The ongoing development and spread ofmultidrug-resistant (MDR) organisms is leading the medical field into apost-antibiotic era (Balkhy et al., 2016). Worldwide, 700,000 deaths arecaused yearly by multidrug-resistant (MDR) bacteria and these are estimated tocause around 10 million deaths by 2050 with severe economic losses (Reale etal., 2017).At the USA alone antimicrobial-resistantbacteria such as methicillin-resistant Staphylococcus aureus cause 19,000deaths yearly.
Among the most problematic MDR organisms are Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii (Khamene et al., 2016). Many studies have been conducted in the gulf region to highlight theemergent problem of MDR, some claims that carbapenem-resistant bacteria killhalf of the infected patients every time they cause an infection (Al-Sweih et al., 2012).The main factors leading to MDR are theindiscriminate use of antimicrobials and the discontinuous antimicrobialprescribed dose in human medical treatment. Beside the medical field, theexcessive use of antibiotics without supervision in animals’ treatment isanother leading factor to MDR, this reaches a level that antimicrobials areused as growth promoters in some countries (Balkhy et al.
, 2016). Significant antimicrobial resistance (AMR)burden has been described in the GCC region; including: Pan-drug-resistant gram-negativebacilli (GNB), Extended Spectrum Beta-Lactamase (ESBL) producing bacteria, Carbapenemase-producingbacterial types, as well as multidrug-resistant tuberculosis. For Klebsiellapneumonia, between 60 and 90% of isolates in the GCC are ESBL producers, andthey are leading to up to 40% mortality rate (Balkhy et al., 2016). Inthe last few years, the development and fast dissemination of ESBL-producingbacterial types has led to the substitution of traditional beta-lactamantibiotics by carbapenems in clinical practices. As a result, bacteria with carbepenemasesgenes have been isolated recently (Shil et al). 60-90% of Acinetobacterthat cause ventilator-related pneumonia in the GCC have shown highresistance to most tested antimicrobials, includingcarbapenems (Balkhy et al., 2016).