J. W. A. Ramahi, Abdelbadee Yacoub, Lamya Abu Shanab
Vancomycin-Intermediate Staphylococcus aureus (VISA) is still uncommon among MRSA isolates. In our region, we rarely encounter a case of VISA and/or GISA bacteremia. Here, we report a man who suffered from autoimmune hepatitis on immunosuppressive therapy and thoracic transverse myelitis suspected to be due to polyomavirus infection; he developed persistent MRSA blood stream infection, PVL-positive and MLST clonal complex 88 which is reported most commonly from Africa. A strain with Vancomycin susceptibility of 4 – 6 µg/ml (VISA) was initially identified, retested again elsewhere and showed MIC of 2µg/ml and Teicoplanin susceptibility of 4µg/ml. Treatment failure occurred while attaining higher serum vancomycin levels than recommended and died.
{"title":"A Patient with autoimmune hepatitis and transverse myelitis presented with persistent Staphylococcus aureus bacteremia, the discrepancies in assessing susceptibility; VISA versus Non-VISA","authors":"J. W. A. Ramahi, Abdelbadee Yacoub, Lamya Abu Shanab","doi":"10.3823/769","DOIUrl":"https://doi.org/10.3823/769","url":null,"abstract":"Vancomycin-Intermediate Staphylococcus aureus (VISA) is still uncommon among MRSA isolates. In our region, we rarely encounter a case of VISA and/or GISA bacteremia. Here, we report a man who suffered from autoimmune hepatitis on immunosuppressive therapy and thoracic transverse myelitis suspected to be due to polyomavirus infection; he developed persistent MRSA blood stream infection, PVL-positive and MLST clonal complex 88 which is reported most commonly from Africa. A strain with Vancomycin susceptibility of 4 – 6 µg/ml (VISA) was initially identified, retested again elsewhere and showed MIC of 2µg/ml and Teicoplanin susceptibility of 4µg/ml. Treatment failure occurred while attaining higher serum vancomycin levels than recommended and died.","PeriodicalId":22518,"journal":{"name":"The International Arabic Journal of Antimicrobial Agents","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86409637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The rise of CTX-M extended spectrum β-lactamase (ESBLs)-producing E. coli in non-human sources is a growing concern of public health. Understanding the extent of public health risk attributed to CTX-M type ESBLs-producing strains from different sources is critical for effective control. Objective: This study focuses on detection and molecular typing of CTX-M type ESBL-producing E. coli isolated from various sources in Taif, Western Saudi Arabia. Material and Methods: A total of 24 E. coli ESBLs-producing isolates from multiple sources were assessed for the presence of CTX-M groups gene by PCR, and subsequently their clonal relatedness by random amplifid of polymorphic DNA (RAPD) analysis. Isolates were selected according to a resistance phenotype consistent with production of ESBL-type beta-lactamase using double disk diffusion method. Results: A CTX-M gene was detected in all 24 isolates. RAPD typing of E. coli isolates bearing CTX-M gene showed 24 patterns verifid into two major clusters (A, B) and three sub-clusters (A1 – A3). Phylogenetic analysis indicating a degree of similarity among clustering isolates from human, sheep and raw milk origins. Identical profie was observed between three isolates obtained from pet bird and chicken.
