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Alkhuraisi LS, Mirghani H, Al Qahtani MM, Alrezqi WA, Alfaifi IA, Jathmi AS, Jathmi AS, Aianazi NS. Knowledge, Attitude, and Practice of Antibiotic Resistance Among General Population in Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e51053. [PMID: 38269240 PMCID: PMC10806351 DOI: 10.7759/cureus.51053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Antibiotic resistance is a global public health concern, and understanding the knowledge, attitudes, and practices (KAP) of the general population is essential for effective prevention and management. This cross-sectional study aimed to assess the KAP of antibiotic resistance among adults in Saudi Arabia. MATERIALS AND METHODS Between August 2023 and October 2023, 1000 participants aged 16-65 years from various regions in Saudi Arabia were surveyed using an online questionnaire. Data were analyzed using Excel and IBM SPSS Statistics version 27.0.0 (Armonk, NY: IBM Corp.). The sociodemographic characteristics of the participants were examined, and KAP variables towards antibiotic resistance were explored through a range of statistical methods, including frequencies, percentages, means, and standard deviations. Significance was defined as a p-value of ≤0.05. RESULTS The majority of participants were Saudi natives (98.1%) with ages between 16 and 25 years (38%), and over half were female (55.7%). More than half held a university degree (54.7%), mainly in non-medical fields (73.3%), and a significant portion reported a monthly income above 10,000 Saudi Riyals (49.7%). Regarding knowledge, 76.5% were aware of antibiotic resistance, but only 24.2% correctly identified its causes. Attitude assessments showed that 50.8% never used antibiotics as a preventive measure, and 47.3% always followed medical prescriptions. Practices revealed that 50.5% rarely used antibiotics, and 68.8% obtained antibiotic prescriptions from doctors. Additionally, 68.9% stopped taking antibiotics only after completing the course. CONCLUSION It is important to implement health education campaigns aimed at the public, emphasize the role of health care providers in health education for the general public, and enforce stringent regulations to control the non-prescription dispensing of antibiotics. However, further studies are needed on this subject in the future.
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Antibiotic use for respiratory syncytial virus in the Middle East: A surveillance study in hospitalized Jordanian children. PLoS One 2021; 16:e0260473. [PMID: 34843571 PMCID: PMC8629301 DOI: 10.1371/journal.pone.0260473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 11/10/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction In developing countries where point-of-care testing is limited, providers rely on clinical judgement to discriminate between viral and bacterial respiratory infections. We performed a cross-sectional cohort study of hospitalized Jordanian children to evaluate antibiotic use for respiratory syncytial virus (RSV) infections. Materials and methods Admitting diagnoses from a prior viral surveillance cohort of hospitalized Jordanian children were dichotomized into suspected viral-like, non-pulmonary bacterial-like, and pulmonary bacterial-like infection. Stratifying by sex, we performed a polytomous logistic regression adjusting for age, underlying medical condition, maternal education, and region of residence to estimate prevalence odds ratios (PORs) for antibiotic use during hospitalization. Sensitivity and specificity of admission diagnoses and research laboratory results were compared. Results Children with a suspected viral-like admission diagnosis, compared to those with suspected non-pulmonary bacterial-like, were 88% and 86% less likely to be administered an empiric/first-line antibiotic (male, aPOR: 0.12; female, aPOR: 0.14; p-value = <0.001). There were slight differences by sex with males having a lower prevalence than females in being administered an expanded coverage antibiotic; but they had a higher prevalence of macrolide administration than males with non-pulmonary bacterial-like infection. Overall, children with RSV had a 34% probability (sensitivity) of being assigned to a suspected viral-like diagnosis; whereas RSV-negative children had a 76% probability (specificity) of being assigned to a suspected pulmonary bacterial-like diagnosis. Conclusions Hospitalized children with a suspected viral-like admission diagnosis were less likely to receive an empiric/first-line and expanded coverage antibiotic compared to suspected non-pulmonary and pulmonary infections; however, when evaluating the accuracy of admission diagnosis to RSV-laboratory results there were considerable misclassifications. These results highlight the need for developing antibiotic interventions for Jordan and the rest of the Middle East.
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Abstract
Introduction Antimicrobial resistance (AMR) is an emerging global threat. It increases mortality and morbidity and strains healthcare systems. Health care professionals can counter the rising AMR by promoting antibiotic stewardship and facilitating new drug development. Even with the economic and scientific challenges, it is reassuring that new agents continue to be developed. Methods This review addresses new antibiotics in the pipeline. We conducted a review of the literature including Medline, Clinicaltrials.org, and relevant pharmaceutical companies for approved and in pipeline antibiotics in phase 3 or new drug application (NDA). Results We found a number of new antibiotics and reviewed their current development status, mode of action, spectra of activity, and indications for which they have been approved. The included studies from phase 3 clinical trials were mainly utilized for the treatment of acute bacterial skin and skin structure infections, community-acquired bacterial pneumonia, and pneumonia acquired in the healthcare settings. The number of these agents is limited against high priority organisms. The identified antibiotics were based mainly on previously known molecules or pre-existing antimicrobial agents. Conclusion There are a limited number of antibiotics against high priority organisms such as multi-drug-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae. New antimicrobial agents directed against the top priority organisms as classified by the World Health Organization are urgently needed.
