{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T06:45:30Z","timestamp":1774766730274,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T00:00:00Z","timestamp":1749686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"TDR"},{"name":"ADPHC"},{"name":"UAEU"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>The antimicrobial resistance (AMR) surveillance network has been monitoring bloodstream bacterial pathogens and their resistance since 1999 in Tunisia. We report the long-term trends in the distribution of bloodstream bacterial pathogens and their resistance patterns from this surveillance database. We analyzed antibiotic resistance rates in 11 tertiary teaching hospital laboratories under the AMR surveillance network during 2011\u20132023, focusing on six priority bacterial pathogens, using the Cochrane\u2013Armitage test for trend analysis. Of 22,795 isolates, K. pneumoniae (38.5%) was the most common, followed by S. aureus (20.4%), E. coli (13.6%), and A. baumannii (10.3%). Carbapenem resistance was highest in A. baumannii (77%), followed by Pseudomonas aeruginosa (29.3%), K. pneumoniae (19.4%), and Enterobacter cloacae (6.8%). Carbapenem-resistant Enterobacterales and third-generation cephalosporin-resistant Enterobacterales (3GCREB) increased from 10.6% to 26.3% (p-value &lt; 0.001), and from 39% to 50.2%, respectively, during 2011\u20132023 (p-value &lt; 0.001). Vancomycin resistance (38.3%) and the emergence of linezolid resistance in 2019 (2.4%) were reported in E. faecium isolates. Resistance to carbapenems and 3GC is a major challenge to controlling BSI in Tunisia. The national AMR surveillance network helps monitor annual patterns and guides empirical therapy. An integrated database combining clinical profiles and resistance data via real-time data-sharing platforms could improve clinical decision-making.<\/jats:p>","DOI":"10.3390\/tropicalmed10060164","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T06:42:48Z","timestamp":1749710568000},"page":"164","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Bacterial Pathogens and Antibiotic Resistance in Bloodstream Infections in Tunisia: A 13-Year Trend Analysis"],"prefix":"10.3390","volume":"10","author":[{"given":"Lamia","family":"Kanzari","sequence":"first","affiliation":[{"name":"National Reference Laboratory on Antimicrobial Resistance Surveillance, Laboratory of Microbiology, Charles Nicolle Hospital, Tunis 1006, Tunisia"},{"name":"Research Laboratory \u201cAntimicrobial Resistance\u201d LR99ES09, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1007, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sana","family":"Ferjani","sequence":"additional","affiliation":[{"name":"National Reference Laboratory on Antimicrobial Resistance Surveillance, Laboratory of Microbiology, Charles Nicolle Hospital, Tunis 1006, Tunisia"},{"name":"Research Laboratory \u201cAntimicrobial Resistance\u201d LR99ES09, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1007, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3312-8265","authenticated-orcid":false,"given":"Khaoula","family":"Meftah","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Bechir Hamza Children\u2019s Hospital, Tunis 1006, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4064-2142","authenticated-orcid":false,"given":"Mariem","family":"Zribi","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, La Rabta Hospital, Tunis 1007, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonda","family":"Mezghani","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology of Sfax University Hospital Center, Sfax 3000, Tunisia"},{"name":"Research Laboratory LR03SP03 \u201cMicro-Organisme et Pathologie Humaine\u201d, Faculty of Medicine, University of Sfax, Sfax 3029, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asma","family":"Ferjani","sequence":"additional","affiliation":[{"name":"National Reference Laboratory on Antimicrobial Resistance Surveillance, Laboratory of Microbiology, Charles Nicolle Hospital, Tunis 1006, Tunisia"},{"name":"Research Laboratory \u201cAntimicrobial Resistance\u201d LR99ES09, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1007, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yosra","family":"Chebbi","sequence":"additional","affiliation":[{"name":"Laboratory Department, Bone and Marrow Transplantation Center, Tunis 1006, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8175-1743","authenticated-orcid":false,"given":"Manel","family":"Hamdoun","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Biology, Aziza Othmana Hospital, Tunis 1008, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hajer","family":"Rhim","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Fatouma Bourguiba Hospital, Monastir 5000, Tunisia"},{"name":"Laboratory of Transmissible Diseases and Biologically Active Substances LR99ES27, Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yosr","family":"Kadri","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Fatouma Bourguiba Hospital, Monastir 5000, Tunisia"},{"name":"Laboratory of Transmissible Diseases and Biologically Active Substances LR99ES27, Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5675-7969","authenticated-orcid":false,"given":"Siwar","family":"Frigui","sequence":"additional","affiliation":[{"name":"Laboratory Department, Bone and Marrow Transplantation Center, Tunis 1006, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emna","family":"Mhiri","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Abderrahmen Mami Hospital, Ariana 