Antimicrobial resistance in Libya: A systematic literature review of two decades

Background: In low- and middle-income countries, antimicrobial resistance (AMR) imposes a significant burden on patients and health-care systems. Due to a lack of data, the overall impact of AMR in Libya is not well known or documented. As a result, this study presents the results of a review of available data on AMR in Libya over the past 20 years (from 2002 to 2021) to aid understanding of the current AMR situation in this portion of the continent. Methods: Articles related to the topic were researched using databases and search engines such as PubMed, Google Scholar, and ResearchGate websites. These articles were selected based on predetermined inclusion and exclusion criteria. The total number of tested isolates for each of the reported Bacterial spp. was used to calculate antibiotic resistance to a specific bacterium. Results: Studies published in the past 20 years, representing reports of 18,160 AMR tests, showed that Urinary Tract Infection (UTI) was the most reported clinical diagnosis in Libya (61.3%). Out of 43 articles, Staphylococcus aureus was the most common Gram-positive bacteria documented in (31, 61.3%) studies, and was most common in 59.78% of skin infections. Whereas, Pseudomonas spps., were the most common Gram-negative bacteria presented in (23, 53.48%) studies, and were commonly isolated in respiratory infection (9.39%). Among Gram-negative bacteria, Pseudomonas spp. reported a high resistance percentage for penicillin beta-lactam antibiotic, i.e., piperacillin (10.4%) and to the first-generation cephalosporins antibiotics, i.e., cefazolin (7.7%). However, they are susceptible to metronidazole, vancomycin, and colistin. Gram-positive bacteria, S. aureus shows high resistance to oxacillin, followed by gentamycin and cefoxitin (8.5%, 8.3%, and 8.3%, respectively). Effective antibiotics against S. aureus were azithromycin, clarithromycin, and metronidazole, whose susceptibility was 99.9% each, while 1% of S. aureus were vancomycin-resistant S. aureus. Conclusion: This study gives a comprehensive analysis of the state of AMR in Libya with respect to the most regularly prescribed antibiotics. The findings of the research show the alarmingly persistent occurrences of AMR in Libya, as well as the critical need to establish national action, plans to combat AMR and improve surveillance programs.