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Al-Tawfiq JA, Al-Homoud AH. Intermittent daily de-escalation rounds did not have significant impact on antimicrobial stewardship program targeting carbapenems. Int J Clin Pract 2021; 75:e14507. [PMID: 34535056 DOI: 10.1111/ijcp.14507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ali H Al-Homoud
- Pharmacy Services Division, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
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Alnasser AHA, Al-Tawfiq JA, Ahmed HAA, Alqithami SMH, Alhaddad ZMA, Rabiah ASM, Albrahim MAA, Al Kalif MSH, Barry M, Temsah MH, Al-Kalaif ZSH, Shahadah RFB, Alharbi KKS, Alnasser AAH. Public knowledge, attitude and practice towards antibiotics use and antimicrobial resistance in Saudi Arabia: A web-based cross-sectional survey. J Public Health Res 2021; 10. [PMID: 34313091 PMCID: PMC8715265 DOI: 10.4081/jphr.2021.2276] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Antimicrobial resistance is a global issue that causes significant morbidity and mortality. Therefore, this study aims to assess knowledge, attitudes, and practices (KAP) of the general Saudi populations toward antibiotics use. Design and method: A cross-sectional, anonymous online survey was conducted from January 1 to May 11, 2020, across five major regions of Saudi Arabia. Participants (aged ≥18 years) were invited through social media to complete an online self-structured questionnaire. All data were analyzed by Statistical Package (SPSS v. 25). Descriptive statistics, Pearson’s Chi-squared, t-tests, one-way analysis of variance (ANOVA), and Pearson correlation analyses were conducted. Results: Out of 443 participants, the majority (n=309, 69.8%) were females, 294 (64.4%) were married, 176 (39.7%) were 25-34 years of age, 338 (76.3%) were living in the Eastern Province, 313 (70.7%) had college or higher education, 139 (31.4%) were not working, and 163 (36.8%) had a monthly income of USD 800-1330. Overall, most participants demonstrated good knowledge and practice (88% and 85.6%, respectively). However, 76.8%had inadequate attitude score levels towards antibiotics use. Of all the respondents, 74.9% knew that not completing a full course of antibiotics may cause antibiotics resistance, 91.33% did not agree that antibiotics should be accessed without a prescription, and 94.04% will not hand over leftover antibiotics to family members. Factors associated with adequate knowledge were female, medical jobs, and higher income (p<0.05). Conclusions: Our findings revealed that while most participants were aware of antibiotics use and demonstrated good knowledge, good practices, they had negative attitudes towards antibiotics use. Significance for public health Antibiotics are considered the miracle of medicine that can cure patients with infectious diseases. In the Kingdom of Saudi Arabia, few studies described antimicrobial practices. Most of the surveys were limited to certain areas. Therefore, this study assessed general knowledge, practices, and attitudes towards antibiotics use in multiple regions of Saudi Arabia. The findings could be used to assess the level of awareness about antibiotic use and may help policymakers to develop plans, laws, and programs to limit misuse of antibiotics and to preserve the health of the general population of Saudi Arabia.
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Affiliation(s)
- Ali Hassan A Alnasser
- Department of Laboratory, Dhahran Eye Specialist Hospital, Ministry of Health, Dhahran 31942, Saudi Arabia.
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia, Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | | | | | | | | | - Maryam Ali A Albrahim
- Department of Dentistry, Dammam Medical Complex, Ministry of Health, Dammam, Saudi Arabia.
| | - Mohammed Sheker H Al Kalif
- Department of Public Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, Technical and Vocational Training Corporation, Riyadh, Saudi Arabia.
| | - Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia.
| | - Mohamad-Hani Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | | | | | - Khulud Khalid S Alharbi
- College of Applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia, The Panuska College of Professional Studies, The University of Scranton, Scranton, PA, USA.
| | - Aqeela Ali H Alnasser
- Al-Awjam First Secondary School for Girls, Al-Qatif Girls Education Office, General Administration of Education in the Eastern Region, Ministry of Education, Qatif, Saudi Arabia.
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Hassan MM, El Zowalaty ME, Lundkvist Å, Järhult JD, Khan Nayem MR, Tanzin AZ, Badsha MR, Khan SA, Ashour HM. Residual antimicrobial agents in food originating from animals. Trends Food Sci Technol 2021; 111:141-150. [PMID: 33746363 PMCID: PMC7953985 DOI: 10.1016/j.tifs.2021.01.075] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The agricultural food products industry in Bangladesh depends on utilizing antimicrobials indiscriminately as growth promoters and for controlling infectious diseases. Thus, there is always a risk of antimicrobial agent accumulation in food sources that originate from agricultural production. METHODS In the present study, we collected data from published articles between January, 2013 and December, 2019 on antimicrobial residues in human food sources such as meat, milk, eggs, and fishes. RESULTS Liver contained the highest percentage of antimicrobial residues (74%; 95% CI: 59.66-85.37) against the in vitro enteric pathogen Escherichia coli in layer chickens. Similar results were demonstrated in liver (68%; 95% CI: 53.30-80.48) and kidney (66%, 95% CI: 51.23-78.79) of layer chickens against Bacillus cereus and Bacillus subtilis. Amongst all antibiotics, the highest concentrations of ciprofloxacin were detected in kidney (48.57%; 95% CI: 31.38-66.01), followed by liver (47.56; 95% CI: 40.88-54.30) of broiler chickens. Ciprofloxacin was also present in liver (46.15%; 95% CI: 33.70-58.96) of layer chickens. The percentage of ciprofloxacin in thigh and breast meat in broiler bird were 41.54% (95% CI: 34.54-48.79) and 37.95% (95% CI: 31.11-45.15) respectively. Enrofloxacin was the second most dominant antimicrobial agent and was present in the liver of both types of poultry (Broiler and Layer chickens: 41.54%; 95% CI: 29.44-54.4 and 437.33%; 95% CI: 30.99-44.01). The prevalence rates of enrofloxacin in thigh and breast meat of broiler chickens were 24.10% (95% CI: 18.28-30.73) and 20.51% (95% CI: 15.08-26.87), respectively. Tetracycline, a commonly used antibiotic in livestock, was present in the liver (49.23%; 95% CI: 36.60-61.93) of layer chickens. In case of aquaculture food products, the highest amount of amoxicillin (683.2 mg/kg) was detected in Tilapia fish (Oreochromis niloticus), followed by 584.4 mg/kg in climbing perch (Anabas testudineus) and 555.6 mg/kg in Rui fish (Labeo rohita). Among the five types of fishes, Rui fish (0.000515 mg/kg) contained the highest concentrations of chloramphenicol antibiotic residues. CONCLUSIONS The presence of antimicrobial residues in meat, milk, egg, and fish is a serious public health threat due to the potential induction of antimicrobial resistance. It can negatively impact the food supply chain, especially with the current strain that it is already facing with the current COVID-19 pandemic. The findings of the present study highlight the ongoing risk of residual antimicrobial agents in food of animal origin in Bangladesh and countries with similar practices. This can draw the attention of public health officials to propose plans to mitigate or stop this practice.
