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Hassan PA, Khider AK. Correlation of biofilm formation and antibiotic resistance among clinical and soil isolates of Acinetobacter baumannii in Iraq. Acta Microbiol Immunol Hung 2020; 67:161-170. [PMID: 31833386 DOI: 10.1556/030.66.2019.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/17/2019] [Indexed: 01/09/2023]
Abstract
Acinetobacter baumannii is an opportunistic pathogen that is reported as a major cause of nosocomial infections. The aim of this study was to investigate the biofilm formation by A. baumannii clinical and soil isolates, to display their susceptibility to 11 antibiotics and to study a possible relationship between formation of biofilm and multidrug resistance. During 8 months period, from June 2016 to January 2017, a total of 52 clinical and 22 soil isolates of A. baumannii were collected and identified through conventional phenotypic, chromo agar, biochemical tests, API 20E system, and confirmed genotypically by PCR for blaOXA-51-like gene. Antibiotic susceptibility of isolates was determined by standard disk diffusion method according to Clinical and Laboratory Standard Institute. The biofilm formation was studied using Congo red agar, test tube, and microtiter plate methods. The clinical isolates were 100% resistance to ciprofloxacin, ceftazidime, piperacillin, 96.15% to gentamicin, 96.15% to imipenem, 92.31% to meropenem, and 78.85% to amikacin. The soil A. baumannii isolates were 100% sensitive to imipenem, meropenem, and gentamicin, and 90.1% to ciprofloxacin. All A. baumannii isolates (clinical and soil) were susceptible to polymyxin B. The percentage of biofilm formation in Congo red agar, test tube, and microtiter plate assays was 10.81%, 63.51%, and 86.48%, respectively. More robust biofilm former population was mainly among non-MDR isolates. Isolates with a higher level of resistance tended to form weaker biofilms. The soil isolates exhibited less resistance to antibiotics than clinical isolates. However, the soil isolates produce stronger biofilms than clinical isolates.
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Affiliation(s)
- Pakhshan A. Hassan
- 1 Department of Biology, College of Science, Salahaddin University, Erbil, Iraq
| | - Adel K. Khider
- 2 Department of Biology, College of Education, Salahaddin University, Erbil, Iraq
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Detection of a hypermucoviscous Klebsiella pneumoniae co-producing NDM-5 and OXA-48 carbapenemases with sequence type 383, Brescia, Italy. Int J Antimicrob Agents 2020; 56:106130. [DOI: 10.1016/j.ijantimicag.2020.106130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 11/21/2022]
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Chen Z, Cai Z, Zhu C, Song X, Qin Y, Zhu M, Zhang T, Cui W, Tang H, Zheng H. Injectable and Self-Healing Hydrogel with Anti-Bacterial and Anti-Inflammatory Properties for Acute Bacterial Rhinosinusitis with Micro Invasive Treatment. Adv Healthc Mater 2020; 9:e2001032. [PMID: 32902190 DOI: 10.1002/adhm.202001032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/09/2020] [Indexed: 12/11/2022]
Abstract
Systemic antibiotic therapy is the main treatment for acute bacterial rhinosinusitis (ABRS). However, this treatment often causes side effects of dizziness, diarrhea, and drug resistance. In this study, a new polyethylene glycol hydrogel (PEG-H) treatment model is developed to achieve sustained release of drugs at the locality while avoiding those adverse effects. The PEG-H is composed of 4-arm-PEG-SH and silver ions through a high affinity and dynamic reversible coordination bond between the thiol and silver ion. In the initial test, PEG-H is loaded with Clarithromycin (CAM-Lips@Hydrogel) or Clarithromycin and Budesonide liposomes (CAM+BUD-Lips@Hydrogel). The results show that PEG-H maintains the characteristics of self-healing, biodegradability, moderate swelling rate, injectibility and sustained drug release. In in vivo studies, the hydrogel is injected into the maxillary sinus of ABRS rabbit models. In both a single or combined load, the hydrogel not only plays an effective role as an anti-bacterial, but also inhibits inflammatory response of local sinus mucosa. In addition, no other side effects are observed in the ABRS rabbit model through behavioral observation and drug sensitivity tests. Therefore, the injectable self-healing hydrogel with anti-bacterial and anti-inflammatory properties provides a new micro invasive therapeutic method for the clinical treatment of ABRS.
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Affiliation(s)
- Zhengming Chen
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Zhengwei Cai
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases Shanghai Institute of Traumatology and Orthopaedics Ruijin Hospital Shanghai Jiao Tong University School of Medicine 197 Ruijin 2nd Road Shanghai 200025 P. R. China
| | - Chengjing Zhu
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Xianmin Song
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Yanghua Qin
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Minhui Zhu
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Tao Zhang
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Wenguo Cui
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases Shanghai Institute of Traumatology and Orthopaedics Ruijin Hospital Shanghai Jiao Tong University School of Medicine 197 Ruijin 2nd Road Shanghai 200025 P. R. China
| | - Haihong Tang
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
| | - Hongliang Zheng
- Department of Otorhinolaryngology & Head and Neck Surgery of Changhai Hospital Naval Military Medical University (The Second Military Medical University) 168 Changhai Road Shanghai 200433 P. R. China
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Moghnieh R, Abdallah D, Awad L, Jadayel M, Haddad N, Tamim H, Zaiter A, Awwad DC, Sinno L, El-Hassan S, Lakkis R, Khalil R, Jisr T. The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study. Ann Clin Microbiol Antimicrob 2020; 19:35. [PMID: 32762758 PMCID: PMC7412806 DOI: 10.1186/s12941-020-00377-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/30/2020] [Indexed: 12/23/2022] Open
Abstract
Background A drug-oriented antibiotic stewardship intervention targeting tigecycline utilization was launched at Makassed General Hospital, Beirut, Lebanon, in 2016 as a part of a comprehensive Antibiotic Stewardship Program (ASP). In this study, we evaluated the effect of this intervention on changing tigecycline prescription behavior in different types of infections, patient outcome and mortality, along with tigecycline drug use density, when compared to an earlier period before the initiation of ASP. Methods This is a retrospective chart review of all adult inpatients who received tigecycline for more than 72 h between Jan-2012 and Dec-2013 [period (P) 1 before ASP] and between Oct-2016 and Dec-2018 [period (P) 2 during ASP]. Results Tigecycline was administered to 153 patients during P1 and 116 patients during P2. The proportion of patients suffering from cancer, those requiring mechanical ventilation, and those with hemodynamic failure was significantly reduced between P1 and P2. The proportion of patients who received tigecycline for FDA-approved indications increased from 19% during P1 to 78% during P2 (P < 0.001). On the other hand, its use in off-label indications was restricted, including ventilator-associated pneumonia (26.1% in P1, 3.4% in P2, P < 0.001), hospital-acquired pneumonia (19.6% in P1, 5.2% in P2, P = 0.001), sepsis (9.2% in P1, 3% in P2, P = 0.028), and febrile neutropenia (15.7% in P1, 0.9% in P2, P < 0.001). The clinical success rate of tigecycline therapy showed an overall significant increase from 48.4% during P1 to 65.5% during P2 (P = 0.005) in the entire patient population. All-cause mortality in the tigecycline-treated patients decreased from 45.1% during P1 to 20.7% during P2 (P < 0.0001). In general, mean tigecycline consumption decreased by 55% between P1 and P2 (P < 0.0001). Conclusion The drug-oriented ASP intervention targeting tigecycline prescriptions improved its use and patient outcomes, where it helped curb the over-optimistic use of this drug in off-label indications where it is not a suitable treatment option.