{"title":"Genetic heterogeneity of CTX-M type extended-spectrum ß-lactamase producing Escherichia coli strains from diverse sources in Saudi Arabia","authors":"S. Hassan, Y. Gherbawy, A. Altalhi","doi":"10.3823/768","DOIUrl":"https://doi.org/10.3823/768","url":null,"abstract":"Background: The rise of CTX-M extended spectrum β-lactamase (ESBLs)-producing E. coli in non-human sources is a growing concern of public health. Understanding the extent of public health risk attributed to CTX-M type ESBLs-producing strains from different sources is critical for effective control. Objective: This study focuses on detection and molecular typing of CTX-M type ESBL-producing E. coli isolated from various sources in Taif, Western Saudi Arabia. Material and Methods: A total of 24 E. coli ESBLs-producing isolates from multiple sources were assessed for the presence of CTX-M groups gene by PCR, and subsequently their clonal relatedness by random amplifid of polymorphic DNA (RAPD) analysis. Isolates were selected according to a resistance phenotype consistent with production of ESBL-type beta-lactamase using double disk diffusion method. Results: A CTX-M gene was detected in all 24 isolates. RAPD typing of E. coli isolates bearing CTX-M gene showed 24 patterns verifid into two major clusters (A, B) and three sub-clusters (A1 – A3). Phylogenetic analysis indicating a degree of similarity among clustering isolates from human, sheep and raw milk origins. Identical profie was observed between three isolates obtained from pet bird and chicken.","PeriodicalId":22518,"journal":{"name":"The International Arabic Journal of Antimicrobial Agents","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72867611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. W. A. Ramahi, Lamya Abu Shanab, Abdelbadee Yacoub, A. Diab, Dania Al Momani, Fawzi Hleil, Haifa Petro, Husam Farraj, Ghassan Wadi, Naheel Halloub, S. Abdulhadi, W. Issa
ObjectivesTo evaluate the growth concordance in paired aerobic/anaerobic sets, and the impact of the anaerobic growth on patients' antimicrobial management.MethodThis is a prospective multicenter study which was conducted in three hospitals, with total beds of 750 beds and 52 ICU beds. Prospectively, laboratory blood cultures logbooks were daily reviewed and patients from whom blood cultures were ordered were followed, their chart were reviewed. Entries on antimicrobial therapeutic changes were noted for all paired sets. Clinicians were blinded to the study, though they were informed about culture results via the usual work protocol in each hospital.ResultsCollected Blood culture sets totaled 2492; 172 single sets were excluded, and 1160 paired sets were analyzed. 1046 were concordant; 79 sets had bacterial growth and 967 sets had no bacterial growth. 114 sets were discordant; 97 in aerobic bottles, 13 in anaerobic, and 4 in both.The proportion of agreement for the concordant paired growth sets was 90.2%. The composite proportion of agreement for sets with any growth (N = 193, composite proportion of agreement = 56%, 95% C.I., 34% - 48%). Cohen kappa composite agreement, measured for the total analyzed paired-sets (N = 1160, K = .52, SE = .038. 95% C.I., .447 - .595). The odds of modifying antimicrobial regimen were for total and subgroups intent to treat odds, based on paired sets showed that one modification took place in one anaerobic growth set (N = 1160, Odds = 0.0008), the odds for all sets with any growth (N = 193, odds = .005), and based on any anaerobic sets (79 concordant, 13 anaerobic, and 4 discordant) with bacterial growth (N = 96: odds = 0.010).ConclusionThe study demonstrates that the proportion of agreement among paired sets were high, and needless to include anaerobic sets in routine blood culture collection. Also the decision-making of anti-infective treatment on patients based on anaerobic blood culture growth was not evident.
{"title":"Usefulness of routine pairing of anaerobic with aerobic blood culture bottles and decision making on antimicrobial therapy","authors":"J. W. A. Ramahi, Lamya Abu Shanab, Abdelbadee Yacoub, A. Diab, Dania Al Momani, Fawzi Hleil, Haifa Petro, Husam Farraj, Ghassan Wadi, Naheel Halloub, S. Abdulhadi, W. Issa","doi":"10.3823/767","DOIUrl":"https://doi.org/10.3823/767","url":null,"abstract":"ObjectivesTo evaluate the growth concordance in paired aerobic/anaerobic sets, and the impact of the anaerobic growth on patients' antimicrobial management.MethodThis is a prospective multicenter study which was conducted in three hospitals, with total beds of 750 beds and 52 ICU beds. Prospectively, laboratory blood cultures logbooks were daily reviewed and patients from whom blood cultures were ordered were followed, their chart were reviewed. Entries on antimicrobial therapeutic changes were noted for all paired sets. Clinicians were blinded to the study, though they were informed about culture results via the usual work protocol in each hospital.ResultsCollected Blood culture sets totaled 2492; 172 single sets were excluded, and 1160 paired sets were analyzed. 1046 were concordant; 79 sets had bacterial growth and 967 sets had no bacterial growth. 114 sets were discordant; 97 in aerobic bottles, 13 in anaerobic, and 4 in both.The proportion of agreement for the concordant paired growth sets was 90.2%. The composite proportion of agreement for sets with any growth (N = 193, composite proportion of agreement = 56%, 95% C.I., 34% - 48%). Cohen kappa composite agreement, measured for the total analyzed paired-sets (N = 1160, K = .52, SE = .038. 