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Dabbousi AA, Dabboussi F, Hamze M, Osman M, Kassem II. The Emergence and Dissemination of Multidrug Resistant Pseudomonas aeruginosa in Lebanon: Current Status and Challenges during the Economic Crisis. Antibiotics (Basel) 2022; 11:687. [PMID: 35625331 PMCID: PMC9137902 DOI: 10.3390/antibiotics11050687] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 12/30/2022] Open
Abstract
Pseudomonas aeruginosa is a common cause of healthcare-associated infections and chronic airway diseases in non-clinical settings. P. aeruginosa is intrinsically resistant to a variety of antimicrobials and has the ability to acquire resistance to others, causing increasingly recalcitrant infections and elevating public health concerns. We reviewed the literature on multidrug-resistant (MDR) P. aeruginosa isolated from humans (nosocomial and community-associated), animals, and the environment in Lebanon, a country that has been suffering from a surge in antimicrobial resistance (AMR). We identified 24 studies that described the epidemiology and antimicrobial susceptibility profiles of P. aeruginosa. Our analysis showed that the bacterium was predominant in lesions of patients on mechanical ventilation and in burn patients and those with diabetic foot infections and hematological malignancies. We also found that carbapenem resistance in P. aeruginosa isolates in Lebanon involved both enzymatic and non-enzymatic mechanisms but depended predominantly on VIM-2 production (40.7%). Additionally, MDR P. aeruginosa was detected in animals, where a recent study reported the emergence of carbapenemase-producing P. aeruginosa in livestock in Lebanon. Notably, no studies evaluated the contribution of MDR P. aeruginosa in the environment to human infections. Taken together, our findings highlight the need for AMR surveillance programs and a national action plan to combat resistance in Lebanon.
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Affiliation(s)
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon; (F.D.); (M.H.)
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon; (F.D.); (M.H.)
| | - Marwan Osman
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Issmat I. Kassem
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223-1797, USA
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Tokajian S, Salloum T, Eisen JA, Jospin G, Farra A, Mokhbat JE, Coil DA. Genomic attributes of extended-spectrum β-lactamase-producing Escherichia coli isolated from patients in Lebanon. Future Microbiol 2017; 12:213-226. [DOI: 10.2217/fmb-2017-0171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Extended-spectrum β-lactamase-producing (ESBL) Escherichia coli are a public threat worldwide. This study aimed at analyzing the genomic and functional attributes of nine ESBLs taken from rectal swabs. Materials & methods: Samples were isolated from patients admitted for gastrointestinal and urological procedures at the University Medical Center-Rizk Hospital (UMCRH) in Lebanon. Illumina paired-end libraries were prepared and sequenced. Results: The isolates were distributed into five lineages: ST131, ST648, ST405, ST73 and ST38, and harbored bla OXA-1, bla TEM-1B, bla TEM-1C and aac(6′)Ib-cr. ST131 isolates were carriers of stx2 converting I phage. Conclusion: This is the first comprehensive genomic analysis performed on ESBLs in Lebanon.
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Affiliation(s)
- Sima Tokajian
- School of Arts & Sciences, Department of Natural Sciences, Lebanese American University, Byblos, Lebanon
| | - Tamara Salloum
- School of Arts & Sciences, Department of Natural Sciences, Lebanese American University, Byblos, Lebanon
| | - Jonathan A Eisen
- Department of Evolution and Ecology, University of California Davis Genome Center, Davis, CA 95616, USA
| | - Guillaume Jospin
- Department of Evolution and Ecology, University of California Davis Genome Center, Davis, CA 95616, USA
| | - Anna Farra
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | | | - David A Coil
- Department of Evolution and Ecology, University of California Davis Genome Center, Davis, CA 95616, USA
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Chamoun K, Farah M, Araj G, Daoud Z, Moghnieh R, Salameh P, Saade D, Mokhbat J, Abboud E, Hamze M, Abboud E, Jisr T, Haddad A, Feghali R, Azar N, El-Zaatari M, Chedid M, Haddad C, Zouain Dib Nehme M, Barakat A, Husni R. Surveillance of antimicrobial resistance in Lebanese hospitals: retrospective nationwide compiled data. Int J Infect Dis 2016; 46:64-70. [PMID: 26996458 DOI: 10.1016/j.ijid.2016.03.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/09/2016] [Accepted: 03/12/2016] [Indexed: 10/22/2022] Open
Abstract