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Affiliation(s)
- Mohammad Mahmudul Hassan
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Mohamed E El Zowalaty
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, 27272, United Arab Emirates
- Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, SE 75 123, Sweden
| | - Åke Lundkvist
- Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, SE 75 123, Sweden
| | - Josef D Järhult
- Zoonosis Science Center, Department of Medial Sciences, Uppsala University, Sweden
| | - Md Raihan Khan Nayem
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Abu Zubayer Tanzin
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Md Rahim Badsha
- Faculty of Food Science and Technology, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Shahneaz Ali Khan
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Hossam M Ashour
- Department of Integrative Biology, College of Arts and Sciences, University of South Florida, St.Petersburg, Florida, 33701, USA
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
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Al Salman J, Al Dabal L, Bassetti M, Alfouzan WA, Al Maslamani M, Alraddadi B, Elhoufi A, Khamis F, Mokkadas E, Romany I, Enani M, Somily A, Kanj SS. Promoting cross-regional collaboration in antimicrobial stewardship: Findings of an infectious diseases working group survey in Arab countries of the Middle East. J Infect Public Health 2021; 14:978-984. [PMID: 34130122 DOI: 10.1016/j.jiph.2021.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is a significant global issue that presents an increasing threat to patients' wellbeing. Although a global concern, the emergence of multi-drug resistant organisms is of particular significance in the Middle East. In recent years, this region has seen an alarming increase in antimicrobial resistance presenting a major challenge to physicians managing various infectious diseases. METHODS A Working Group comprising experts in infectious diseases from Arab countries of Middle East assembled to review similarities and differences in antimicrobial practices and management of multi-drug resistant organisms across the region and assess the barriers to achieving cross-regional collaboration. The Working Group conducted an anonymous online survey to evaluate current practice and understanding of management of multi-drug resistant organisms across the region. RESULTS A total of 122 physicians from Arab countries of the Middle East responded to the survey. Their responses demonstrated heterogeneity between countries in awareness of local epidemiology, management of multi-drug resistant organisms and antimicrobial stewardship practices. The Working Group recognized similarities and differences in the management of multi-drug resistant organisms across the region, and these were validated by the data collected in the survey. Overall, the similarities across the region reflect several key issues that can have an impact on the management of multi-drug resistant organisms and the prevention of antimicrobial resistance. CONCLUSIONS This paper highlights the urgency of addressing antimicrobial resistance in Arab countries of the Middle East. The Working Group identified key barriers to effective management which may guide the development of future coherent strategies to promote effective antimicrobial stewardship in the region. Here, we outline a call to action for the region, with a need to focus on training and education, capacity building, infrastructure, regional research, and regional surveillance.
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Affiliation(s)
| | | | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences University of Genoa and Policlinico San Martino Hospital, Genoa, Italy
| | - Wadha A Alfouzan
- Kuwait University, Kuwait City, Kuwait; Farwanyia Hospital, Ministry of Health, Kuwait City, Kuwait
| | | | - Basem Alraddadi
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
| | | | | | | | - Ingy Romany
- Pfizer Gulf FZ LLC, Dubai, United Arab Emirates
| | | | - Ali Somily
- King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Souha S Kanj
- American University of Beirut Medical Center, Beirut, Lebanon.
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Lawrence MW, Sachdeva M, Bennett JW, Menninger GU, Barrera MA, Benitez JG, Kliewer ML. Rare Multidrug-resistant Pseudomonas aeruginosa Identified in a U.S. Deployed Service Member Following Host-nation Medical Treatment. Mil Med 2021; 187:e773-e777. [PMID: 33449105 DOI: 10.1093/milmed/usaa560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/30/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Decision-making related to the utilization of host-nation medical resources in austere forward-deployed environments is complex. Clinical circumstances, local medical intelligence availability, transportation assets, uncertainty regarding standard-of-care variations, military/host-nation funding complications, and regional security concerns all factor into consideration. A case of a U.S. active duty military service member who suffered a cardiac arrest on a military base in Southwest Asia is described in this report. After return of circulation following defibrillation, he was administered thrombolytic therapy for an electrocardiogram-identified ST-elevation myocardial infarction and transported to a local host-nation cardiac hospital for emergent percutaneous coronary intervention. During his subsequent transportation back to the USA, surveillance testing identified that he was colonized with a rare strain of Pseudomonas aeruginosa, demonstrating New Delhi metallo-beta-lactamase-1 and 16S RNA methyltransferase-2 enzymes, which confer significant resistance to carbapenem and aminoglycoside antibiotics, respectively.1-3 This combination of antibiotic resistance has been reported very rarely in the medical literature and has never been reported within the deployed military health system until now. The risk of exposure to multidrug-resistant organisms was not a factor initially considered in the decision to utilize host-nation medical resources in this case, which provided lesson learned and raised new questions, for future operational medical planning.