95% C.I., .447 - .595). The odds of modifying antimicrobial regimen were for total and subgroups intent to treat odds, based on paired sets showed that one modification took place in one anaerobic growth set (N = 1160, Odds = 0.0008), the odds for all sets with any growth (N = 193, odds = .005), and based on any anaerobic sets (79 concordant, 13 anaerobic, and 4 discordant) with bacterial growth (N = 96: odds = 0.010).ConclusionThe study demonstrates that the proportion of agreement among paired sets were high, and needless to include anaerobic sets in routine blood culture collection. Also the decision-making of anti-infective treatment on patients based on anaerobic blood culture growth was not evident.","PeriodicalId":22518,"journal":{"name":"The International Arabic Journal of Antimicrobial Agents","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89964379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The emergence of s-lactamase- producing Klebsiella pneumonia (K. pneumoniae), represents a significant diagnostic and therapeutic challenge to the management of infections caused by this organism. This prospective study aimed at studying the frequency of s-lactamase production by K. pneumoniae in neonatal intensive care unit (NICU) of Mansoura University Children’s Hospital.Methods: This prospective study was conducted over a period of thirty six months from September 2010 to August 2013, where 684 samples were collected from different body sites of neonates in the NICU. Microbial isolation, identification and antimicrobial susceptibility testing were carried out. s-lactamase production by K. pneumoniae isolates was tested by phenotypic methods and PCR amplification of related genes using a six-gene panel for the amplification of the blaCMY-2, blaDHA, blaACC, blaSHV, blaTEM and blaCTX-M genes. In vitro transformation and conjugation were carried out to test for plasmid mediated AmpC s- lactamase resistance transmission to E. coli. Results: K. pneumoniae was isolated at a percentage of 12.6% and s-lactamase production was detected in 62.8% of the isolates. The most commonly detected s-lactamase gene was blaSHV (51.9%), followed by BlaCMY-2 (16.67), blaDHA (12.96%), blaTEM (9.2%), blaCTX- M(7.4%) and lastly blaACC (1.85%). Additionally, some strains carried combinations of two or three genes. The plasmid carrying blaCMY-2 was 100% successfully transformed into the competent E. coli LE392 while conjugation with the E. coli ATCC 25922 was (77.8%) successful.Conclusion: K. pneumoniae is a common multidrug resistant isolate; the production of s-lactamases is the mechanism of resistance in a significant number of cases and represents a real risk for failure of many therapeutic options. This problem is highly complicated by the horizontal spread of resistance plasmids among microbial population.
{"title":"Molecular determinants of ß-lactamase producing Klebsiella pneumoniae in Mansoura University Neonatal Intensive Care Unit","authors":"E. Hammad, Hamdia Askar, M. Saleh, B. Shouman","doi":"10.3823/766","DOIUrl":"https://doi.org/10.3823/766","url":null,"abstract":"Background: The emergence of s-lactamase- producing Klebsiella pneumonia (K. pneumoniae), represents a significant diagnostic and therapeutic challenge to the management of infections caused by this organism. This prospective study aimed at studying the frequency of s-lactamase production by K. pneumoniae in neonatal intensive care unit (NICU) of Mansoura University Children’s Hospital.Methods: This prospective study was conducted over a period of thirty six months from September 2010 to August 2013, where 684 samples were collected from different body sites of neonates in the NICU. Microbial isolation, identification and antimicrobial susceptibility testing were carried out. s-lactamase production by K. pneumoniae isolates was tested by phenotypic methods and PCR amplification of related genes using a six-gene panel for the amplification of the blaCMY-2, blaDHA, blaACC, blaSHV, blaTEM and blaCTX-M genes. In vitro transformation and conjugation were carried out to test for plasmid mediated AmpC s- lactamase resistance transmission to E. coli. Results: K. pneumoniae was isolated at a percentage of 12.6% and s-lactamase production was detected in 62.8% of the isolates. The most commonly detected s-lactamase gene was blaSHV (51.9%), followed by BlaCMY-2 (16.67), blaDHA (12.96%), blaTEM (9.2%), blaCTX- M(7.4%) and lastly blaACC (1.85%). Additionally, some strains carried combinations of two or three genes. The plasmid carrying blaCMY-2 was 100% successfully transformed into the competent E. coli LE392 while conjugation with the E. coli ATCC 25922 was (77.8%) successful.Conclusion: K. pneumoniae is a common multidrug resistant isolate; the production of s-lactamases is the mechanism of resistance in a significant number of cases and represents a real risk for failure of many therapeutic options. This problem is highly complicated by the horizontal spread of resistance plasmids among microbial population.","PeriodicalId":22518,"journal":{"name":"The International Arabic Journal of Antimicrobial Agents","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89597706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mirna Rajeh, A. Sabra, K. A. Kissoyan, Sukayna Fadlallah, G. Matar