Antimicrobial resistance is closely linked to antimicrobial use and is a growing concern worldwide. Antimicrobial resistance increases healthcare costs substantially in many countries, including Lebanon. National data from Lebanon have, in the most part, been limited to a few academic hospitals. The Lebanese Society of Infectious Diseases conducted a retrospective study to better describe the antimicrobial susceptibility patterns of bacterial isolates in Lebanon. Data were based on records retrieved from the bacteriology laboratories of 16 different Lebanese hospitals between January 2011 and December 2013. The susceptibility results of a total 20684 Gram-positive and 55594 Gram-negative bacteria were analyzed. The prevalence rate of methicillin-resistant Staphylococcus aureus was 27.6% and of vancomycin-resistant Enterococcus spp was 1%. Streptococcus pneumoniae had susceptibilities of 46% to oxacillin, 63% to erythromycin, and 98% to levofloxacin. Streptococcus pyogenes had susceptibilities of 94% to erythromycin and 95% to clindamycin. The mean ampicillin susceptibility of Haemophilus influenzae, Salmonella spp, and Shigella spp isolates was 79%, 81.3%, and 62.2%, respectively. The extended-spectrum beta-lactamase production rate for Escherichia coli was 32.3% and for Klebsiella spp was 29.2%. Acinetobacter spp showed high resistance to most antimicrobials, with low resistance to colistin (17.1%). Pseudomonas spp susceptibilities to piperacillin-tazobactam and imipenem were lower than 80% (79.7% and 72.8%, respectively). This study provides population-specific data that are valuable in guiding antimicrobial use in Lebanon and neighbouring countries and will help in the establishment of a surveillance system for antimicrobial resistance following the implementation of a nationwide standardization of laboratory methods and data entry.
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Affiliation(s)
- Kamal Chamoun
- Department of Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Maya Farah
- Department of Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Georges Araj
- Department of Microbiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad Daoud
- Department of Microbiology, Faculty of Medicine, University of Balamand and Centre Hospitalier du nord Hospital, Beirut, Lebanon
| | - Rima Moghnieh
- Department of Infectious Diseases, Makassed Hospital, Beirut, Lebanon
| | - Pascale Salameh
- School of Pharmacy, Pharmacy Practice Department, Lebanese American University, Byblos, Lebanon
| | - Danielle Saade
- Epidemiological Surveillance Unit, Ministry of Public Health, Beirut, Lebanon
| | - Jacques Mokhbat
- Department of Internal Medicine, Division of Infectious Diseases, Lebanese American University - Rizk Hospital, Beirut, Lebanon
| | - Emme Abboud
- Department of Microbiology, Mount Lebanon Hospital, Beirut, Lebanon
| | - Monzer Hamze
- Department of Microbiology, NINI Hospital, Tripoli, Lebanon
| | - Edmond Abboud
- Department of Microbiology, Middle East Institute of Health, Mount Lebanon, Lebanon
| | - Tamima Jisr
- Department of Microbiology, Makassed Hospital, Beirut, Lebanon
| | - Antoine Haddad
- Department of Microbiology, Sacré Coeur Hospital, Mount Lebanon, Lebanon
| | - Rita Feghali
- Department of Microbiology, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Nadim Azar
- Department of Microbiology, Hotel Dieu de France Hospital, Beirut, Lebanon
| | | | - Marwan Chedid
- Department of Microbiology, Mazloum Hospital, Tripoli, Lebanon
| | - Christian Haddad
- Department of Microbiology, Notre Dame des Secours Hospital, Byblos, Lebanon
| | | | - Angelique Barakat
- Department of Microbiology, Bellevue Hospital, Mount Lebanon, Lebanon
| | - Rola Husni
- Department of Internal Medicine, Division of Infectious Diseases, Lebanese American University - Rizk Hospital, Beirut, Lebanon.
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Shehabi AA, Masoud H, Maslamani FAB. Common Antimicrobial Resistance Patterns, Biotypes and Serotypes Found amongPseudomonas aeruginosaIsolatesfrom Patient's Stools and Drinking Water Sources in Jordan. J Chemother 2013; 17:179-83. [PMID: 15920903 DOI: 10.1179/joc.2005.17.2.179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Pseudomonas aeruginosa was isolated in low rates from stool specimens of outpatients and inpatients (7% versus 12%) but in higher rates from chlorinated and nonchlorinated water sources (15% versus 44%), respectively in Jordan. The same biotype was recognized among 90% of P. aeruginosa isolates from patient's stools and water sources using specific biochemical profiles. Three serogroups belonging to 01, 06 and 011 accounted for the majority of these isolates in water (66%) and stools (78%), respectively. All P. aeruginosa isolates from water were highly susceptible (87%-100%) to piperacillin-tazobactam, amikacin, gentamicin, imipenem, aztreonam, ceftazidime and ciprofloxacin, whereas the isolates from stool were slightly less susceptible (81%-98%) to these antimicrobials. P. aeruginosa isolates from water and stool sources were almost equally highly resistant to tetracycline (86%-89%) and carbenicillin (88%-89%), respectively. One common small plasmid (15.4 kb) was detected in 14/25 (56%) of multidrug-resistant P. aeruginosa isolates from both water and stool. This study demonstrates certain common epidemiological characteristics including antimicrobial resistance pattern, biotypes and serotypes among P. aeruginosa isolates from patient's stools and drinking water sources in Jordan.