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Affiliation(s)
- Rima Moghnieh
- Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon. .,Division of Infectious Diseases, Department of Internal Medicine, Hôtel Dieu de France, Beirut, Lebanon.
| | - Dania Abdallah
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Lyn Awad
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Marwa Jadayel
- School of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Nicholas Haddad
- Infectious Disease and Residency Program, Internal Medicine, Central Michigan University, Saginaw, MI, 48602, USA
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Aline Zaiter
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | | | - Loubna Sinno
- Department of Medical Research, Makassed General Hospital, Beirut, Lebanon
| | | | - Rawad Lakkis
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Rabab Khalil
- Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Tamima Jisr
- Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon
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Management of infections caused by WHO critical priority Gram-negative pathogens in Arab countries of the Middle East: a consensus paper. Int J Antimicrob Agents 2020; 56:106104. [PMID: 32721603 DOI: 10.1016/j.ijantimicag.2020.106104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022]
Abstract
Antimicrobial resistance is an important global issue that impacts the efficacy of established antimicrobial therapy. This is true globally and within the Arab countries of the Middle East, where a range of key Gram-negative pathogens pose challenges to effective therapy. There is a need to establish effective treatment recommendations for this region given specific challenges to antimicrobial therapy, including variations in the availability of antimicrobials, infrastructure and specialist expertise. This consensus provides regional recommendations for the first-line treatment of hospitalized patients with serious infections caused by World Health Organization critical priority Gram-negative pathogens Acinetobacter baumannii and Pseudomonas aeruginosa resistant to carbapenems, and Enterobacteriaceae resistant to carbapenems and third-generation cephalosporins. A working group comprising experts in infectious disease across the region was assembled to review contemporary literature and provide additional consensus on the treatment of key pathogens. Detailed therapeutic recommendations are formulated for these pathogens with a focus on bacteraemia, nosocomial pneumonia, urinary tract infections, skin and soft tissue infections, and intra-abdominal infections. First-line treatment options are provided, along with alternative agents that may be used where variations in antimicrobial availability exist or where local preferences and resistance patterns should be considered. These recommendations take into consideration the diverse social and healthcare structures of the Arab countries of the Middle East, meeting a need that is not filled by international guidelines. There is a need for these recommendations to be updated continually to reflect changes in antimicrobial resistance in the region, as well as drug availability and emerging data from clinical trials.
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Moghnieh R, Tamim H, Jadayel M, Abdallah D, Al-Kassem R, Kadiri H, Hafez H, Al-Hassan S, Ajjour L, Lakkis R, Jisr T, Samaha NL, Haddad N. The effect of temporary closure and enhanced terminal disinfection using aerosolized hydrogen peroxide of an open-bay intensive care unit on the acquisition of extensively drug-resistant Acinetobacter baumannii. Antimicrob Resist Infect Control 2020; 9:108. [PMID: 32665037 PMCID: PMC7362486 DOI: 10.1186/s13756-020-00772-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/02/2020] [Indexed: 12/04/2022] Open
Abstract
Background At Makassed Hospital’s open-bay intensive care unit (ICU), enhanced terminal disinfection (ETD) using hydrogen peroxide (H2O2) was performed without a predefined schedule in extensively-drug-resistant Acinetobacter baumannii (XDR-AB) outbreaks. In this study, we aimed to check for the value of the temporary closure of the ICU and the use of ETD with aerosolized H2O2 and Ag+ on minimizing the rate of XDR-AB acquisition in patients admitted to the ICU of our facility, which might consequently help us determine the optimal schedule for such procedure in this unit. Methods This is a retrospective medical file review of patients admitted to the ICU between January 2016 and May 2018. We divided this period into numerical weeks (NW) after each closure and ETD episode. Risk factors of acquisition (RFA) were determined by comparing the characteristics of patients who acquired XDR-AB to those who didn’t. The proportion of patients residing in each NW was included in the RFA analysis. Results Out of 335 patients, 13% acquired XDR-AB. The overall incidence of XDR-AB acquisition was 14.6 cases/1000 patient days. RFA were XDR-AB contact pressure ≥ 3 days [Odds Ratio (OR) = 9.86, 95% Confidence Interval (CI) (3.65–26.64), P < 0.0001)], mechanical ventilation [OR = 4.99, 95%CI (1.76–14.15), P = 0.002)], and having a wound [OR = 3.72, 95%CI (0.99–13.96), P = 0.05)]. Patients who stayed during NW 7,11 and 14 were at risk of acquisition where the odds significantly increased by 6.5, 9.7 and 14.4 folds respectively (P = 0.03,0.01, and 0.01, respectively). We considered NW 7 as the most suitable time for temporary closure of the ICU and ETD with aerosolized H2O2. Conclusion Contact pressure, mechanical ventilation, and presence of a wound were RFA of XDR-AB. Temporary closure of the ICU with ETD using aerosolized H2O2 decreased the rate of XDR-AB acquisition, yet this effect fades away with time. The ETD was shown to be most efficiently done when repeated every 7 calendar weeks in our open-bay ICU as part of a prevention bundle.
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Affiliation(s)
- Rima Moghnieh
- Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon. .,Division of Infectious Diseases, Hôtel Dieu de France, Beirut, Lebanon.