Background: Methicillin-resistant staphylococci (MRS) are major human pathogens accounting for most hospital-acquired (HA) and community acquired (CA) infections worldwide. The recent increase in MRS in a medical center in Lebanon elicited the determination of SCCmec types, genotypes, and prevalence of Panton-Valentine leucociden (PVL) and toxic shock syndrome toxin-1 (TSST-1) among the MRS isolates. Methods: Thirty-six MRS isolates collected between October 2010 and September 2011 at a medical center, Lebanon were typed using phenotypic and genotypic methods. Antimicrobial susceptibility was determined using the disk diffusion agar method. SCCmec typing was performed by multiplex PCR and sequence analysis. The prevalence of the genes encoding PVL and TSST-1 virulence factors and their transcription levels, were determined respectively by PCR and semi-quantitative real-time PCR. The genomic relatedness of the isolates was assessed by random amplified polymorphic DNA (RAPD) analysis.Results: Antimicrobial susceptibility revealed three distinct antibiotypes. The predominant SCCmec type found among the MRS isolates was type IVa (51%). Twenty-nine percent harbored SCCmec type III and 14% harbored SCCmec type II. One isolate harbored SCCmec type IVc, and another harbored SCCmec type I. All methicillin-resistant Staphylococcus aureus (MRSA) isolates were negative for the gene encoding for PVL, and two were positive for the gene encoding for TSST-1. RAPD analysis demonstrated high genomic diversity among the MRS isolates.Conclusion: This study demonstrated the SCCmec types and the clonality of the MRS strains, allowing the differentiation between HA and CA-MRS strains. CA-MRS have increased in the hospital environment and rendered highly resistant to erythromycin and clindamycin.
{"title":"Molecular characterization of staphylococcal cassette chromosome mec and virulence encoding genes in methicillin-resistant staphylococci at a medical center in Lebanon","authors":"Mirna Rajeh, A. Sabra, K. A. Kissoyan, Sukayna Fadlallah, G. Matar","doi":"10.3823/765","DOIUrl":"https://doi.org/10.3823/765","url":null,"abstract":"Background: Methicillin-resistant staphylococci (MRS) are major human pathogens accounting for most hospital-acquired (HA) and community acquired (CA) infections worldwide. The recent increase in MRS in a medical center in Lebanon elicited the determination of SCCmec types, genotypes, and prevalence of Panton-Valentine leucociden (PVL) and toxic shock syndrome toxin-1 (TSST-1) among the MRS isolates. Methods: Thirty-six MRS isolates collected between October 2010 and September 2011 at a medical center, Lebanon were typed using phenotypic and genotypic methods. Antimicrobial susceptibility was determined using the disk diffusion agar method. SCCmec typing was performed by multiplex PCR and sequence analysis. The prevalence of the genes encoding PVL and TSST-1 virulence factors and their transcription levels, were determined respectively by PCR and semi-quantitative real-time PCR. The genomic relatedness of the isolates was assessed by random amplified polymorphic DNA (RAPD) analysis.Results: Antimicrobial susceptibility revealed three distinct antibiotypes. The predominant SCCmec type found among the MRS isolates was type IVa (51%). Twenty-nine percent harbored SCCmec type III and 14% harbored SCCmec type II. One isolate harbored SCCmec type IVc, and another harbored SCCmec type I. All methicillin-resistant Staphylococcus aureus (MRSA) isolates were negative for the gene encoding for PVL, and two were positive for the gene encoding for TSST-1. RAPD analysis demonstrated high genomic diversity among the MRS isolates.Conclusion: This study demonstrated the SCCmec types and the clonality of the MRS strains, allowing the differentiation between HA and CA-MRS strains. CA-MRS have increased in the hospital environment and rendered highly resistant to erythromycin and clindamycin.","PeriodicalId":22518,"journal":{"name":"The International Arabic Journal of Antimicrobial Agents","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73864284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Bassyouni, M. Nassar, Z. Ibrahim, Mohammed Saad Zaghloul Ahmed
Object: Lactobacillus acidophilus is a nonpathogenic member of gastrointestinal tract and it is widely used in fermented dairy products. This study aimed to assess the antimicrobial potential of two strains of L. acidophilus on some pathogenic bacteria frequently causing diarrhea or gastroenteritis. Methods: The antibacterial activity cell free supernatant (CFS) of two control standard strains of L. acidophilus (L. acidophilus-la5 and L. acidophilus against fie control standard strains of bacteria causing diarrhea; Enterotoxogenic Escherichia coli (ETEC), Enterohaemorrhagic E. coli O 157:H7(EHEC) Salmonella typhimurium Shigella flxeneri and Staphylococcus aureus were determined using agar well diffusion method. The sensitivity of the pathogenic bacteria to the CFS of each L. acidophilus in relation to time was determined by standard plate count .The antibiotic susceptibility tests of 20 antibiotics against tested organisms with and without CFS were assessed by disc diffusion method. The minimum inhibitory concentration (MIC) of ciproflxacin with and without CFS was determined by tube dilution method. Results: Both Lactobacilli strains decrease the colony count of tested strains by more than 90% after 60 min contact time. Both Lactobacilli strains signifiantly improve the antibacterial effect of tested antibiotics against ETEC, S. typhimurium and S. aureus, and S. flxeneri (P< 0.05). The MIC of ciproflxacin alone against all tested strains was 15.625 μg/ml, while when combined with both Lactobacilli CFSs, the MIC decreased signifiantly to 0.488 μg/ml for ETEC, S. typhimurium, and S. flxeneri and to 0.977 μg/ml for EHEC and S. aureus (P= 0.000). Conclusion : living L. acidophilus strains could be used in prevention and treatment of diarrhea caused by certain bacterial pathogens, either in fermented milk/ yoghurt or as mediations.