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Affiliation(s)
- Matthew W Lawrence
- Department of Emergency Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Mohit Sachdeva
- 3rd Medical Command FWD, Camp Arifjan, Kuwait, T838, Zone-7 APO AE 09366
| | - Jason W Bennett
- Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | | | | | - John G Benitez
- 3rd MCDS Command Surgeon Ft Gillem, Forest Park, GA 30297, USA
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Al-Tawfiq JA, Al-Homoud AH. Pattern of systemic antibiotic use among hospitalized patients in a general hospital in Saudi Arabia. Travel Med Infect Dis 2020; 36:101605. [DOI: 10.1016/j.tmaid.2020.101605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 11/25/2022]
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Al Marjania MF, Kouhsari E, Ali FS, Authman SH. Evaluation of type II Toxin-Antitoxin Systems, Antibiotic Resistance Profiles, and Biofilm Quorum Sensing Genes in Acinetobacter Baumannii Isolates in Iraq. Infect Disord Drug Targets 2020; 21:180-186. [PMID: 32484105 DOI: 10.2174/1871526520666200525170318] [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: 01/06/2020] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bacterial Toxin-Antitoxin (TAs) systems are extensive two-component elements in the bacterial genome, which are involved in many key biological functions, including growth arrest, survival, biofilm formation, plasmid maintenance, defense against phages, persistence, and virulence. AIM This study aimed to assess the molecular determinants involved in TAs, biofilm quorum sensing, and antibiotic resistance profiles in Acinetobacter baumannii isolated from Baghdad's hospitals in Iraq. METHODS A total of 127 A. baumannii isolates were collected from 2160 different clinical samples. The antimicrobial susceptibility test was performed using the disk diffusion test. All isolates were characterized for molecular determinants involved in TAs and biofilm formation using the wellknown PCR-based sequencing assay. RESULTS A high multi-drug resistant (MDR) (96.06%; 122/127) and imipenem resistance (84.25%; 107/127) rates were observed from A.baumannii isolates. Results showed the presence of rhlIR gene in three isolates (2.36%), and lasIR gene appeared in two isolates (1.57%) isolates, whilst, mazEF, ccdAB, and relBE genes have not been detected among any of the isolates. CONCLUSION A high MDR and imipenem resistance rates within a low prevalence of rhlIR, and lasIR genes could be found in clinical A. baumannii isolates from some of the Iraqi hospitals.
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Affiliation(s)
| | - Ebrahim Kouhsari
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Fatima S Ali
- Department of Biology, College of Science, Mustansiriyah University, Baghdad, Iraq
| | - Sawsan H Authman
- Department of Biology, College of Science, Mustansiriyah University, Baghdad, Iraq
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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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Al Mayahi Z, Kamel S, Amer H, Beatty M. Outbreak of colistin-resistant organisms at a tertiary hospital in Riyadh, Saudi Arabia, 2016. Pan Afr Med J 2020; 34:162. [PMID: 32153702 PMCID: PMC7046114 DOI: 10.11604/pamj.2019.34.162.19998] [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: 08/06/2019] [Accepted: 09/05/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Multidrug-resistant organisms (MDROs) have been a major concern in King Saud Medical City (KSMC) recently. The number of cases with colistin resistance was growing rapidly in the first half of 2016, challenging the infection control practices and mandating a thorough outbreak investigation. The objective of this study was to determine the extent of the outbreak, identify potential risk factors and prevent further increase in the rates of MDROs. Methods Reviewing the medical records of the 22 admitted cases with colistin resistance using an abstraction form composed of demographical data, comorbidities, details of current admissions, and procedures. Also, tracking patients' movements in the hospital, reviewing all cultures isolates, and reviewing the surveillance and infection control strategies. Results Mean age was 49.71±17.824 (20-79 years), 90.9% were males, 63.6% cases admitted under medical unit. The average duration of stay in the ED was 1.23 day. Over 2/3 had hypertension and diabetes mellitus. Majority of patients staying between 20-40 days in the hospital & the average number of days until developing colistin resistance was 44.18. Resistance was solely related to two organisms that were Acinetobacter baumanni (59.1%) and Klebsiella pneumoniae (40. 9%). Ventilators and folly's catheters were equally (95.5%) used by 21 patients. The most common site of infection was respiratory (41.3%), of which most were sputum samples. Resistance of over 75% is recorded by antibiotics like tazocin, ciprofloxacin, imepenen and oxacillin. Conclusion The uncontrolled use of antibiotics, prolonged stay in the Intensive Care Unit (ICU), frequent uses of different devices, are the potential risk factors of developing colistin resistance.
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Affiliation(s)
- Zayid Al Mayahi
- Field Epidemiology Training Program, Ministry of Health, Riyadh, Saudi Arabia
| | - Shady Kamel
- Field Epidemiology Training Program, Ministry of Health, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, King Saud University, Riyadh, KSA
| | - Hala Amer
- Infection Control Administration, King Saud Medical City, Ministry of Health, Riyadh, KSA.,Department of Community Medicine, National Research Centre, Egypt
| | - Mark Beatty
- Field Epidemiology Training Program, Ministry of Health, Riyadh, Saudi Arabia
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Khairalla AS, Wasfi R, Ashour HM. Carriage frequency, phenotypic, and genotypic characteristics of methicillin-resistant Staphylococcus aureus isolated from dental health-care personnel, patients, and environment. Sci Rep 2017; 7:7390. [PMID: 28784993 PMCID: PMC5547136 DOI: 10.1038/s41598-017-07713-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/28/2017] [Indexed: 01/03/2023] Open
Abstract
There is limited data on methicillin-resistant Staphylococcus aureus (MRSA) carriage in dental clinics. 1300 specimens from patients, health personnel, and environmental surfaces of a dental clinic in Egypt were tested for MRSA. Antibiotic susceptibility, biofilm formation, Staphylococcal protein A (spa) typing, SCCmec typing, and PCR-based assays were used to detect mecA, mecC, vanA, Panton-Valentine Leukocidin toxin (PVL), and toxic shock syndrome toxin-1 (tst) genes. Among 34 mecA-positive MRSA isolates, five (14.7%) were PVL-positive, seventeen (50%) were tst-positive, ten (29.4%) were vanA-positive, while none harboured mecC. MRSA hand carriage rates in patients, nurses, and dentists were 9.8%, 6.6%, and 5%. The respective nasal colonization rates were 11.1%, 6.7%, and 9.7%. 1.3% of the environmental isolates were MRSA-positive. Strong and moderate biofilm-forming isolates represented 23.5% and 29.4% of MRSA isolates. 24 MRSA isolates (70.6%) were multi-resistant and 18 (52.9%) harboured SCCmec IV. Among eight spa types, t223 (26.5%), t267 (23.5%), and t14339 (23.5%) were predominant. We noted an alarming genetic relatedness between 7 (20.6%) MRSA isolates and the epidemic EMRSA-15 clone, as well as a combined occurrence of tst and PVL in 3 (8.8%) isolates. Results suggest high MRSA pathogenicity in dental wards highlighting the need for more efficient surveillance/infection control strategies.
