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Ibrahim K, Thwood D, ELgheriani H, Salem M, Elgadiym Z, Zaghdani A, Alhudiri I, Habibi A, Elfahem A, Belaid S, Ermithi O, Almaghrabi M, ELmaryul A, Almadah S, Rayes A, El Meshri SE, El Salabi A, Elzagheid A. Prevalence of multi-drug resistant bacteria in intensive care units at Tripoli University Hospital, Tripoli, Libya. Libyan J Med 2024; 19:2348235. [PMID: 38718270 PMCID: PMC11080667 DOI: 10.1080/19932820.2024.2348235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
Among hospitalized patients worldwide, infections caused by multidrug-resistant (MDR) bacteria are a major cause of morbidity and mortality. This study aimed to isolate MDR bacteria from five intensive care units (ICUs) at Tripoli University Hospital (TUH). A prospective cross-sectional study was conducted over a seven-month period (September 2022 to March 2023) across five ICUs at TUH. A total of 197 swabs were collected from Patients', healthcare workers' and ICUs equipment. Samples collected from patients were nasal swabs, oral cavity swabs, hand swabs, sputum specimens, skin swabs, umbilical venous catheter swabs, and around cannula. Swabs collected from health care workers were nasal swabs, whereas ICUs equipment's samples were from endotracheal tubes, oxygen masks, and neonatal incubators. Identification and antimicrobial susceptibility test was confirmed by using MicroScan auto SCAN 4 (Beckman Coulter). The most frequent strains were Gram negative bacilli 113 (57.4%) with the predominance of Acinetobacter baumannii 50/113 (44%) followed by Klebsiella pneumoniae 44/113 (40%) and Pseudomonas aeruginosa 6/113 (5.3%). The total Gram positive bacterial strains isolated were 84 (42.6%), coagulase negative Staphylococci 55 (66%) with MDRs (89%) were the most common isolates followed by Staphylococcus aureus 15 (17.8%). Different antibiotics were used against these isolates; Gram- negative isolates showed high resistance rates to ceftazidime, gentamicin, amikacin and ertapenem. A. baumannii were the most frequent MDROs (94%), and the highest resistance rates in Gram-positive strains were observed toward ampicillin, oxacillin, ampicillin/sulbactam and Cefoxitin, representing 90% of total MDR Gram-positive isolates. ESBL and MRS were identified in most of strains. The prevalence of antibiotic resistance was high for both Gram negative and Gram positive isolates. This prevalence requires strict infection prevention and control intervention, continuous monitoring, implementation of effective antibiotic stewardship, immediate, concerted and collaborative action to monitor its prevalence and spread in the hospital.
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Affiliation(s)
- Khaled Ibrahim
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Dalal Thwood
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Hajer ELgheriani
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Mohamed Salem
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Zaynab Elgadiym
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Ahmed Zaghdani
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Inas Alhudiri
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Abdulraouf Habibi
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Abdurrezagh Elfahem
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Saadeddin Belaid
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Otman Ermithi
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Mahmoud Almaghrabi
- Pediatric Intensive Care Unit, Tripoli University Hospital, Tripoli, Libya
| | - Abubaker ELmaryul
- Medical Intensive Care Unit, Tripoli University Hospital, Tripoli, Libya
| | - Suad Almadah
- Neonatal Intensive Care Unit, Tripoli University Hospital, Tripoli, Libya
| | - Abdunnabi Rayes
- Infection Control Office, Tripoli University Hospital, Tripoli, Libya
| | - Salah Edin El Meshri
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Allaaeddin El Salabi
- Department of Environmental Health, Faculty of Public Health, University of Benghazi, Benghazi, Libya
| | - Adam Elzagheid
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