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Marwa Jadayel
- School of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Dania Abdallah
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Rasha Al-Kassem
- Nursing Department, Makassed General Hospital, Beirut, Lebanon
| | - Hind Kadiri
- Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Hani Hafez
- Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Salam Al-Hassan
- Nursing Department, Makassed General Hospital, Beirut, Lebanon
| | - Lina Ajjour
- Nursing Department, Makassed General Hospital, Beirut, Lebanon
| | - Rawad Lakkis
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Tamima Jisr
- Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Nadia-Lara Samaha
- College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Nicholas Haddad
- Associate Professor of Infectious Disease and Residency Program Director, Internal Medicine, Central Michigan University, Saginaw, MI, 48602, USA
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Al-Joufi FA, Aljarallah KM, Hagras SA, Al Hosiny IM, Salem-Bekhit MM, Youssof AME, Shakeel F. Microbial spectrum, antibiotic susceptibility profile, and biofilm formation of diabetic foot infections (2014-18): a retrospective multicenter analysis. 3 Biotech 2020; 10:325. [PMID: 32656058 DOI: 10.1007/s13205-020-02318-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/23/2020] [Indexed: 12/13/2022] Open
Abstract
This study identifies the risk factors, microbiological properties, antimicrobial susceptibility patterns, mortality, and clinical complications associated with organisms causing diabetic foot infections (DFIs) with or without antibiotic treatment using data from a retrospective multicenter surveillance. Specimens collected from different hospitals were cultured and the extended-spectrum β-lactamase (ESBL) excretion was estimated. The antibacterial susceptibility pattern and biofilm formation were completed along with the recommended standard methods. Overall, 792 diabetic foot patients (DFPs) were enrolled and a total of 1803 causative organisms were isolated. Polymicrobial infection was identified in 48.5% of the patients. The isolated Gram-positive pathogens (46.7%) were higher than Gram-negative (38.6%) or anaerobes (7.9%). The predominant pathogens were S. aureus (22.2%), methicillin-resistant S. aureus (7.7%), Enterococcus spp. (12.8%), Pseudomonas aeruginosa (9.4%), E. coli (7.9%), Klebsiella spp. (7.5%), Proteus mirabilis (8.9%), coagulase negative staphylococci (CoNS) (6.6%), anaerobic organisms (5.9%), and fungi (2.3%). Vancomycin and clindamycin exhibited no activity against Gram-positive bacteria. However, meropenem and imipenem displayed high activity against the Gram-negative isolates. Out of the 765 tested strains, 251 showed moderate (15.8%) to high (34%) level biofilm-producing phenotype. DFIs were widespread among the diabetic patients with different microbial etiology and the major organisms were aerobic organisms. Our findings may provide an insight into the development of appropriate therapeutic strategies for the management of DFIs.
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Affiliation(s)
| | - Khalid M Aljarallah
- College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
- College of Applied Sciences, Almaarefa University, Riyadh, Saudi Arabia
| | - Soheir A Hagras
- Inaya Medical Colleges, Riyadh, Saudi Arabia
- NCRRT, EAEA, Cairo, Egypt
| | - Ibrahim M Al Hosiny
- Microbiology and Immunology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mounir M Salem-Bekhit
- Department of Pharmaceutics, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, 11451 Saudi Arabia
| | - Abdullah M E Youssof
- Department of Pharmaceutics, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, 11451 Saudi Arabia
| | - Faiyaz Shakeel
- Department of Pharmaceutics, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, 11451 Saudi Arabia
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Jafari A, Falahatkar S, Delpasand K, Sabati H, Sedigh Ebrahim-Saraie H. Emergence of Escherichia coli ST131 Causing Urinary Tract Infection in Western Asia: A Systematic Review and Meta-Analysis. Microb Drug Resist 2020; 26:1357-1364. [PMID: 32380906 DOI: 10.1089/mdr.2019.0312] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Escherichia coli sequence type (ST) 131 is considered a high-risk pandemic clone and frequently extended-spectrum β-lactamase (ESBL)-producing clone that is strongly associated with the global dissemination of CTX-M-15 type. The emergence of ST131 has become a public health threat because this clonal group typically exhibits multiple virulence factors and antimicrobial resistance. Therefore, this study aimed to analyze the literature published on the estimation of the prevalence of clone ST131 among E. coli strains isolated from patients with urinary tract infections in western Asia. A systematic search was carried out to identify eligible articles in the Web of Science, PubMed, Scopus, Embase, and Google Scholar electronic databases from January 2010 to December 2018. Next, 13 articles meeting the inclusion criteria were selected for data extraction and analysis by Comprehensive Meta-Analysis Software. The included studies were conducted in Iran, Jordan, Kuwait, Pakistan, Saudi Arabia, Turkey, and Yemen. In all studies, the pooled prevalence of ST131 was 24.6% (95% CI: 13.5%-40.4%) in wild type isolates, 42.7% (95% CI: 32.5%-53.5%) among ESBLs-producing isolates, and 64.8% (95% CI: 36%-85.5%) among multiple-drug resistant (MDR) isolates. Moreover, the prevalence of ST131 isolates carrying CTX-M-15 type was 68% (95% CI: 48.4%-82.8%). Our study indicated the high prevalence of broadly disseminated ST131 clone among MDR and ESBLs isolates in western Asia. Moreover, O25b was the predominant ST131 clone type, which was mostly associated with CTX-M-15 type.