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Affiliation(s)
- Ahmed S Khairalla
- Department of Microbiology & Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Reham Wasfi
- Department of Microbiology & Immunology, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), Giza, Egypt
| | - Hossam M Ashour
- Department of Biological Sciences, College of Arts and Sciences, University of South Florida St. Petersburg, St. Petersburg, Florida, USA.
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
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Leangapichart T, Rolain JM, Memish ZA, Al-Tawfiq JA, Gautret P. Emergence of drug resistant bacteria at the Hajj: A systematic review. Travel Med Infect Dis 2017; 18:3-17. [PMID: 28652197 DOI: 10.1016/j.tmaid.2017.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/15/2017] [Accepted: 06/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hajj is the annual mass gathering of Muslims, and is a reservoir and potential source of bacterial transmission. The emergence of bacterial transmission, including multi-drug resistance (MDR) bacteria, during Hajj has not been systematically assessed. METHODS Articles in Pubmed, Scopus, and Google scholar were identified using controlled words relating to antibiotic resistance (AR) at the Hajj from January 2002 to January 2017. Eligible studies were identified by two researchers. AR patterns of bacteria were obtained for each study. RESULTS We included 31 publications involving pilgrims, Hajj workers or local patients attending hospitals in Mecca, Mina, and the Medina area. Most of these publications provided antibiotic susceptibility results. Ten of them used the PCR approach to identify AR genes. MRSA carriage was reported in pilgrims and food handlers at a rate of 20%. Low rates of vancomycin-resistant gram-positive bacteria were reported in pilgrims and patients. The prevalence of third-generation cephalosporin-resistant bacteria was common in the Hajj region. Across all studies, carbapenem-resistant bacteria were detected in fewer than 10% of E.coli isolates tested but up to 100% in K. pneumoniae and A. baumannii. Colistin-resistant Salmonella enterica, including mcr-1 colistin-resistant E.coli and K.pneumoniae were only detected in the pilgrim cohorts. CONCLUSION This study provides an overview of the prevalence of MDR bacteria at the Hajj. Pilgrims are at high risk of AR bacterial transmission and may carry and transfer these bacteria when returning to their home countries. Thus, pilgrims should be instructed by health care practitioners about hygiene practices aiming at reducing traveler's diarrhea and limited use of antibiotics during travel in order to reduce the risk of MDR bacterial transmission.
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Affiliation(s)
- Thongpan Leangapichart
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE) CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Jean-Marc Rolain
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE) CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Ziad A Memish
- Ministry of Health, Riyadh, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Philippe Gautret
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE) CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France.
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Khalifeh MM, Moore ND, Salameh PR. Self-medication misuse in the Middle East: a systematic literature review. Pharmacol Res Perspect 2017; 5. [PMID: 28805984 PMCID: PMC5684864 DOI: 10.1002/prp2.323] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
Regulations usually distinguish between prescription‐only (POM) and over‐the‐counter (OTC) medicines. The former requires medical prescription; the latter are available for SM of common minor or easily treated ailments. However, in the Eastern Mediterranean countries, theoretical prescription medicines can easily be purchased without a prescription, as self‐medication (SM) resulting in potential misuse and unnecessary risk for patients. The magnitude of this activity is uncertain. The aim of this article, therefore, is to undertake a comprehensive review to identify the different types of medicines that can easily be purchased as SM in Middle East and recognized as misused. An extensive review of the published literature (1990–2015) was conducted using Pubmed, web of science, Cochrane, and Google Scholar databases, for OTC medicine misuse in the Middle East. A total of 72 papers were identified. Medicines involved in misuse included: codeine containing products, topical anesthetics, topical corticosteroids, antimalarial, and antibiotics. Self‐medication misuse of medicines seemed widespread. Individual treatment patterns were not clearly identified. Studies were not standardized, limiting the comparability between studies and the estimation of the scale of misuse. Pharmacists, friends, or parents were found to be the main sources of SMs. Knowledge and attitudes are an important contributing factor in the misuse of these medications. Strategies and interventions to limit misuse were rarely identified in literature. In conclusion, a massive problem involving a range of medicines was found in Middle East. Standardization of studies is a prerequisite to the understanding and prevention of misuse of self‐medication.
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Affiliation(s)
- Malak M Khalifeh
- INSERM U 1219 - Pharmaco-épidémiologie et évaluation de l'impact des produits de santé sur les populations, University de Bordeaux, Bordeaux, France.,Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Nicholas D Moore
- INSERM U 1219 - Pharmaco-épidémiologie et évaluation de l'impact des produits de santé sur les populations, University de Bordeaux, Bordeaux, France
| | - Pascale R Salameh
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
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Al-Maliky GR, Al-Ward MM, Taqi A, Balkhair A, Al-Zakwani I. Evaluation of antibiotic prescribing for adult inpatients at Sultan Qaboos University Hospital, Sultanate of Oman. Eur J Hosp Pharm 2017; 25:195-199. [PMID: 31157018 DOI: 10.1136/ejhpharm-2016-001146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 11/04/2022] Open
Abstract
Objective Little is known into the prudent use of antibiotics in hospitals in Oman. This study is to evaluate antibiotic prescribing by measuring the overall compliance with the local antibiotic prescribing guidelines. Methods An observational study involving 366 patients' admission episodes as determined by power analysis on patients (≥18 years) on oral and/or parenteral antibiotic during admission, in the period of 10 weeks (1 February-15 April, 2014). The adapted audit tool of the Barking, Havering and Redbridge University Hospitals NHS Trust was used for this study. Analyses were performed using descriptive statistics. Main outcome measures: antibiotic prescribing compliance with the local guidelines as well as the overall restricted antibiotic policy adherence at Sultan Qaboos University Hospital (SQUH). Results The number of prescribed and audited antibiotics totalled 825, compliance with local guidelines was suboptimal at 63% (n=520), and of 211 restricted antibiotics prescribed, the overall adherence to restricted antibiotic policy was inadequate at 46% (n=98). The majority of the antibiotics prescribed were broad spectrum at 90% (n=739), mainly penicillins at 31% (n=256) and cephalosporins at 17% (n=139). Conclusion The study has provided valuable baseline details of antibiotic prescribing patterns in SQUH. The diagnosis was documented in 89% (n=327) of the admission episodes. However, the compliance with SQUH antibiotic prescribing guidelines was suboptimal, and the overall compliance with SQUH restricted antibiotic guidelines was in 46% of the prescriptions. Further studies are required to address the reasons behind the non-compliance with local guidelines.