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Taha MS, Hagras MM, Shalaby MM, Zamzam YA, Elkolaly RM, Abdelwahab MA, Maxwell SY. Genotypic Characterization of Carbapenem-Resistant Klebsiella pneumoniae Isolated from an Egyptian University Hospital. Pathogens 2023; 12:121. [PMID: 36678469 PMCID: PMC9866858 DOI: 10.3390/pathogens12010121] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
Globally, Klebsiella pneumoniae (K. pneumoniae) has been identified as a serious source of infections. The objectives of our study were to investigate the prevalence of multidrug-resistant (MDR) K. pneumoniae in Tanta University Hospitals, Gharbia Governorate, Egypt; characterize their carbapenem resistance profiles; and identify their different capsular serotypes. We identified and isolated 160 (32%) K. pneumoniae from 500 different clinical samples, performed antimicrobial susceptibility testing, and then used multiplex PCR to detect carbapenemase genes and capsular serotypes K1, K2, K3, K5, K20, K54, and K57. We detected phenotypic carbapenem resistance in 31.3% (50/160) of the isolates; however, molecular assays revealed that 38.75% (62/160) of isolates were carrying carbapenemase-encoding genes. Generally, blaOXA-48 was the prevalent gene (15.5%), followed by blaVIM (15%), blaIMP (7.5%), blaKPC (4%), and blaNDM (3.8%). BlaVIM and blaOXA-48 correlated with phenotypic resistance in 91.67% and 88% of the isolates that harbored them, respectively. Capsular typing showed that the most prevalent pathotype was K1 (30.6%), followed by K57 (24.2%), K54 (19.35%), K20 (9.67%), and K2 (6.45%). A critical risk to community health is posed by the high incidence of multidrug-resistant (MDR) virulent K. pneumoniae isolates from our hospital, and our study examines this pathogen's public health and epidemiological risks.
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Affiliation(s)
- Marwa S. Taha
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Maha M. Hagras
- Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Marwa M. Shalaby
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | | | - Reham M. Elkolaly
- Department of Chest Diseases, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Marwa A. Abdelwahab
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Sara Youssef Maxwell
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
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Hosien B, Belhaj H, Atia A. Characteristics of Antibiotic-Resistant Bacteria in Libya Based on Different Source of Infections. LIBYAN INTERNATIONAL MEDICAL UNIVERSITY JOURNAL 2022. [DOI: 10.1055/s-0042-1759621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractIn recent years and for decades, antimicrobial resistance (AMR) has expanded into a major clinical issue. Infections were no longer a life-threatening issue for clinicians after the discovery of antibiotics. The misuse or overuse of antibiotics, however, contributes to global AMR, and numerous mobile genetic elements and relevant resistant genes worsen the spread of resistance. As antibiotics lose their effectiveness, a growing number of infections such as pneumonia, tuberculosis, and gonorrhea are getting harder and sometimes impossible to treat. Infections that are resistant to antibiotics are correlated with antibiotic misuse. The majority of the antibiotic resistance in microbes is caused by improper use of antibiotics. Because there are a few antibiotics available to treat multidrug-resistant bacterial infections, there is a high rate of morbidity and mortality. Libya has a high burden of antibiotic resistance, and antimicrobial malpractice has frequently been reported. Providing information on the current state of antimicrobial resistance in Libya may assist the health authorities in addressing the problem more effectively in the future. Therefore, this review highlights the current situation of bacterial profile and their antimicrobial resistance in Libya based on the source of infection. Articles related to the topic were searched using databases and search engines such as PubMed, Google Scholar, and ResearchGate websites. These articles were selected if they were conducted in Libya and provided information on bacterial pathogens and AMR. Required data were extracted for the purpose of this review report, and then further verified for identifying the prevalence and number of susceptible and resistant pathogens in each source of infection.