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Affiliation(s)
- Alireza Jafari
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Siavash Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Kourosh Delpasand
- Department of Medical Ethics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hoda Sabati
- Biotechnology and Biological Science Research Center, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Hadi Sedigh Ebrahim-Saraie
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Moghnieh R, Awad L, Abdallah D, Jadayel M, Sinno L, Tamim H, Jisr T, El-Hassan S, Lakkis R, Dabbagh R, Bizri AR. Effect of a "handshake" stewardship program versus a formulary restriction policy on High-End antibiotic use, expenditure, antibiotic resistance, and patient outcome. J Chemother 2020; 32:368-384. [PMID: 32364030 DOI: 10.1080/1120009x.2020.1755589] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study reports the effect of implementing an antibiotic stewardship program (ASP) based on the "handshake" strategy for 2 years on multiple endpoints compared with that in a preceding period when an antimicrobial restriction policy was only applied in the absence of a complete program in a tertiary-care Lebanese hospital. The studied endpoints were broad-spectrum antibiotic consumption, antibiotic expenditure, nosocomial bacteremia incidence rate, and patient outcome.An interrupted time series analysis was undertaken to assess the changes in the trend (ΔT) and level (ΔL) of the aforementioned endpoints among adult inpatients before (October 2013 to September 2015) and after the introduction of the ASP (October 2016 to September 2018).After the implementation of the "handshake" ASP, marked changes were observed in the consumption of broad-spectrum antibiotics. The mean use density levels for imipenem and meropenem decreased by 13.72% (P = 0.017), coupled with a decreasing rate of prescription (ΔT = -24.83 defined daily dose [DDD]/1,000 patient days [PD]/month; P = 0.02). Tigecycline use significantly decreased in level by 69.19% (P < 0.0001) and in trend (ΔT = -25.63 DDD/1,000 PD/month; P < 0.0001). A reduction in the use of colistin was also documented but did not reach statistical significance (ΔL = -8.71%, P = 0.56; ΔT = -5.51 DDD/1,000 PD/month = -5.5; P = 0.67). Antibiotic costs decreased by 24.6% after ASP implementation (P < 0.0001), and there was a distinct change from an increasing rate to a decreasing rate of expenditure (ΔT = -12.19 US dollars/PD/month; P = 0.002). The incidence rate of nosocomial bacteremia caused by carbapenem-resistant gram-negative bacteria (CRGNB) decreased by 34.84% (P = 0.13) coupled with a decreasing trend (ΔT = -0.23 cases/1,000 PD/month, P = 0.08). Specifically, a noticeable reduction in the incidence rate of bacteremia due to carbapenem-resistant Acinetobacter baumannii was documented (ΔL = -54.34%, P = 0.01; ΔT = -0.24 cases/1000 PD/month, P = 0.01). Regarding patient outcome, all-cause mortality rates did not increase in level or in rate (ΔL = -3.55%, P = 0.59; ΔT = -0.29 deaths/1000 PD/month, P = 0.6). The length of stay and 7-day readmission rate remained stable between the two periods.In conclusion, the "handshake" ASP succeeded in controlling the prescription rates of antibiotics and in decreasing the nosocomial bacteremia rates caused by CRGNB without compromising patient outcome in our facility. It also had an economic effect in reducing antibiotic costs compared with the previous restriction policy on antimicrobial dispensing.
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Affiliation(s)
- Rima Moghnieh
- Department of Internal Medicine, Division of Infectious Diseases, Makassed General Hospital, Beirut, Lebanon.,Division of Infectious Diseases, Hôtel Dieu de France, Beirut, Lebanon
| | - Lyn Awad
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Dania Abdallah
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Marwa Jadayel
- School of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Loubna Sinno
- Department of Medical Research, Makassed General Hospital, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Tamima Jisr
- Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon
| | | | - Rawad Lakkis
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima Dabbagh
- Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Abdul Rahman Bizri
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut, Beirut, Lebanon
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Al-Tawfiq JA, Rabaan AA, Saunar JV, Bazzi AM. Antimicrobial resistance of gram-negative bacteria: A six-year longitudinal study in a hospital in Saudi Arabia. J Infect Public Health 2020; 13:737-745. [DOI: 10.1016/j.jiph.2020.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 01/05/2020] [Accepted: 01/15/2020] [Indexed: 02/06/2023] Open
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Detection of Antimicrobial Resistance Genes Associated with Carbapenem Resistance from the Whole-Genome Sequence of Acinetobacter baumannii Isolates from Malaysia. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2020; 2020:5021064. [PMID: 32318127 PMCID: PMC7154965 DOI: 10.1155/2020/5021064] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/20/2019] [Accepted: 01/09/2020] [Indexed: 12/20/2022]
Abstract
Background The spread of carbapenem-resistant A. baumannii (CrAb) is gaining worldwide attention. The spread of this pathogen is largely due to its ability to acquire various resistance genes of intrinsic and extrinsic origins that confer unpredictable susceptibility to β-lactams. The aim of this study was to analyze β-lactamase genetic compositions of CrAb in Malaysia. Methods Whole-genome sequencing (WGS) was carried out on 13 CrAb isolates from clinical samples in Malaysia from 2011 to 2016. Results Endotracheal aspirate was the dominant clinical sample source (n = 6), and only one isolate was obtained from wound swab. A total of 6 sequence types (STs) of the Oxford scheme were identified, including 4 reported STs and 2 novel STs. Eleven isolates were classified into clonal complex 92 (CC92/ICII), among which ST195 and ST208 were the most prevalent STs. All 13 CrAb isolates harbored multiple β-lactamase genes. blaOXA-23 (n = 13) and blaOXA-66 (n = 11) were the dominant carbapenemase gene families found in these isolates. All isolates harbor blaADC, blaOXA-51-like, and blaOXA-23-like genes. blaTEM (n = 7), blaNDM-1 (n = 3), blaCARB-8 (n = 1), and blaPER-3 (n = 1) are amongst other β-lactamase genes found in this study. ISAba1 was found upstream to blaOXA-23 (n = 13), blaOXA-66 (n = 1), and blaADC (n = 11). All blaNDM-1 isolates had ISAba125 (mobile genetic element) upstream to the genes. All isolates were positive for Tn2006/2008 and Tn2009 but were negative for Tn2007. Conclusion Most of the isolates were grouped under the CC92 clonal complex which belongs to international clonal lineage 2. These findings predict that carriage of carbapenem-resistant genes possibly constitutes the underlying basis of high level of international clone II prevalence. Therefore, molecular surveillance and antimicrobial stewardship are essential in implementing policies to prevent and control the spread of CrAb in hospital settings.
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Moghnieh R, Tamim H, Abyad A, Jadayel M, Awad L, Abdallah D, Haddad N, Berberi J, Alwazir R, Taher R, Jisr T, Lakkis R, Zahran K, Ibrahim A. Pre-engraftment infectious complications and patient outcomes after allogeneic hematopoietic cell transplantation: a single-center experience from Lebanon. Infection 2020; 48:385-401. [PMID: 32170652 DOI: 10.1007/s15010-020-01407-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Infectious complications are significant causes of morbidity and mortality after allogeneic hematopoietic cell transplantation (allo-HCT). They occur variably over different periods, with scant data reported from Lebanon and neighboring countries. In this study, we described the pre-engraftment neutropenic phase, febrile episodes, and peri-transplant medical complications in patients undergoing allo-HCT at a tertiary-care hospital. METHODS This is a retrospective chart review of patients who underwent allo-HCT between 2007 and 2016 at Makassed General Hospital in Beirut, Lebanon. Data were extracted from medical records, the HCT registry, and medical laboratory logbooks. RESULTS One hundred and six patients were included, 75% having hematologic malignancies and 13% aplastic anemia. None received antibacterial prophylaxis with fluoroquinolones. Yet from conditioning chemotherapy till the say before HCT, 32% of the patients received broad-spectrum antibiotics (BSA) due to fever or infection. At the day of cell infusion, 41.5% of the patients were on BSA. Neutrophil engraftment failure was recorded in 8% of the patients. The cumulative incidence of pre-engraftment bacteremia and Gram-negative bacteremia was 14.3 and 7.1%, respectively. Aplastic anemia was an independent risk factor for pre-engraftment bacteremia [hazard ratio (HR) = 3.86, 95% confidence interval (CI) (1.29-11.5), P = 0.02]. The cumulative incidence of pre-engraftment pneumonia was 11.2%. Patient age significantly increased the risk of pre-engraftment pneumonia [HR = 12.35, 95% CI (1.27-120.50), P = 0.03]. Six-month post-transplant mortality reached 17% in our cohort. Myelodysplastic syndrome was the only significant parameter increasing the risk of death [HR = 3.40, 95% CI (1.05-10.98), P = 0.04]. CONCLUSION The cumulative incidence of pre-engraftment bacteremia and pneumonia was 14.3% and 11.2% respectively in this cohort. Aplastic anemia predicted for the occurrence of bacteremia, increasing patient age contributed to the occurrence of pneumonia, and myelodysplastic syndrome increased the risk of death.
