverse; and social, economic, and demographic conditions are challenging. Nearly two thirds of the countries are affected by conflicts, wars, and population displacement, posing grave implications for health and severe disruption of health systems.[5] Factors contributing to the emergence and spread of AMR in the EMR include the high burden of infectious diseases; weak health and surveillance systems; inadequate regulatory frameworks; poor infection prevention and control (IPC) in healthcare facilities; limited capacities of microbiology laboratories; lack of access to quality-assured antimicrobial drugs for humans and animals; poverty; inadequate access to water, sanitation, and hygiene; and limited antimicrobial stewardship (AMS) programs.[6] Antimicrobial drugs are available over the counter, and self-medication is a common practice in most countries. Inappropriate prescription practices among physicians are widespread. Antimicrobial drugs are used to compensate for the lack of basic public health infrastructure (e.g., vaccination coverage and IPC).[7,8]

WHO identified surveillance as 1 of the 5 strategic priorities of the global and national AMR action plans.[9,10] Because most countries did not have good quality AMR data, in 2015, WHO launched the Global Antimicrobial Resistance Surveillance System (GLASS, To measure the regional AMR burden and generate quality data, WHO supported countries to establish and enhance national AMR surveillance. We evaluated the burden of AMR for selected serious resistant bacterial infections reported to WHO through GLASS over 3 years (2017–2019), along with the regional capacities of AMS and IPC programs. We also explored the challenges faced by countries responding to AMR and propose priority actions to advance the AMR control agenda in the EMR.