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Affiliation(s)
- Bushra Hosien
- Department of Medical Laboratories, The University of Tripoli Alahlia, Janzur, Libya
| | - Howida Belhaj
- Department of Medical Laboratories, The University of Tripoli Alahlia, Janzur, Libya
| | - Ahmed Atia
- Department of Anesthesia and Intensive Care, Faculty of Medical Technology, The University of Tripoli, Libya
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Slimene K, El Salabi AA, Dziri O, Mabrouk A, Miniaoui D, Gharsa H, Shokri SA, Alhubge AM, Achour W, Rolain JM, Chouchani C. High Carbapenem Resistance Caused by VIM and NDM Enzymes and OprD Alteration in Nonfermenter Bacteria Isolated from a Libyan Hospital. Microb Drug Resist 2021; 27:1546-1554. [PMID: 34029121 DOI: 10.1089/mdr.2020.0175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Acinetobacter baumannii and Pseudomonas aeruginosa are among the most prevalent pathogens causing a wide range of serious infections in hospitalized patients and contaminating intensive care units and inanimate surfaces. The purpose of this study was to investigate the mechanism of carbapenem resistance in clinical and hospital environmental isolates of A. baumannii and P. aeruginosa recovered from a Libyan hospital. From a total of 82 Gram-negative bacteria, 8 isolates of A. baumannii and 3 isolates of P. aeruginosa exhibited resistance to imipenem with minimum inhibitory concentrations ranging from 16 to >32 μg/mL. Five isolates of A. baumannii harbored blaOXA-23 gene, from which three isolates were collected from patients and two from hospital environment. Only one isolate harbored blaNDM-1 gene, which was responsible for carbapenem resistance in A. baumannii. The OprD gene seems to be disturbed by an insertion sequence (IS) in two isolates and affected by polymorphism in one isolate. Pulsed-field gel electrophoresis results showed high genetic diversity among carbapenemase producing A. baumannii. This study highlights the dissemination of blaOXA-23 and blaNDM-1 genes in a Libyan setting. Therefore, infection prevention and control practices, antimicrobial stewardship initiatives, and antimicrobial resistance surveillance systems should be implemented to prevent the wide spread of antimicrobial resistance.
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Affiliation(s)
- Khouloud Slimene
- Microbes Evolution Phylogenie et Infections (MEPHI), Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France.,IHU Méditerranée Infection, Valorisation and Transfer, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France.,Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université de Tunis El-Manar, Tunis, Tunisie.,Laboratoire de Recherche des Sciences et Technologies de l'Environnement, Institut Supérieur des Sciences et Technologies de l'Environnement de Borj-Cedria, Université de Carthage, Borj-Cedria, Tunisie
| | - Allaaeddin Ali El Salabi
- Department of Environmental Health, Faculty of Public Health, University of Benghazi, Benghazi, Libya
| | - Olfa Dziri
- Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université de Tunis El-Manar, Tunis, Tunisie.,Laboratoire de Recherche des Sciences et Technologies de l'Environnement, Institut Supérieur des Sciences et Technologies de l'Environnement de Borj-Cedria, Université de Carthage, Borj-Cedria, Tunisie
| | - Aymen Mabrouk
- Faculté de Médecine de Tunis, LR18ES39, Centre National de Greffe de Moelle Osseuse, Université Tunis El Manar, Tunis, Tunisie
| | - Dhouha Miniaoui
- Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université de Tunis El-Manar, Tunis, Tunisie.,Laboratoire de Recherche des Sciences et Technologies de l'Environnement, Institut Supérieur des Sciences et Technologies de l'Environnement de Borj-Cedria, Université de Carthage, Borj-Cedria, Tunisie
| | - Haythem Gharsa
- Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université de Tunis El-Manar, Tunis, Tunisie.,Institut Supérieur des Sciences Biologiques et Appliqués de Tunis, Université Tunis El Manar, Tunis, Tunisie
| | - Salah A Shokri
- Department of Microbiology, Faculty of Science, Misurata University, Misurata, Libya
| | - Altaher M Alhubge
- Department of Microbiology, Faculty of Science, Misurata University, Misurata, Libya
| | - Wafa Achour
- Faculté de Médecine de Tunis, LR18ES39, Centre National de Greffe de Moelle Osseuse, Université Tunis El Manar, Tunis, Tunisie