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Affiliation(s)
- A A Shehabi
- Department of Pathology-Microbiology, Faculty of Medicine, University of Jordan, Amman, Jordan.
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Abstract
Several studies have reported the isolation of resistant Gram-Negative Bacilli in Lebanon. However, those studies are new and scarce as compared to worldwide data and mostly restricted to single center studies. In this review, we attempt to provide a reliable and comprehensive report describing the current situation and providing prospects for bacterial resistance in Lebanon. Several studies have shown that Extended Spectrum β-Lactamase-producing E. coli and K. pneumoniae strains are being increasingly reported. Moreover, 2.15% of E. coli and 7.84% of K. pneumoniae isolates have shown carbapenem resistance and up to 30% of isolated E. coli strains were found to be Multi-Drug Resistant. Molecular studies showed that the most widespread β-Lactamases in Lebanon are of the CTX-M-15 and SHV types. In addition, K. pneumoniae strains producing metallo-β-Lactamase and Klebsiella pneumoniae Carbapenemase have been reported. Resistant Pseudomonas aeruginosa and Acinetobacter baumannii caused several nosocomial infections and some Acinetobacter baumannii strains were found to produce OXA-58 type ESBL. The few data addressing the rate of antibiotic consumption in Lebanon show a high rate of antibiotic misuse and abuse. In conclusion, there is a need for antibiotic stewardship programs and additional studies that go beyond the scope of single-center studies in Lebanon.
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Affiliation(s)
- S. E. Salem
- Clinical Microbiology, Department of Biomedical Sciences, Faculty of Medicine & Medical Sciences, University of Balamand, P.O. Box 100, Tripoli, Lebanon
| | - E. Dahdouh
- Clinical Microbiology, Department of Biomedical Sciences, Faculty of Medicine & Medical Sciences, University of Balamand, P.O. Box 100, Tripoli, Lebanon
| | - Z. Daoud
- Clinical Microbiology, Department of Biomedical Sciences, Faculty of Medicine & Medical Sciences, University of Balamand, P.O. Box 100, Tripoli, Lebanon
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Epidemiologic characteristics, serotypes, and antimicrobial susceptibilities of invasive Streptococcus pneumoniae isolates in a nationwide surveillance study in Lebanon. Vaccine 2012; 30 Suppl 6:G11-7. [DOI: 10.1016/j.vaccine.2012.07.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hamze M, Dabboussi F, Daher W, Izard D. [Antibiotic resistance of Staphylococcus aureus at north Lebanon: place of the methicillin resistance and comparison of detection methods]. PATHOLOGIE-BIOLOGIE 2003; 51:21-6. [PMID: 12628288 DOI: 10.1016/s0369-8114(02)00315-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to evaluate the susceptibility of 100 Staphylococcus aureus strains isolated from the laboratory of Microbiology of the Islami Hospital of Tripoli (Lebanon) to 19 antibiotics, and to determine the prevalence of methicillin resistant strains. 30% of strains studied were methicillin resistant, 96% were resistant to the penicillin G. Clavulanic acid restaurated the amoxicillin activity to 29%. The resistance level was 34% for amikacin, 3% for gentamycin and tobramycin, 10% for chloramphenicol, 44.33% for tetracyclin, 7% for erythromycin, 4.04% for clindamycin, 20% for trimethoprim-sulfametoxasol and 0% for vancomycin and teicoplanin. The methicillin-resistant Staphylococcus aureus possess more important resistant level in comparison with the methicillin sensitive strains. We compared the ability of latex agglutination test (Slidex(R) SARM, bioMérieux, France) to detect the production of penicillin-binding protein 2' (PBP 2') in 100 clinical isolates of S. aureus with two reference methods: the oxacillin disk diffusion test and the MIC determination by the E-test (AB BIODISK, Sweden). The two reference methods give the same results for the detection of methicillin resistant S. aureus. The Slidex test was positive for all 30 isolates determined to be methicillin resistant by the reference methods (sensitivity 100%). The latex test was negative for 42 of 70 isolates determined to be methicillin susceptible by the reference methods, and the latex test was positive for 28 isolates determined to be susceptible (specificity 60%).
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Affiliation(s)
- M Hamze
- Faculté de Santé Publique, Section 3, Université Libanaise, P.O. Box 246, Tripoli, Liban.
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