{"title":"The antimicrobial potential of Lactobacillus acidophilus on pathogenic bacteria causing diarrhea","authors":"R. Bassyouni, M. Nassar, Z. Ibrahim, Mohammed Saad Zaghloul Ahmed","doi":"10.3823/764","DOIUrl":"https://doi.org/10.3823/764","url":null,"abstract":"Object: Lactobacillus acidophilus is a nonpathogenic member of gastrointestinal tract and it is widely used in fermented dairy products. This study aimed to assess the antimicrobial potential of two strains of L. acidophilus on some pathogenic bacteria frequently causing diarrhea or gastroenteritis. Methods: The antibacterial activity cell free supernatant (CFS) of two control standard strains of L. acidophilus (L. acidophilus-la5 and L. acidophilus against fie control standard strains of bacteria causing diarrhea; Enterotoxogenic Escherichia coli (ETEC), Enterohaemorrhagic E. coli O 157:H7(EHEC) Salmonella typhimurium Shigella flxeneri and Staphylococcus aureus were determined using agar well diffusion method. The sensitivity of the pathogenic bacteria to the CFS of each L. acidophilus in relation to time was determined by standard plate count .The antibiotic susceptibility tests of 20 antibiotics against tested organisms with and without CFS were assessed by disc diffusion method. The minimum inhibitory concentration (MIC) of ciproflxacin with and without CFS was determined by tube dilution method. Results: Both Lactobacilli strains decrease the colony count of tested strains by more than 90% after 60 min contact time. Both Lactobacilli strains signifiantly improve the antibacterial effect of tested antibiotics against ETEC, S. typhimurium and S. aureus, and S. flxeneri (P< 0.05). The MIC of ciproflxacin alone against all tested strains was 15.625 μg/ml, while when combined with both Lactobacilli CFSs, the MIC decreased signifiantly to 0.488 μg/ml for ETEC, S. typhimurium, and S. flxeneri and to 0.977 μg/ml for EHEC and S. aureus (P= 0.000). Conclusion : living L. acidophilus strains could be used in prevention and treatment of diarrhea caused by certain bacterial pathogens, either in fermented milk/ yoghurt or as mediations.","PeriodicalId":22518,"journal":{"name":"The International Arabic Journal of Antimicrobial Agents","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75661345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Wadi, Ali Sameh Ayesh, Lamya Abu Shanab, Bilal Harara, Haifa Petro, A. Rumman, Mustafa Alaskar, Malek Maswadeh, M. Tadbir
Objective: To evaluate the prevalence of C. difficile infection (CDI) among hospitalized patients with toxin-positive stools. Methods: This study is a multicenter study held in Jordan and focused on the prevalence of in-patients with C. difficile toxin-positive diarrhea-stools. The study included three hospitals with approximately 750 beds. In-patients charts, laboratory logbooks for in-patients with diarrhea-stool specimens were reviewed. The participating hospitals used a rapid test, which detects fecal C. difficile toxins A and B. Results: 174 stool specimens were reviewed from March 2013 to October 2014, and 170 stool specimens from 168 patients were evaluated. The patients included 102 (60%) males, and 66 (40%) females including seven (10.6%) peripartum females. The patients were classified in the following age groups:neonates ≤ 28 days, infants 29 days - less than one year old (n = 4, 2.4%), 1 – 4 years (n = 3, 1.8%), and arbitrarily: 5 - 9 years (n = 3, 1.8%), 10 – 14 years (n = 3, 1.8%), 15 – 40 years (n = 33, 19.4%), 41- 64 years, (n = 53, 31.2%) and ≥ 65 years were (n = 71, 41.8%).Adults and older age groups make up the majority of all patients (92.4%). Comorbidities were highly prevalent among the patients: diabetic (n = 71, 41.8%), chronic lung diseases (n = 25, 14.7%), solid tumors other than colonic tumors (n = 12, 7.1%), immune-suppressive state (n = 15, 8.8%), and one patient had colonic tumor. The majority of the patients (n = 21) were on more than one class of broad-spectrum antimicrobials. The prevalence of C. difficile toxin-positive stools were 14.63/1000 discharged patients, 12.65% of patients (12.96% of stool specimens)