| | - Jean-Marc Rolain
- Microbes Evolution Phylogenie et Infections (MEPHI), Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France.,IHU Méditerranée Infection, Valorisation and Transfer, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Chedly Chouchani
- Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université de Tunis El-Manar, Tunis, Tunisie.,Laboratoire de Recherche des Sciences et Technologies de l'Environnement, Institut Supérieur des Sciences et Technologies de l'Environnement de Borj-Cedria, Université de Carthage, Borj-Cedria, Tunisie
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Ssekatawa K, Byarugaba DK, Nakavuma JL, Kato CD, Ejobi F, Tweyongyere R, Eddie WM. Prevalence of pathogenic Klebsiella pneumoniae based on PCR capsular typing harbouring carbapenemases encoding genes in Uganda tertiary hospitals. Antimicrob Resist Infect Control 2021; 10:57. [PMID: 33736698 PMCID: PMC7977577 DOI: 10.1186/s13756-021-00923-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/02/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Klebsiella pneumoniae is an opportunistic pathogen that has been implicated as one of commonest cause of hospital and community acquired infections. The K. pneumoniae infections have considerably contributed to morbidity and mortality in patients with protracted ailments. The capacity of K. pneumoniae to cause diseases depends on the presence of an array virulence factors. Coexistence and expression of virulence factors and genetic determinants of antibiotic resistance complicates treatment outcomes. Thus, emergence of pathogenic MDR K. pneumoniae poses a great threat to the healthcare system. However, the carriage of antibiotic resistance among pathogenic K. pneumoniae is yet to be investigated in Uganda. We sought to investigate the carbapenem resistance profiles and pathogenic potential based on capsular serotypes of K. pneumoniae clinical isolates. METHODS This was a cross sectional study involving use of archived Klebsiella pneumoniae isolates collected between January and December, 2019 at four tertiary hospitals in Uganda. All isolates were subject to antimicrobial susceptibility assays to determine phenotypic antibiotic resistance, pentaplex PCR to detect carbapenemases encoding genes and heptaplex PCR to identify capsular serotypes K1, K2, K3, K5, K20, K54 and K57. RESULTS The study found an overall phenotypic carbapenem resistance of 23.3% (53/227) and significantly higher genotypic resistance prevalence of 43.1% (98/227). Over all, the most prevalent gene was blaOXA-48-like (36.4%), followed by blaIMP-type (19.4%), blaVIM-type (17.1%), blaKPC-type (14.0%) and blaNDM-type (13.2%). blaVIM-type and blaOXA-48-like conferred phenotypic resistance in all isolates and 38.3% of isolates that harbored them respectively. Capsular multiplex PCR revealed that 46.7% (106/227) isolates were pathogenic and the predominantly prevalent pathotype was K5 (18.5%) followed by K20 (15.1%), K3 (7.1%), K2 (3.1%) and K1 (2.2%). Of the 106 capsular serotypes, 37 expressed phenotypic resistance; thus, 37 of the 53 carbapenem resistant K. pneumoniae were pathogenic. CONCLUSION The high prevalence of virulent and antibiotic resistant K. pneumoniae among clinical isolates obtained from the four tertiary hospital as revealed by this study pose a great threat to healthcare. Our findings underline the epidemiological and public health risks and implications of this pathogen.
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Affiliation(s)
- Kenneth Ssekatawa
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University-Western Campus, P. O. Box 71, Bushenyi, Uganda
- Africa Center Excellence in Materials Product Development and Nanotechnology (MAPRONANO ACE), College of Engineering Design Art and Technology, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Denis K. Byarugaba
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Jesca L. Nakavuma
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Charles D. Kato
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Francis Ejobi
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Robert Tweyongyere
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Wampande M. Eddie
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda
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