2080, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asma","family":"Ghariani","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Abderrahmen Mami Hospital, Ariana 2080, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nour","family":"Ben Ayed","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology of Sfax University Hospital Center, Sfax 3000, Tunisia"},{"name":"Research Laboratory LR03SP03 \u201cMicro-Organisme et Pathologie Humaine\u201d, Faculty of Medicine, University of Sfax, Sfax 3029, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faouzia","family":"Mahjoubi","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology of Sfax University Hospital Center, Sfax 3000, Tunisia"},{"name":"Research Laboratory LR03SP03 \u201cMicro-Organisme et Pathologie Humaine\u201d, Faculty of Medicine, University of Sfax, Sfax 3029, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yomna","family":"Ben Lamine","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Mohamed Kassab Orthopedics Institute, La Manouba 2010, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salma","family":"Kaoual","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Mohamed Kassab Orthopedics Institute, La Manouba 2010, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basma","family":"Mnif","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology of Sfax University Hospital Center, Sfax 3000, Tunisia"},{"name":"Research Laboratory LR03SP03 \u201cMicro-Organisme et Pathologie Humaine\u201d, Faculty of Medicine, University of Sfax, Sfax 3029, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Habiba","family":"Naija","sequence":"additional","affiliation":[{"name":"Laboratory of 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Box 529, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Safa","family":"Bouwazra","sequence":"additional","affiliation":[{"name":"Laboratory Department, Bone and Marrow Transplantation Center, Tunis 1006, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hajer","family":"Battikh","sequence":"additional","affiliation":[{"name":"Unit of Laboratories, Ministry of Health, Tunis 1006, Tunisia"},{"name":"Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramzi","family":"Ouhichi","sequence":"additional","affiliation":[{"name":"World Health Organization Country Office, Tunis 1082, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lamia","family":"Thabet","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Biology, Burn and Trauma Center, Ben Arous 2013, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jalel","family":"Boukadida","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Farhat Hached Hospital, Sousse 4000, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0494-8080","authenticated-orcid":false,"given":"Farouk","family":"Barguellil","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Military Hospital, Tunis 1008, Tunisia"},{"name":"Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophia","family":"Besbes","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Mohamed Kassab Orthopedics Institute, La Manouba 2010, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4324-0579","authenticated-orcid":false,"given":"Leila","family":"Slim","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Abderrahmen Mami Hospital, Ariana 2080, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3630-5255","authenticated-orcid":false,"given":"Maha","family":"Mastouri","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Fatouma Bourguiba Hospital, Monastir 5000, Tunisia"},{"name":"Laboratory of Transmissible Diseases and Biologically Active Substances LR99ES27, Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olfa","family":"Bahri","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Biology, Aziza Othmana Hospital, Tunis 1008, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7245-9190","authenticated-orcid":false,"given":"Wafa","family":"Achour","sequence":"additional","affiliation":[{"name":"Laboratory Department, Bone and Marrow Transplantation Center, Tunis 1006, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5140-2216","authenticated-orcid":false,"given":"Adnene","family":"Hammami","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology of Sfax University Hospital Center, Sfax 3000, Tunisia"},{"name":"Research Laboratory LR03SP03 \u201cMicro-Organisme et Pathologie Humaine\u201d, Faculty of Medicine, University of Sfax, Sfax 3029, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4026-0259","authenticated-orcid":false,"given":"Hanen","family":"Smaoui","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Bechir Hamza Children\u2019s Hospital, Tunis 1006, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6590-2406","authenticated-orcid":false,"given":"Ilhem","family":"Boutiba-Ben Boubaker","sequence":"additional","affiliation":[{"name":"National Reference Laboratory on Antimicrobial Resistance Surveillance, Laboratory of Microbiology, Charles Nicolle Hospital, Tunis 1006, Tunisia"},{"name":"Research Laboratory \u201cAntimicrobial Resistance\u201d LR99ES09, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1007, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"30319","DOI":"10.2807\/1560-7917.ES.2016.21.33.30319","article-title":"The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: A multicentre retrospective cohort study","volume":"21","author":"Stewardson","year":"2016","journal-title":"Eurosurveillance"},{"key":"ref_2","unstructured":"(2023, November 26). 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