{"title":"Prevalence of Clostridium difficile infections among hospitalized patients in Amman, Jordan: A Multi-Center Study","authors":"J. Wadi, Ali Sameh Ayesh, Lamya Abu Shanab, Bilal Harara, Haifa Petro, A. Rumman, Mustafa Alaskar, Malek Maswadeh, M. Tadbir","doi":"10.3823/763","DOIUrl":"https://doi.org/10.3823/763","url":null,"abstract":"Objective: To evaluate the prevalence of C. difficile infection (CDI) among hospitalized patients with toxin-positive stools. Methods: This study is a multicenter study held in Jordan and focused on the prevalence of in-patients with C. difficile toxin-positive diarrhea-stools. The study included three hospitals with approximately 750 beds. In-patients charts, laboratory logbooks for in-patients with diarrhea-stool specimens were reviewed. The participating hospitals used a rapid test, which detects fecal C. difficile toxins A and B. Results: 174 stool specimens were reviewed from March 2013 to October 2014, and 170 stool specimens from 168 patients were evaluated. The patients included 102 (60%) males, and 66 (40%) females including seven (10.6%) peripartum females. The patients were classified in the following age groups:neonates ≤ 28 days, infants 29 days - less than one year old (n = 4, 2.4%), 1 – 4 years (n = 3, 1.8%), and arbitrarily: 5 - 9 years (n = 3, 1.8%), 10 – 14 years (n = 3, 1.8%), 15 – 40 years (n = 33, 19.4%), 41- 64 years, (n = 53, 31.2%) and ≥ 65 years were (n = 71, 41.8%).Adults and older age groups make up the majority of all patients (92.4%). Comorbidities were highly prevalent among the patients: diabetic (n = 71, 41.8%), chronic lung diseases (n = 25, 14.7%), solid tumors other than colonic tumors (n = 12, 7.1%), immune-suppressive state (n = 15, 8.8%), and one patient had colonic tumor. The majority of the patients (n = 21) were on more than one class of broad-spectrum antimicrobials. The prevalence of C. difficile toxin-positive stools were 14.63/1000 discharged patients, 12.65% of patients (12.96% of stool specimens)","PeriodicalId":22518,"journal":{"name":"The International Arabic Journal of Antimicrobial Agents","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89277291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Bustami, Nermen Dakkak, Lauy F. Abu-Qatouseh, R. Khalil, K. Matalka
Acinetobacter baumannii isolates have been recovered from hospitalized patients over the past few years from two hospitals in Jordan. Phenotypic and biochemical characterization in addition to disc susceptibility testing of all clinical isolates indicated that all of them were belonging to A. baumannii. A high degree of conservation of both the ITS length and the ITS sequence was observed, and their identities were further confirmed by amplified ribosomal DNA gene restriction analysis (ARDRA). The application of ARDRA for the identification of Acinetobacter species has several advantages over phenotypic identification. ARDRA considered rapid and reliable and universally applicable method for identification of most of the Acinetobacter genomic species, thus contribute to better understanding of the clinical importance and epidemiology of isolates.