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Affiliation(s)
- Rima Moghnieh
- Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon. .,Division of Infectious Diseases, Department of Internal Medicine, Hôtel Dieu de France, Beirut, Lebanon.
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Amin Abyad
- Division of Hematology/Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Marwa Jadayel
- School of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Lyn Awad
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Dania Abdallah
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Nicholas Haddad
- Infectious Disease and Residency Program, Internal Medicine, Central Michigan University, Saginaw, MI, 48602, USA
| | | | - Rawya Alwazir
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Rida Taher
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Tamima Jisr
- Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Rawad Lakkis
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Kamal Zahran
- Division of Hematology/Oncology, Middle East Institute of Health, Bsalim, Lebanon
| | - Ahmad Ibrahim
- Division of Hematology/Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
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Alghoribi MF, Binkhamis K, Alswaji AA, Alhijji A, Alsharidi A, Balkhy HH, Doumith M, Somily A. Genomic analysis of the first KPC-producing Klebsiella pneumoniae isolated from a patient in Riyadh: A new public health concern in Saudi Arabia. J Infect Public Health 2020; 13:647-650. [PMID: 32067931 DOI: 10.1016/j.jiph.2020.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/24/2019] [Accepted: 01/02/2020] [Indexed: 11/25/2022] Open
Abstract
Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae have been isolated from human patients in many countries across the globe but rarely in Saudi Arabia. Here we provide the genomic characterization of the first KPC-producing K. pneumoniae isolated from the urine of a patient in Riyadh, Saudi Arabia, who had a recent travel history to Egypt involving a medical procedure. Presence of KPC-encoding gene initially detected with the Xpert Carba-R assay was confirmed by traditional PCR. Susceptibility testing using the VITEK 2 system, E-test and microbroth dilution methods showed that the K. pneumoniae isolate, namely SA01_KPC-2, was resistant to all antibiotics except colistin and ceftazidime/avibactam. Whole-genome sequencing (WGS), performed on the Illumina Miseq instrument, identified the isolate as sequence type (ST) 383 and serotype KL30-D1 O1v2. Genome assembly of SA01_KPC-2 indicated the presence of two plasmids. Plasmid pSA01_KPC-2, of approximately 45.9 kb in size, harbored the blaKPC-2 flanked by ISKpn27 and ISKpn6 and had a backbone similar to published KPC-carrying IncX6 plasmids. The second plasmid pSA01_incHIB1, a derivative of published 372-kb plasmid pKpvST383, carried genes encoding virulence factors and resistance to five classes of antibiotics. The isolation of the first KPC producer in Saudi Arabia requires high attention and rapid interventions to prevent further spread.
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Affiliation(s)
- Majed F Alghoribi
- King Abdullah International Medical Research Center, Infectious Diseases Research Department, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Khalifa Binkhamis
- Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman A Alswaji
- King Abdullah International Medical Research Center, Infectious Diseases Research Department, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali Alhijji
- Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Aynaa Alsharidi
- Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Hanan H Balkhy
- King Abdullah International Medical Research Center, Infectious Diseases Research Department, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Michel Doumith
- King Abdullah International Medical Research Center, Infectious Diseases Research Department, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali Somily
- Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Aljindan RY, Alkharsah KR. Pattern of increased antimicrobial resistance of Salmonella isolates in the Eastern Province of KSA. J Taibah Univ Med Sci 2020; 15:48-53. [PMID: 32110182 PMCID: PMC7033400 DOI: 10.1016/j.jtumed.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES The antimicrobial resistance of Salmonella species is increasing worldwide. This study was conducted to determine the pattern of antimicrobial susceptibility of Salmonella species in a tertiary hospital from 2011 to 2018. METHODS In this retrospective study, the medical records of all patients with Salmonella infections were reviewed. The clinical, demographic, and microbiological data of the selected patients were analysed. RESULTS A total of 752 patients were included. The resistance of Salmonella species to antimicrobial drugs increased from 24.6% in 2011 to 37.8% in 2018 (p = 0.002). By 2018 all Salmonella isolates were completely resistant to cefalotin, cefuroxime, and cefoxitin, while we found some susceptibility to other cephalosporins and ciprofloxacin. The most commonly isolated Salmonella serogroups were groups D (36.5%), C (23.5%), and B (11.7%). CONCLUSIONS The incidence of resistance of Salmonella to antibiotics is on the rise. The results of this study highlight the need for an active monitoring system of antibiotic usage in humans and domestic animals.
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Affiliation(s)
- Reem Y. Aljindan
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, KSA
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Machine Learning and Multidrug-Resistant Gram-Negative Bacteria: An Interesting Combination for Current and Future Research. Antibiotics (Basel) 2020; 9:antibiotics9020054. [PMID: 32023986 PMCID: PMC7167992 DOI: 10.3390/antibiotics9020054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 12/15/2022] Open
Abstract
The dissemination of multidrug-resistant Gram-negative bacteria (MDR-GNB) is associated with increased morbidity and mortality in several countries. Machine learning (ML) is a branch of artificial intelligence that consists of conferring on computers the ability to learn from data. In this narrative review, we discuss three existing examples of the application of ML algorithms for assessing three different types of risk: (i) the risk of developing a MDR-GNB infection, (ii) the risk of MDR-GNB etiology in patients with an already clinically evident infection, and (iii) the risk of anticipating the emergence of MDR in GNB through the misuse of antibiotics. In the next few years, we expect to witness an increasingly large number of research studies perfecting the application of ML techniques in the field of MDR-GNB infections. Very importantly, this cannot be separated from the availability of a continuously refined and updated ethical framework allowing an appropriate use of the large datasets of medical data needed to build efficient ML-based support systems that could be shared through appropriate standard infrastructures.
