The Use of the WHO AWaRe Tool to Optimize Antibiotic Selection after Surgery | ||
| Egyptian Journal of Medical Microbiology | ||
| Volume 35, Issue 2, April 2026 | ||
| Document Type: New and original researches in the field of Microbiology. | ||
| DOI: 10.21608/ejmm.2025.422316.1864 | ||
| Authors | ||
| Mohammed Elshaer1; Mohamed Saleh1; Marwa Eldegwi2; Radwa H. Salem3; Dalia K. Nassar* 4 | ||
| 1Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt | ||
| 2Department of Pediatrics, Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh, Egypt | ||
| 3Department of Clinical Microbiology and Immunology, National Liver Institute, Menoufia University | ||
| 4Medical microbiology and immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt Department of Basic Medical Sciences, Faculty of Medicine, Ibn Sina University for Medical Sciences, Amman, Jordan | ||
| Abstract | ||
| Background: Antibiotic resistance is a global health problem that needs urgent attention. WHO introduced AWaRe (Access, Watch, Reserve) classification of antibiotics to help in optimizing antibiotic use. Objective: This study aimed to evaluate the efficacy of the WHO AWaRe classification in guiding antibiotic selection and optimizing treatment outcomes for pathogens isolated from post-surgical patients at Mansoura University Hospitals. Methodology: A retrospective analysis was conducted on microbiological cultures obtained from post-surgical patients between January 2022 and December 2023. Samples included blood, urine, sputum, wound swabs, surgical drains, and aspirates. Automated identification of isolates was performed using the Vitek 2 system, while antibiotic susceptibility was assessed using the Kirby-Bauer disk diffusion method and Vitek 2. Antibiotics were categorized according to the WHO AWaRe classification. Results: Out of 1159 cultures, 401 (34.6%) were positive, with Gram-negative bacteria accounting for 73.6% of isolated organisms and Gram-positive bacteria for 26.4%. Escherichia coli (34%) and Klebsiella spp. (20%) were the predominant Gram-negative organisms, while Staphylococcus aureus and coagulase-negative staphylococci represented 19% of total isolates. Antibiotic susceptibility testing revealed variable resistance patterns, with carbapenems showing high efficacy against Enterobacter cloacae and E. coli but reduced activity against Acinetobacter baumannii. Aminoglycosides and Piperacillin/Tazobactam were effective against most isolates, while resistance to β-lactams and fluoroquinolones was prominent. Conclusions: The WHO AWaRe classification is a valuable framework for optimizing antibiotic selection in post-surgical infections. The study highlights the predominance of Gram-negative bacteria and their resistance patterns, emphasizing the need for targeted antibiotic stewardship to preserve the efficacy of critical antibiotics. | ||
| Keywords | ||
| Antibiotic stewardship; Escherichia coli; Klebsiella pneumoniae | ||
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