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Affiliation(s)
| | | | - Aqila Taqi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Al Khoudh, Oman
| | - Abdullah Balkhair
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Al Khoud, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Al Khoudh, Oman.,Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Al Khoudh, Oman
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How should we respond to the emergence of plasmid-mediated colistin resistance in humans and animals? Int J Infect Dis 2017; 54:77-84. [DOI: 10.1016/j.ijid.2016.11.415] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/08/2016] [Accepted: 11/22/2016] [Indexed: 01/29/2023] Open
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Al-Harthi SE, Khan LM, Osman AMM, Alim MA, Saadah OI, Almohammadi AA, Khan FM, Kamel FO. Perceptions and knowledge regarding antimicrobial stewardship among clinicians in Jeddah, Saudi Arabia. Saudi Med J 2016; 36:813-20. [PMID: 26108585 PMCID: PMC4503900 DOI: 10.15537/smj.2015.7.11833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To understand the perceptions, attitude, and prescribing practices of clinicians regarding antimicrobial resistance (AMR). METHODS A multidisciplinary cross-sectional study comprising 447 clinicians of university, public, and private hospitals of Jeddah, Saudi Arabia was carried out from August to October 2014 using a self-administered questionnaire. RESULTS Interestingly, 33% of the general physicians yielded to patient/parent's demand for the choice of antimicrobials (AMs) as compared with only 13.2% of the residents, and 4.3% of the specialists. In addition, expensive AMs are more often prescribed by the general physician (70.4%) in comparison with 26.4% residents and 30.4% of the specialists. However, no significant differences were observed between the knowledge and perceptions regarding the current scope of AM agents, as well as their use and misuse. Furthermore, dependability of specialist and residents seems to be significantly higher than general physicians on pocketbooks and smartphone for AM education sources. CONCLUSION This study revealed that despite a clear concept of AMR, general physicians lacks consistency in prescribing aptitude and use of effective educational resources, while all respondents lacks dedication to follow the guidelines of AM use. This highlights the requirement of AM stewardship with decisive objective of reduction in AMR.
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Affiliation(s)
- Sameer E Al-Harthi
- Department of Pharmacology, College of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Editorial. Int J Infect Dis 2016; 50:83-4. [DOI: 10.1016/j.ijid.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 11/30/2022] Open
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Gebeyehu E, Bantie L, Azage M. Inappropriate Use of Antibiotics and Its Associated Factors among Urban and Rural Communities of Bahir Dar City Administration, Northwest Ethiopia. PLoS One 2015; 10:e0138179. [PMID: 26379031 PMCID: PMC4574735 DOI: 10.1371/journal.pone.0138179] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/26/2015] [Indexed: 11/24/2022] Open
Abstract
Background Inappropriate use of antibiotics in the community plays a role in the emergence and spread of bacteria resistant to antibiotics which threatens human health significantly. The present study was designed to determine inappropriate use of antibiotics and its associated factors among urban and rural communities of Bahir Dar city administration. Methods A comparative cross sectional study design was conducted in urban and rural kebeles of Bahir Dar city administration from February 1 to March 28, 2014. A total of 1082 participants included in the study using a systematic random sampling technique. Data was collected using pre-tested and structured questionnaire. Data was coded and entered into SPSSS version 16 for statistical analysis. Bivariate and multivariate logistic regression model were used to identify factors associated with inappropriate use of antibiotics. Results Inappropriate use of antibiotics was 30.9% without significant difference between urban (33.1%) and rural (29.2%) communities. From the inappropriate antibiotic use practice, self-medication was 18.0% and the remaining (12.9%) was for family member medication. Respiratory tract symptoms (74.6%), diarrhea (74.4%), and physical injury/wound (64.3%) were the three main reasons that the communities had used antibiotics inappropriately. Factors associated with inappropriate use of antibiotics were low educational status, younger age, unsatisfaction with the health care services, engagement with a job, and low knowledge on the use of antibiotic preparations of human to animals. Conclusions Inappropriate use of antibiotic exists in the study area with no significant difference between urban and rural communities. The study indicated an insight on what factors that intervention should be made to reduce inappropriate use of antibiotics in the community. Interventions that consider age groups, educational status, common health problems and their jobs together with improvement of health care services should be areas of focus to reduce inappropriate use of antibiotics.