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Kotb S, Lyman M, Ismail G, Abd El Fattah M, Girgis SA, Etman A, Hafez S, El-Kholy J, Zaki MES, Rashed HAG, Khalil GM, Sayyouh O, Talaat M. Epidemiology of Carbapenem-resistant Enterobacteriaceae in Egyptian intensive care units using National Healthcare-associated Infections Surveillance Data, 2011-2017. Antimicrob Resist Infect Control 2020; 9:2. [PMID: 31911830 PMCID: PMC6942386 DOI: 10.1186/s13756-019-0639-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/31/2019] [Indexed: 11/21/2022] Open
Abstract
Objective To describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) healthcare-associated infections (HAI) in Egyptian hospitals reporting to the national HAI surveillance system. Methods Design: Descriptive analysis of CRE HAIs and retrospective observational cohort study using national HAI surveillance data. Setting: Egyptian hospitals participating in the HAI surveillance system. The patient population included patients admitted to the intensive care unit (ICU) in participating hospitals. Enterobacteriaceae HAI cases were Klebsiella, Escherichia coli, and Enterobacter isolates from blood, urine, wound or respiratory specimen collected on or after day 3 of ICU admission. CRE HAI cases were those resistant to at least one carbapenem. For CRE HAI cases reported during 2011-2017, a hospital-level and patient-level analysis were conducted using only the first CRE isolate by pathogen and specimen type for each patient. For facility, microbiology, and clinical characteristics, frequencies and means were calculated among CRE HAI cases and compared with carbapenem-susceptible Enterobacteriaceae HAI cases through univariate and multivariate logistic regression using STATA 13. Results There were 1598 Enterobacteriaceae HAI cases, of which 871 (54.1%) were carbapenem resistant. The multivariate regression analysis demonstrated that carbapenem resistance was associated with specimen type, pathogen, location prior to admission, and length of ICU stay. Between 2011 and 2017, there was an increase in the proportion of Enterobacteriaceae HAI cases due to CRE (p-value = 0.003) and the incidence of CRE HAIs (p-value = 0.09). Conclusions This analysis demonstrated a high and increasing burden of CRE in Egyptian hospitals, highlighting the importance of enhancing infection prevention and control (IPC) programs and antimicrobial stewardship activities and guiding the implementation of targeted IPC measures to contain CRE in Egyptian ICU's .
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Affiliation(s)
- Sara Kotb
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Cairo, Egypt
| | - Meghan Lyman
- Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | | | | | - Ahmed Etman
- Ministry of Health and Population, Cairo, Egypt
| | - Soad Hafez
- Alexandria University Hospitals, Alexandria, Egypt
| | | | | | | | | | - Omar Sayyouh
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Cairo, Egypt
| | - Maha Talaat
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Cairo, Egypt
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Zaidi FZ, Dali-Yahia R, Zenati K, Yazi L, Lounes M, Aberkane S, Jean Pierre H, Barraud O, Godreuil S, Touati A. Characterization of VIM-4 Producing Clinical Pseudomonas aeruginosa Isolates from Western Algeria: Sequence Type and Class 1 Integron Description. Microb Drug Resist 2019; 26:1437-1441. [PMID: 31829797 DOI: 10.1089/mdr.2019.0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives: Pseudomonas aeruginosa occupies a central position in nosocomial infections and remains a significant cause of morbidity and mortality. The aim of this study was to characterize carbapenem resistance mechanisms in P. aeruginosa isolates from clinical specimens collected at the University Hospital of Oran, western Algeria. Materials and Methods: The identification of 214 nonduplicated P. aeruginosa isolates (collected from January to December 2016) was confirmed using matrix-assisted laser desorption/ionization-time of flight mass spectrometry. Thirteen antibiotics were tested using the disc diffusion method. Carbapenemase-encoding genes were detected with the GeneXpert system and multiplex polymerase chain reaction (PCR). Clonal relatedness was determined using multilocus sequence typing (MLST) and the seven housekeeping genes were further used for phylogenetic analysis of imipenem-resistant P. aeruginosa using concatenated gene fragments. The flanking regions of the blaVIM-4 gene were analyzed by whole-genome sequencing. Results: Eleven isolates (5.39%) were resistant to carbapenems. PCR amplification and sequencing showed that six of these isolates (2.94%) harbored the blaVIM-4 gene that was carried on a novel class 1 integron. MLST analysis assigned the tested isolates to seven different sequence types (STs), of which two were new (ST3349 and ST3350) and five were previously described (ST244, ST499, ST709, ST809, and ST1239). Conclusion: In this study, we reported P. aeruginosa isolates producing VIM-4 in an Algerian hospital. The blaVIM-4 is harbored in class 1 integron with a new arrangement of genes cassettes.