{"title":"Value of phenotyic and genotypic identification of Acinetobacter baumannii isolates from two hospitals in Jordan","authors":"M. Bustami, Nermen Dakkak, Lauy F. Abu-Qatouseh, R. Khalil, K. Matalka","doi":"10.3823/762","DOIUrl":"https://doi.org/10.3823/762","url":null,"abstract":"Acinetobacter baumannii isolates have been recovered from hospitalized patients over the past few years from two hospitals in Jordan. Phenotypic and biochemical characterization in addition to disc susceptibility testing of all clinical isolates indicated that all of them were belonging to A. baumannii. A high degree of conservation of both the ITS length and the ITS sequence was observed, and their identities were further confirmed by amplified ribosomal DNA gene restriction analysis (ARDRA). The application of ARDRA for the identification of Acinetobacter species has several advantages over phenotypic identification. ARDRA considered rapid and reliable and universally applicable method for identification of most of the Acinetobacter genomic species, thus contribute to better understanding of the clinical importance and epidemiology of isolates.","PeriodicalId":22518,"journal":{"name":"The International Arabic Journal of Antimicrobial Agents","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80755506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. A. Daniel, M. Shawky, H. Abou-Shleib, M. El-Nakeeb
Background: Recently there has been a growing concern that the indiscriminate use of antimicrobial agents in the household, food industry and in hospitals may contribute to the emergence of bacteria resistant to antibiotics. Aim of the work: To detect any possible link between the susceptibility profiles of different clinical and environmental isolates to biocides and antibiotics in an Egyptian hospital. Methods: 66 different microbial isolates were isolated from different clinical specimens and different environmental samples obtained from a University Hospital in Alexandria. These isolates were screened for their susceptibility to 22 broad spectrum antibiotics using disc agar diffusion technique. Also the susceptibility of the isolates to 6 commonly used biocides was screened through MIC determination by agar dilution technique. Correlations between the obtained data were made through Spearman’s correlation using SPSS ® Statistical program. Results: 62% of the isolates were multidrug resistant (MDR); and 11% were extremely drug resistant (XDR). On the other hand, 34% of the tested isolates were multi-disinfectant reduced susceptibility (MDRS) isolates. The statistical analysis of the obtained data revealed a moderate positive correlation between antibiotic resistance and biocide tolerance (0.376≥ρ≥0.278, p<0.05). In addition, strong significant correlations (p<0.01) were also found between reduced susceptibilities to multiple biocides such as benzalkonium chloride (BK), cetrimide (CET), chlorhexidine (CHX), povidone-iodine (PVPI) and Dettol ® . Conclusion: Cross-resistance between biocides and antibiotics can aggravate the existing problem of antibiotic resistance in hospitals.
{"title":"Antibiotic Resistance and its Association with Biocides Susceptibilities among Microbial Isolates in an Egyptian Hospital","authors":"S. A. Daniel, M. Shawky, H. Abou-Shleib, M. El-Nakeeb","doi":"10.3823/761","DOIUrl":"https://doi.org/10.3823/761","url":null,"abstract":"Background: Recently there has been a growing concern that the indiscriminate use of antimicrobial agents in the household, food industry and in hospitals may contribute to the emergence of bacteria resistant to antibiotics. Aim of the work: To detect any possible link between the susceptibility profiles of different clinical and environmental isolates to biocides and antibiotics in an Egyptian hospital. Methods: 66 different microbial isolates were isolated from different clinical specimens and different environmental samples obtained from a University Hospital in Alexandria. These isolates were screened for their susceptibility to 22 broad spectrum antibiotics using disc agar diffusion technique. Also the susceptibility of the isolates to 6 commonly used biocides was screened through MIC determination by agar dilution technique. Correlations between the obtained data were made through Spearman’s correlation using SPSS ® Statistical program. Results: 62% of the isolates were multidrug resistant (MDR); and 11% were extremely drug resistant (XDR). On the other hand, 34% of the tested isolates were multi-disinfectant reduced susceptibility (MDRS) isolates. The statistical analysis of the obtained data revealed a moderate positive correlation between antibiotic resistance and biocide tolerance (0.376≥ρ≥0.278, p<0.05). In addition, strong significant correlations (p<0.01) were also found between reduced susceptibilities to multiple biocides such as benzalkonium chloride (BK), cetrimide (CET), chlorhexidine (CHX), povidone-iodine (PVPI) and Dettol ® . Conclusion: Cross-resistance between biocides and antibiotics can aggravate the existing problem of antibiotic resistance in hospitals.","PeriodicalId":22518,"journal":{"name":"The International Arabic Journal of Antimicrobial Agents","volume":"235 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87470824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sara Amrieh, M. Hamzé, H. Mallat, M. Achkar, F. Dabboussi
