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J Acute Care Surg > Volume 11(3); 2021 > Article
Journal of Acute Care Surgery 2021;11(3):89-101.
DOI: https://doi.org/10.17479/jacs.2021.11.3.89    Published online November 23, 2021.
Antimicrobial Management of Complicated Skin and Soft Tissue Infections in an Era of Emerging Multi-Drug Resistance: Perspectives from 5 Gulf Countries
Wadha Alfouzan1,2  , Zainab Al-Balushi3  , Muna Al-Maslamani4  , Asmaa Al-Rashed5  , Salman Al-Sabah6,7  , Jameela Al-Salman8  , Mohamed Baguneid9,10,11  , Faryal Khamis12  , Nervana Habashy13  , Ayman Kurdi13  , Christian Eckmann14 
1Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
2Microbiology Unit, Department of Laboratory Medicine, Farwaniya Hospital, Ministry of Health, Kuwait City, Kuwait
3Department of Pediatric Surgery, Sultan Qaboos University Hospital, Seeb, Oman
4Infectious Diseases Division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
5Department of General Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
6Department of Surgery, Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, Kuwait
7Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
8Department of Infectious Diseases, Salmaniya Medical Complex, Manama, Bahrain
9Consultant Vascular Surgeon, Tawam Hospital, Al Ain, Abu Dhabi
10Adjunct Professor College of Medicine and Healthcare Science, UAE University
11Honorary Senior Lecturer, University of Manchester, UK
12Infectious Diseases Department, Royal Hospital, Muscat, Oman
13Pfizer Gulf FZ LLC, Dubai Media City, Dubai, UAE
14Department of General, Visceral and Thoracic Surgery, Hannoversch-Muenden Clinic, Academic Hospital of Goettingen University, Hannoversch-Muenden, Germany
Correspondence:  Christian Eckmann,
Email: chr.eckmann@gmx.de; c.eckmann@khmue.de
Received: 28 September 2021   • Accepted: 18 October 2021
Abstract
The number of complicated skin and soft tissue infections (cSSTIs) in the Arabian Gulf region has risen in recent years, particularly those caused by multi-drug resistant (MDR) pathogens. The high prevalence of diabetes, obesity, and associated cardio-metabolic comorbidities in the region renders medical and surgical management of cSSTI patients with MDR infections challenging. An experienced panel of international and regional cSSTI experts (consensus group on cSSTIs) was convened to discuss clinical considerations for MDR infections from societal, antimicrobial stewardship, and cost perspectives, to develop best practice recommendations. This article discusses antibiotic therapies suitable for treating MDR cSSTIs in patients from the Gulf region and recommends that these should be tailored according to the local bacterial ecology by country and region. The article highlights the need for a comprehensive patient treatment pathway and defined roles of each of the multidisciplinary teams involved with managing patients with MDR cSSTIs. Aligned and inclusive definitions of cSSTIs for clinical and research purposes, thorough and updated epidemiological data on cSSTIs and methicillin-resistant Staphylococcus aureus in the region, clearcut indications of novel agents and comprehensive assessment of comparative data should be factored into decision-making are necessary.
Key Words: antibiotic resistance, epidemiology, microbiology, soft tissue infection
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