# Results from the Survey of Antibiotic Resistance (SOAR) 2018–21 in Kuwait and the United Arab Emirates: data based on CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints

## TL;DR

This study analyzed antibiotic resistance in respiratory tract bacteria from Kuwait and UAE, showing high susceptibility to fluoroquinolones and lower to penicillin and other drugs.

## Contribution

The study provides region-specific antibiotic susceptibility data using multiple breakpoint standards for S. pneumoniae and H. influenzae.

## Key findings

- Fluoroquinolones showed ≥98% susceptibility in pneumococci across both regions.
- Penicillin susceptibility was low (20%–27%) using CLSI oral/EUCAST low-dose breakpoints.
- H. influenzae in Kuwait had lower susceptibility to trimethoprim/sulfamethoxazole (47.1%) compared to UAE (55.7%).

## Abstract

To determine antibiotic susceptibility of Streptococcus pneumoniae and Haemophilus influenzae from community-acquired respiratory tract infections in Kuwait and United Arab Emirates (UAE), collected in 2018–21.

MICs determined by CLSI broth microdilution; susceptibility data interpreted using CLSI and EUCAST breakpoints.

A total of 49 S. pneumoniae and 79 H. influenzae and 49 S. pneumoniae and 34 H. influenzae were collected from Kuwait and UAE, respectively. Of the pneumococci, 26.5% (UAE) and 20.4% (Kuwait) were penicillin susceptible by CLSI oral/EUCAST low-dose breakpoints; by CLSI intravenous/EUCAST high-dose administration, 95.9% (UAE) and 85.7% (Kuwait) were susceptible. Similar susceptibility was observed to ceftriaxone, amoxicillin/clavulanic acid, amoxicillin and cefotaxime (CLSI: 73.5%–93.9%) but lower to other cephalosporins, tetracyclines, macrolides and trimethoprim/sulfamethoxazole. Fluoroquinolones were ≥98.0% susceptible (CLSI/EUCAST high-dose). Compared with CLSI, activity was similar by EUCAST high-dose or pharmacokinetic/pharmacodynamic (PK/PD) breakpoints with few exceptions. Of the H. influenzae isolates, 17.7% (Kuwait) and 8.8% (UAE) carried β-lactamases. Significant differences in H. influenzae susceptibility (CLSI) were found for amoxicillin/clavulanic acid (81.0% Kuwait/97.1% UAE) and fluoroquinolones (UAE: levofloxacin 88.2%, moxifloxacin 82.4%; Kuwait: both 98.7%). Susceptibility was overall >91.2% (CLSI) except for ampicillin (81.0% Kuwait) and trimethoprim/sulfamethoxazole (47.1% UAE/55.7% Kuwait). EUCAST susceptibility was similar, except for cefuroxime. PK/PD susceptibility was similar to CLSI, but lower for cefaclor, cefuroxime and macrolides.

Pneumococci were susceptible to fluoroquinolones (>98%), amoxicillin and amoxicillin/clavulanic acid (>79%–94%), ceftriaxone and cefotaxime (>73%–94%). Susceptibility was lower to oral/low-dose penicillin (20%–27%), macrolides (33%–51%), tetracyclines (53%–59%) and trimethoprim/sulfamethoxazole (33%–61%). Susceptibility was generally >80% in H. influenzae except for trimethoprim/sulfamethoxazole (47%–56%).