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Affiliation(s)
- Endalew Gebeyehu
- Department of Pharmacology, College of Medicine and Health Sciences, Bahir Dar University, P.O Box 79, Bahir Dar, Ethiopia
- * E-mail:
| | - Laychiluh Bantie
- Department of Pharmacology, College of Medicine and Health Sciences, Bahir Dar University, P.O Box 79, Bahir Dar, Ethiopia
| | - Muluken Azage
- Department of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
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Al-Jassim N, Ansari MI, Harb M, Hong PY. Removal of bacterial contaminants and antibiotic resistance genes by conventional wastewater treatment processes in Saudi Arabia: Is the treated wastewater safe to reuse for agricultural irrigation? WATER RESEARCH 2015; 73:277-90. [PMID: 25687420 DOI: 10.1016/j.watres.2015.01.036] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/22/2015] [Accepted: 01/23/2015] [Indexed: 05/12/2023]
Abstract
This study aims to assess the removal efficiency of microbial contaminants in a local wastewater treatment plant over the duration of one year, and to assess the microbial risk associated with reusing treated wastewater in agricultural irrigation. The treatment process achieved 3.5 logs removal of heterotrophic bacteria and up to 3.5 logs removal of fecal coliforms. The final chlorinated effluent had 1.8 × 10(2) MPN/100 mL of fecal coliforms and fulfils the required quality for restricted irrigation. 16S rRNA gene-based high-throughput sequencing showed that several genera associated with opportunistic pathogens (e.g. Acinetobacter, Aeromonas, Arcobacter, Legionella, Mycobacterium, Neisseria, Pseudomonas and Streptococcus) were detected at relative abundance ranging from 0.014 to 21 % of the total microbial community in the influent. Among them, Pseudomonas spp. had the highest approximated cell number in the influent but decreased to less than 30 cells/100 mL in both types of effluent. A culture-based approach further revealed that Pseudomonas aeruginosa was mainly found in the influent and non-chlorinated effluent but was replaced by other Pseudomonas spp. in the chlorinated effluent. Aeromonas hydrophila could still be recovered in the chlorinated effluent. Quantitative microbial risk assessment (QMRA) determined that only chlorinated effluent should be permitted for use in agricultural irrigation as it achieved an acceptable annual microbial risk lower than 10(-4) arising from both P. aeruginosa and A. hydrophila. However, the proportion of bacterial isolates resistant to 6 types of antibiotics increased from 3.8% in the influent to 6.9% in the chlorinated effluent. Examples of these antibiotic-resistant isolates in the chlorinated effluent include Enterococcus and Enterobacter spp. Besides the presence of antibiotic-resistant bacterial isolates, tetracycline resistance genes tetO, tetQ, tetW, tetH, tetZ were also present at an average 2.5 × 10(2), 1.6 × 10(2), 4.4 × 10(2), 1.6 × 10(1) and 5.5 × 10(3) copies per mL of chlorinated effluent. Our study highlighted that potential risks associated with the reuse of treated wastewater arise not only from conventional fecal indicators or known pathogens, but also from antibiotic-resistant bacteria and genes.
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Affiliation(s)
- Nada Al-Jassim
- Water Desalination and Reuse Center, Environmental Science and Engineering, Division of Biological and Environmental Science and Engineering, King Abdullah University of Science and Technology (KAUST), 4700 King Abdullah Boulevard, Thuwal 23955-6900, Saudi Arabia
| | - Mohd Ikram Ansari
- Water Desalination and Reuse Center, Environmental Science and Engineering, Division of Biological and Environmental Science and Engineering, King Abdullah University of Science and Technology (KAUST), 4700 King Abdullah Boulevard, Thuwal 23955-6900, Saudi Arabia
| | - Moustapha Harb
- Water Desalination and Reuse Center, Environmental Science and Engineering, Division of Biological and Environmental Science and Engineering, King Abdullah University of Science and Technology (KAUST), 4700 King Abdullah Boulevard, Thuwal 23955-6900, Saudi Arabia
| | - Pei-Ying Hong
- Water Desalination and Reuse Center, Environmental Science and Engineering, Division of Biological and Environmental Science and Engineering, King Abdullah University of Science and Technology (KAUST), 4700 King Abdullah Boulevard, Thuwal 23955-6900, Saudi Arabia.
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Al-Tawfiq JA, Memish ZA. Potential risk for drug resistance globalization at the Hajj. Clin Microbiol Infect 2014; 21:109-14. [PMID: 25682276 DOI: 10.1016/j.cmi.2014.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 11/13/2014] [Accepted: 11/14/2014] [Indexed: 12/20/2022]
Abstract
Antibiotics were once considered the miracle cure for infectious diseases. The tragedy would be the loss of these miracles as we witness increased antibiotic resistance throughout the world. One of the concerns during mass gatherings is the transmission of antibiotic resistance. Hajj is one of the most common recurring mass gatherings, attracting millions of people from around the world. The transmission of drug-resistant organisms during the Hajj is not well described. In the current review, we summarize the available literature on the transmission and acquisition of antibiotic resistance during the Hajj and present possible solutions.
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Affiliation(s)
- J A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Z A Memish
- Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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Jomha MY, Yusef H, Holail H. Antimicrobial and biocide resistance of bacteria in a Lebanese tertiary care hospital. J Glob Antimicrob Resist 2014; 2:299-305. [PMID: 27873691 DOI: 10.1016/j.jgar.2014.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 08/14/2014] [Accepted: 09/09/2014] [Indexed: 11/28/2022] Open
Abstract
The environment in a Lebanese tertiary-level care hospital was examined for bacterial contamination. In total, 8 open-air and 62 surface samples were taken and CFU were enumerated. Morphologically different isolates (n=104) were obtained and tested for resistance to a wide range of antibiotics by the Kirby-Bauer disc diffusion method. Minimum bactericidal concentrations of isolates to seven different biocides used within this facility were also determined using both qualitative and quantitative methods. Gram-positive bacteria (82.7% of isolates) were encountered more often than Gram-negative bacteria (17.3%), and the genus Staphylococcus was most prevalent among isolates (59.6% of the isolates). Gram-positive isolates showed the highest resistance to penicillin (60.6%), clindamycin (54.5%) and ceftazidime (39.4%); the lowest frequencies of resistance were seen with vancomycin (0% of isolates), nitrofurantoin (3.5%), tetracycline (12.1%) and ciprofloxacin (12.1%). The prevalence of meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-resistant coagulase negative staphylococci among all environmental samples was 3.8% and 11.5% of isolates, respectively. All Gram-negative isolates were multidrug-resistant (MDR). With respect to biocides, the highest frequency of resistance was to quaternary ammonium compounds (QACs) (13.5% of isolates) and the lowest frequency of resistance was to QAC/biguanide complex (<1% of isolates) and Anios DVA (3.8%). MDR bacteria can pose a serious threat in the hospital environment, showing the need for prudent use of antibiotics and correct infection control procedures.