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Affiliation(s)
- Fatma Zohra Zaidi
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia, Algérie.,Laboratoire de Bactériologie, CHU de Montpellier, MIVEGEC, IRD-CNRS, Université de Montpellier, Montpellier, France
| | | | - Karima Zenati
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia, Algérie
| | - Leila Yazi
- Laboratoire de Bactériologie, EHU d'Oran, Oran, Algérie
| | - Manon Lounes
- Laboratoire de Bactériologie, CHU de Montpellier, MIVEGEC, IRD-CNRS, Université de Montpellier, Montpellier, France
| | - Salim Aberkane
- Laboratoire de Bactériologie, CHU de Montpellier, MIVEGEC, IRD-CNRS, Université de Montpellier, Montpellier, France
| | - Helen Jean Pierre
- Laboratoire de Bactériologie, CHU de Montpellier, MIVEGEC, IRD-CNRS, Université de Montpellier, Montpellier, France
| | - Olivier Barraud
- University Limoges, INSERM, CHU Limoges, RESINFIT, U1092, Limoges, France
| | | | - Abdelaziz Touati
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia, Algérie
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Song X, Wu Y, Cao L, Yao D, Long M. Is Meropenem as a Monotherapy Truly Incompetent for Meropenem-Nonsusceptible Bacterial Strains? A Pharmacokinetic/Pharmacodynamic Modeling With Monte Carlo Simulation. Front Microbiol 2019; 10:2777. [PMID: 31849910 PMCID: PMC6895071 DOI: 10.3389/fmicb.2019.02777] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/14/2019] [Indexed: 01/28/2023] Open
Abstract
Infections due to meropenem-nonsusceptible bacterial strains (MNBSs) with meropenem minimum inhibitory concentrations (MICs) ≥ 16 mg/L have become an urgent problem. Currently, the optimal treatment strategy for these cases remains uncertain due to some limitations of currently available mono- and combination therapy regimens. Meropenem monotherapy using a high dose of 2 g every 8 h (q 8 h) and a 3-h traditional simple prolonged-infusion (TSPI) has proven to be helpful for the treatment of infections due to MNBSs with MICs of 4–8 mg/L but is limited for cases with higher MICs of ≥16 mg/L. This study demonstrated that optimized two-step-administration therapy (OTAT, i.e., a new administration model of i.v. bolus plus prolonged infusion) for meropenem, even in monotherapy, can resolve this problem and was thus an important approach of suppressing such highly resistant bacterial isolates. Herein, a pharmacokinetic (PK)/pharmacodynamic (PD) modeling with Monte Carlo simulation was performed to calculate the probabilities of target attainment (PTAs) and the cumulative fractions of response (CFRs) provided by dosage regimens and 39 OTAT regimens in five dosing models targeting eight highly resistant bacterial species with meropenem MICs ≥ 16 mg/L, including Acinetobacter baumannii, Acinetobacter spp., Enterococcus faecalis, Enterococcus faecium, Pseudomonas aeruginosa, Staphylococcus epidermidis, Staphylococcus haemolyticus, and Stenotrophomonas maltophilia, were designed and evaluated. The data indicated that meropenem monotherapy administered at a high dose of 2 g q 8 h and as an OTAT achieved a PTA of ≥90% for isolates with an MIC of up to 128 mg/L and a CFR of ≥90% for all of the targeted pathogen populations when 50% f T > MIC (50% of the dosing interval during which free drug concentrations remain above the MIC) is chosen as the PD target, with Enterococcus faecalis being the sole exception. Even though 50% f T > 5 × MIC is chosen as the PD target, the aforementioned dosage regimen still reached a PTA of ≥90% for isolates with an MIC of up to 32 mg/L and a CFR of ≥90% for Acinetobacter spp., Pseudomonas aeruginosa, and Klebsiella pneumoniae populations. In conclusion, meropenem monotherapy displays potential competency for infections due to such highly resistant bacterial isolates provided that it is administered as a reasonable OTAT but not as the currently widely recommended TSPI.
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Affiliation(s)
- Xiangqing Song
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yi Wu
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Lizhi Cao
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Dunwu Yao
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Minghui Long
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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Prevalence of blaTEM, blaSHV, and blaCTX-M Genes among ESBL-Producing Klebsiella pneumoniae and Escherichia coli Isolated from Thalassemia Patients in Erbil, Iraq. Mediterr J Hematol Infect Dis 2019; 11:e2019041. [PMID: 31308917 PMCID: PMC6613628 DOI: 10.4084/mjhid.2019.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/10/2019] [Indexed: 11/23/2022] Open
Abstract
Background Due to the recent appearance of organisms that are resistant to several drugs (multidrug-resistant) like Enterobacteriaceae that produce extended-spectrum β-lactamase (ESBL, concerns have remarkably increased regarding the suitable treatment of infections. The present study was an investigation into ESBL molecular characteristics among clinical isolates of Klebsiella pneumoniae and Escherichia coli resulting in urinary tract infections (UTIs) and their pattern of antimicrobial resistance in order to come up with helpful information on the epidemiology of these infections and risk factors accompanied with them. Methods In order to conduct the study, 20 K. pneumoniae and 48 E. coli were isolated and retrieved from thalassemia center in Erbil, Iraq during July 2016 and September 2016. The collected strains were analyzed and the profile of their antimicrobial susceptibility was specified. In order to spot β-lactamase genes (i.e. blaTEM, blaSHV, and blaCTX-M), polymerase chain reaction was conducted. Results The findings obtained from multiplex PCR assay showed that out of the collected strains of ESBL-producing E. coli, had 81% blaTEM, 16.2% blaSHV, and 32.4% blaCTX-M genes. Similarly, 64.7% blaTEM, 35.2% blaSHV, and 41.1% blaCTX-M genes existed in the isolates of K. pneumoniae. It was found that antibiotic resistance pattern of E. coli and K. pneumoniae isolates to 20 antibiotics varied widely. It was also concluded that the majority of the K. pneumoniae and E. coli isolates were multi-drug resistant (MDR). Moreover, 75% and 87.5% of respectively K. pneumoniae and E. coli isolates showed the MDR phenotypes. Conclusion TEM prevalence was high among other types of ESBLs. Over all, the most active antimicrobial agents in vitro remained to be the carbapenems.
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Khoder M, Osman M, Diene SM, Okdah L, Lalaoui R, Al Achkar M, Mallat H, Hamze M, Rolain JM. Evaluation of different testing tools for the identification of non-gonococcal Neisseria spp. isolated from Lebanese male semen: a strong and significant association with infertility. J Med Microbiol 2019; 68:1012-1020. [DOI: 10.1099/jmm.0.000990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- May Khoder
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
- Aix-Marseille University, IRD, APHM, MEPHI, IHU Méditerranée infection, Faculté de Médecine et de Pharmacie, 19-21 boulevard Jean Moulin, 13385 Marseille CEDEX 05, France
| | - Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Seydina M. Diene
- Aix-Marseille University, IRD, APHM, MEPHI, IHU Méditerranée infection, Faculté de Médecine et de Pharmacie, 19-21 boulevard Jean Moulin, 13385 Marseille CEDEX 05, France
| | - Liliane Okdah
- Aix-Marseille University, IRD, APHM, MEPHI, IHU Méditerranée infection, Faculté de Médecine et de Pharmacie, 19-21 boulevard Jean Moulin, 13385 Marseille CEDEX 05, France
| | - Rym Lalaoui
- Aix-Marseille University, IRD, APHM, MEPHI, IHU Méditerranée infection, Faculté de Médecine et de Pharmacie, 19-21 boulevard Jean Moulin, 13385 Marseille CEDEX 05, France
| | | | - Hassan Mallat
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Jean-Marc Rolain
- Aix-Marseille University, IRD, APHM, MEPHI, IHU Méditerranée infection, Faculté de Médecine et de Pharmacie, 19-21 boulevard Jean Moulin, 13385 Marseille CEDEX 05, France
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Alghoribi MF, Doumith M, Alrodayyan M, Al Zayer M, Köster WL, Muhanna A, Aljohani SM, Balkhy HH, Desin TS. S. Enteritidis and S. Typhimurium Harboring SPI-1 and SPI-2 Are the Predominant Serotypes Associated With Human Salmonellosis in Saudi Arabia. Front Cell Infect Microbiol 2019; 9:187. [PMID: 31214517 PMCID: PMC6554431 DOI: 10.3389/fcimb.2019.00187] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/15/2019] [Indexed: 12/25/2022] Open
Abstract
Non-typhoidal Salmonella (NTS) strains are Gram negative bacterial pathogens that are associated with foodborne illness worldwide. During the process of infection, Salmonella uses two molecular injectisomes known as Type 3 Secretion Systems (T3SS) to secrete virulence factors that are encoded by Salmonella Pathogenicity Island-1 (SPI-1) and SPI-2 into host cells. These secretion systems play a major role in virulence, as shown in various animal models, but little is known about their role in human infections. In Saudi Arabia, NTS strains frequently cause human infections but data regarding these pathogenic strains is fairly limited. The aim of this study was to characterize Salmonella human clinical isolates in Riyadh, Saudi Arabia, by determining their serotype, testing for the presence of SPI-1 and SPI-2 genes and to determine the antibiotic resistance profiles of these strains. Using the rapid Check and Trace Salmonella™ (CTS) system our results demonstrate that S. Enteritidis and S. Typhimurium were the predominant serovars, followed by S. Livingstone, S. Kentucky and S. Poona among a list of 36 serovars reported for the first time in the country. In addition, SPI-1 genes were detected in 99% of the isolates, while the sifA gene (SPI-2) was not detected in 13.5% of the isolates. These results suggest that both the SPI-1 and SPI-2 virulence determinants are important for human infection. Moreover, we report the presence of a Multi-Drug (MDR) carbapenem resistant S. Kentucky isolate harboring the blaOXA−48 gene not reported previously in Saudi Arabia.