Background. While most strains of Escherichia coli (E. coli) are harmless, some are causing intestinal infections of varying severity. Then Shiga toxin-producing E. coli (STEC)/ enterohemorrhagic E. coli strains can be associated with fatal clinical manifestations. Of these E. coli Serotypes O157: H7 and O104: H4 were responsible for worldwide epidemics causing thousands of intestinal infections and dozens of deaths.The aim of this research is to investigate the prevalence of E. coli O157: H7 and O104: H4 in the diarrheal stools of 242 Lebanese patients.Materials and methods. This study includes 242 E. coli strains isolatedfrom fecal specimens of patients with diarrhea between February2013 and May 2014 in the microbiology department of Nini HospitalLaboratory in Tripoli - North Lebanon. All specimens were inoculatedon sorbitol MacConkey agar. Sorbitol negative strains were investigated for detection of stx1, stx2 and eae genes using real-time PCR. All carbapenem-resistant strains and ESBL producers were investigated by PCR for presence of KPC, IMI, NMC-A, EMS, GHG, VIM, NDM, IMP,OXA-48, blaTEM, blaCTX-M, blaSHV, blaOXA, blaGES and blaPER..Results. A total of 14 sorbitol negative strains were detected. The search for stx1, stx2 and eae genes showed the presence of a single positive strain for E. coli O157: H7. Out of 242 E.coli strains, 48 (19.8%) were ESBL-positive, 4 (1.6%) were resistant to ertapenem, and all were negative for stx2 genes, The blaCTX-M gene was the most frequentamong ESBL positive strains (85%), followed by the blaTEM gene (50%). One strain had the blaNDM-1 gene, another had the blaOXA-48 gene and 2 strains were probably resistant due to impermeability.Conclusion. The results of this study demonstrate rarely presence of enterohemorrhagic E. coli, but shows the frequent presence of multidrug resistant E.coli in the intestinal flra of North Lebanese patients. Therefore, it is important to search for MDR E.coli in the intestinal flra of patients who are going to be treated with major operations or those admitted to intensive care units
{"title":"Detection of Escherichia coli O157:H7 and O104:H4 in patients with diarrhea in Northern Lebanon and characterization of fecal E.coli producing ESBL and carbapenemase genes","authors":"Sara Amrieh, M. Hamzé, H. Mallat, M. Achkar, F. Dabboussi","doi":"10.3823/756","DOIUrl":"https://doi.org/10.3823/756","url":null,"abstract":"Background. While most strains of Escherichia coli (E. coli) are harmless, some are causing intestinal infections of varying severity. Then Shiga toxin-producing E. coli (STEC)/ enterohemorrhagic E. coli strains can be associated with fatal clinical manifestations. Of these E. coli Serotypes O157: H7 and O104: H4 were responsible for worldwide epidemics causing thousands of intestinal infections and dozens of deaths.The aim of this research is to investigate the prevalence of E. coli O157: H7 and O104: H4 in the diarrheal stools of 242 Lebanese patients.Materials and methods. This study includes 242 E. coli strains isolatedfrom fecal specimens of patients with diarrhea between February2013 and May 2014 in the microbiology department of Nini HospitalLaboratory in Tripoli - North Lebanon. All specimens were inoculatedon sorbitol MacConkey agar. Sorbitol negative strains were investigated for detection of stx1, stx2 and eae genes using real-time PCR. All carbapenem-resistant strains and ESBL producers were investigated by PCR for presence of KPC, IMI, NMC-A, EMS, GHG, VIM, NDM, IMP,OXA-48, blaTEM, blaCTX-M, blaSHV, blaOXA, blaGES and blaPER..Results. A total of 14 sorbitol negative strains were detected. The search for stx1, stx2 and eae genes showed the presence of a single positive strain for E. coli O157: H7. Out of 242 E.coli strains, 48 (19.8%) were ESBL-positive, 4 (1.6%) were resistant to ertapenem, and all were negative for stx2 genes, The blaCTX-M gene was the most frequentamong ESBL positive strains (85%), followed by the blaTEM gene (50%). One strain had the blaNDM-1 gene, another had the blaOXA-48 gene and 2 strains were probably resistant due to impermeability.Conclusion. The results of this study demonstrate rarely presence of enterohemorrhagic E. coli, but shows the frequent presence of multidrug resistant E.coli in the intestinal flra of North Lebanese patients. Therefore, it is important to search for MDR E.coli in the intestinal flra of patients who are going to be treated with major operations or those admitted to intensive care units","PeriodicalId":22518,"journal":{"name":"The International Arabic Journal of Antimicrobial Agents","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72601308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}