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Affiliation(s)
- Mariam Yousif Jomha
- Department of Biological and Environmental Sciences, Faculty of Science, Beirut Arab University, Beirut, Lebanon.
| | - Hoda Yusef
- Department of Biological and Environmental Sciences, Faculty of Science, Beirut Arab University, Beirut, Lebanon
| | - Hanafy Holail
- Department of Biological and Environmental Sciences, Faculty of Science, Beirut Arab University, Beirut, Lebanon
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β-Lactamase production in key gram-negative pathogen isolates from the Arabian Peninsula. Clin Microbiol Rev 2014; 26:361-80. [PMID: 23824364 DOI: 10.1128/cmr.00096-12] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
SUMMARY Infections due to Gram-negative bacilli (GNB) are a leading cause of morbidity and mortality worldwide. The extent of antibiotic resistance in GNB in countries of the Gulf Cooperation Council (GCC), namely, Saudi Arabia, United Arab Emirates, Kuwait, Qatar, Oman, and Bahrain, has not been previously reviewed. These countries share a high prevalence of extended-spectrum-β-lactamase (ESBL)- and carbapenemase-producing GNB, most of which are associated with nosocomial infections. Well-known and widespread β-lactamases genes (such as those for CTX-M-15, OXA-48, and NDM-1) have found their way into isolates from the GCC states. However, less common and unique enzymes have also been identified. These include PER-7, GES-11, and PME-1. Several potential risk factors unique to the GCC states may have contributed to the emergence and spread of β-lactamases, including the unnecessary use of antibiotics and the large population of migrant workers, particularly from the Indian subcontinent. It is clear that active surveillance of antimicrobial resistance in the GCC states is urgently needed to address regional interventions that can contain the antimicrobial resistance issue.
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Amer MR, Akhras NS, Mahmood WA, Al-Jazairi AS. Antimicrobial stewardship program implementation in a medical intensive care unit at a tertiary care hospital in Saudi Arabia. Ann Saudi Med 2013; 33:547-54. [PMID: 24413857 PMCID: PMC6074906 DOI: 10.5144/0256-4947.2013.547] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Antimicrobial stewardship programs (ASPs) have shown to prevent the emergence of antimicrobial resistance associated with an inappropriate antimicrobial use. The primary objective of this study was to compare the prescribing appropriateness rate of the empirical antibiotic therapy before and after the ASP implementation in a tertiary care hospital. Secondary objectives include the rate of Clostridium difficile-associated diarrhea (CDAD), physicians' acceptance rate, patient's intensive care unit (ICU) course, total utilization using defined daily dose, and total direct cost of antibiotics. DESIGN AND SETTINGS This is a comparative, historically controlled study. Adult medical ICU patients were enrolled in a prospective fashion under the active ASP arm and compared with historical patients who were admitted to the same unit before the ASP implementation. This study was approved by the institutional review board, and the need for informed consent was waived because the interventions and recommendations were evidence based and considered the standard of care. The study was conducted at KFSHRC, Riyadh. METHODS Adult medical ICU patients were enrolled under the active ASP arm if they were on any of the 5 targeted antibiotics (piperacillin/tazobactam, imipenem/cilastatin, meropenem, vancomycin, tigecycline), and had no official infectious disease consultation. The interventions were conducted via prospective audit and feedback. RESULTS A total of 73 subjects were recruited, 49 in historical control and 24 in the active arm. The appropriateness of empirical antibiotics was improved from 30.6% (15/49) in the historical control arm to 100% (24/24) in the proactive ASP arm (P value < .05). For the ASP group, initially 79.1% (19/24) of the antibiotic uses were inappropriate and diminished by ASPs to 0% on the recommendations implementation. A total of 27 interventions were made with an acceptance rate of 96.3%. The rate of CDAD did not differ between the groups. A reduction in antibiotics utilization and direct cost were also noticed in the ASP arm. CONCLUSION A proactive ASP is a vital approach in optimizing the appropriate empirical antibiotics utilization in an ICU setting in tertiary care hospitals. This study highlights the importance of such a program and may serve as a foundation for further ASP initiatives particularly in our region.
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Affiliation(s)
| | | | | | - Abdulrazaq S Al-Jazairi
- Dr. Abdulrazaq S. Al-Jazairi, Head, Medical/Critical Pharmacy Department,, Division of Pharmacy Services,, King Faisal Specialist Hospital and Research Centre,, PO Box 3354, MBC-11, Riyadh 11211,, Saudi Arabia, T: +966-11-4427603, F: +966-11-4427608,
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Abstract
BACKGROUND AND OBJECTIVE Hospitals should measure antimicrobial use based on the WHO's recommended metric, the defined daily dose (DDD). There is no data on antimicrobial usage based on DDD in Saudi Arabia. Thus, this study evaluates the trend in antimicrobial consumption based on this concept. DESIGN AND SETTING Observational study in a general hospital in Saudi Arabia from 2006-2008. METHODS We analyzed the use of intravenous systemic antibacterial agents (group J01 of the Anatomical Therapeutic Chemical [ATC] classification and the classes of this group) that were administered to hospitalized patients by reviewing the data obtained from the pharmacy records. Antimicrobial consumption was calculated as the number of DDD per 100 bed-days. RESULTS Of the total parenteral antibiotics, ciprofloxacin was the most commonly used intravenous antibiotic (67.6%), followed by ceftriaxone (6%), cefazolin (5%), and imipenem-enzyme inhibitor (4.3%). The DDD per 100 patient-days usage of intravenous antimicrobial agents was as follows: J01MA02 ciprofloxacin (parenteral) 82.643, J01DD04 ceftriaxone 7.447, J01DB02 cefazolin 6.166, J01DH51 imipenem-enzyme inhibitor 5.234, J01MA12 levofloxacin 3.188, and J01XA01 vancomycin 2.97. Intravenous ciprofloxacin usage increased from 3.55 to 82.643 DDD/100 patient days. CONCLUSION The study showed that the most commonly used intravenous systemic antimicrobial agent was ciprofloxacin. Thus, strategies are needed to specifically target these agents for prescribing improvement.
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