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Affiliation(s)
- Majed F Alghoribi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Michel Doumith
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maha Alrodayyan
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maha Al Zayer
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Wolfgang L Köster
- Vaccine and Infectious Disease Organization-International Vaccine Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Abdulhai Muhanna
- John H. Stroger Junior Hospital of Cook County, Chicago, IL, United States
| | - Sameera M Aljohani
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hanan H Balkhy
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Taseen S Desin
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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72
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Moghnieh R, Araj GF, Awad L, Daoud Z, Mokhbat JE, Jisr T, Abdallah D, Azar N, Irani-Hakimeh N, Balkis MM, Youssef M, Karayakoupoglou G, Hamze M, Matar M, Atoui R, Abboud E, Feghali R, Yared N, Husni R. A compilation of antimicrobial susceptibility data from a network of 13 Lebanese hospitals reflecting the national situation during 2015-2016. Antimicrob Resist Infect Control 2019; 8:41. [PMID: 30828445 PMCID: PMC6381724 DOI: 10.1186/s13756-019-0487-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/01/2019] [Indexed: 12/05/2022] Open
Abstract
Background There is a lack of official national antimicrobial resistance (AMR) data in Lebanon. Individual hospitals generate their own antibiotic susceptibility data in the form of yearly pamphlets. Methods In this study, antibiotic susceptibility data from 13 hospitals distributed across different governorates of Lebanon were collected to conduct a compilation-based surveillance of AMR in Lebanon for the years 2015-2016. The findings were compared with those of a previous nationwide study in this country conducted between 2011 and 2013 as well as with similar data obtained from the 2015 and 2016 European surveillance reports of AMR. To provide a clear presentation of the AMR situation, mean percent susceptibility of different antibiotic-microbe combinations was calculated. Results During 2015-2016, the percent susceptibility of Enterobacteriaceae to third-generation cephalosporins and to carbapenems was 59 and 97%, respectively. Among Pseudomonas aeruginosa and Acinetobacter spp., carbapenem susceptibility reached 70 and 12%, respectively. Among Gram positive organisms, the percent susceptibility to methicillin in Staphylococcus aureus was 72%, that to vancomycin in Enterococcus spp. was 98% and that to penicillin in Streptococcus pneumoniae was 75%. Compared with results of 2011-2013, there was an overall trend of decreased susceptibility of bacteria to the tested antibiotics, with a variation of 5 to 10%. The antibiotic susceptibility data from Lebanon were found to be comparable with those from Eastern and South-eastern European countries. Conclusion This study highlights the need to establish a robust national AMR surveillance system that enables data from Lebanon to be included in global AMR maps.
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Affiliation(s)
- Rima Moghnieh
- Department of Internal Medicine, Division of Infectious Diseases, Makassed General Hospital, Beirut, Lebanon
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Georges F. Araj
- Professor and Director of Clinical Microbiology, Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lyn Awad
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Ziad Daoud
- Department of Microbiology, Centre Hospitalier du Nord, Zgharta, Lebanon
- Faculty of Medicine and Medical Sciences, University of Balamand, Koura, Lebanon
| | - Jacques E. Mokhbat
- Department of Internal Medicine, Division of Infectious Diseases, Lebanese American University-Rizk Hospital, Beirut, Lebanon
- Faculty of Medicine, Lebanese American University, Beirut, Lebanon
| | - Tamima Jisr
- Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Dania Abdallah
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Nadim Azar
- Department of Microbiology, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Noha Irani-Hakimeh
- Faculty of Medicine and Medical Sciences, University of Balamand, Koura, Lebanon
- Department of Laboratory Medicine, Saint George University Hospital, Beirut, Lebanon
| | - Maher M. Balkis
- Department of Internal Medicine, Division of Infectious Diseases, Labib Medical Center, Saida, Lebanon
- Medical Subspecialties Institute, Infectious Diseases, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mona Youssef
- Department of Internal Medicine, Division of Infectious Diseases, Haykel Hospital, Tripoli, Lebanon
| | | | - Monzer Hamze
- Department of Microbiology, Nini Hospital, Tripoli, Lebanon
| | - Madonna Matar
- Department of Internal Medicine, Division of Infectious Diseases, Notre Dame de Secours University Hospital, Jbeil, Lebanon
- Faculty of Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Roula Atoui
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
- Department of Internal Medicine, Zahraa Hospital, Beirut, Lebanon
| | - Edmond Abboud
- Department of Microbiology, The Middle East Institute of Health University Hospital, Mount Lebanon, Lebanon
| | - Rita Feghali
- Department of Laboratory Medicine, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Nadine Yared
- Chairperson Internal Medicine, Lebanese University, Beirut, Lebanon
| | - Rola Husni
- Department of Internal Medicine, Division of Infectious Diseases, Lebanese American University-Rizk Hospital, Beirut, Lebanon
- Faculty of Medicine, Lebanese American University, Beirut, Lebanon
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