Background: The increased resistance of microorganisms to widely prescribed antibiotics in current medical practice has become a major challenge. Healthcare-associated infections (HAIs) are complications of healthcare and linked with high morbidity and mortality. This study aims to investigate the susceptibility pattern of bacteria isolated from different bacterial infections to commonly used antimicrobials from Al-Aqsa hospital in Gaza Strip, Palestine. Methods: A total of 8062 various clinical specimens were collected from August 2018 to February 2020 and sent to Al-Aqsa medical microbiology laboratory for bacteriological culture. Specimens were processed based on the recommended microbiology procedures. The modified Kirby-Bauer disc diffusion method was used for antimicrobial susceptibility testing on Muller Hinton agar (MHA) as per the Clinical Laboratory Standards Institute (CLSI) guideline. Results: Enterobacteriaceae were the most frequent of all isolated pathogens (58.3%), followed by Staphylococcus spp (24.6%), Pseudomonas and Non-fermenters (6.9%), Streptococcus and Enterococcus (6.2%), and others (4.0). E. coli was the most frequent of all isolated pathogens (38.2%), followed by Coagulase Negative Staphylococci (14.9%), Klebsiella spp (14.2%), and Staphylococcus aureus (9.4%). The resistance of Gram-negative isolates for Piperacillin, Cephalexin, Cefuroxime, Cefotaxim, Ceftazidim, Ceftriaxone, Cefazolin, Co Trimoxazole, Nalidixic acid, Aztreonam, Amoxicillin/clavulanic acid, Meropenem and Techoplanin was between 62% and 92%. On the other hand, Gram-positive isolates (Staphylococcus spp) were found susceptible to Cloxacillin (65.0%), Erythromycin (47.3%), Clindamycin (81.7%), Levofloxacin (100.0%), Rifampicin (95.2%) and Vancomycin (89.2%). Conclusion: High rates of resistance were found among bacterial pathogens isolated from Al-Aqsa hospital. Regular antimicrobial resistance surveillance should be a continuous process to provide up-to-date information to physicians with local antimicrobial resistance data. Keywords: Antimicrobial resistance, Healthcare-associated infections, Gaza, Palestine.
Introduction: A considerable proportion of patients hospitalized with coronavirus disease 2019 (COVID-19) acquired bacterial infections. The aim of this study was to investigate the etiology and antimicrobial resistance of bacterial co-infection for more informed antimicrobial treatment. Methods: This retrospective study reviewed electronic medical records of all the patients hospitalized with COVID-19 in the Northern Lebanon, Nini Hospital between august 2020-september 2021. According to the inclusion and exclusion criteria, patients who acquired bacterial infection were enrolled. Demographic, etiology and antimicrobial resistance data of the co-infection were collected. Results: The rate of infection by Gram-negative bacteria was 61.7%, while the rate of infection by Gram-positive bacteria was 23.4%. Escherichia coli was the dominant species isolated in this study (25.5%), followed by Candida spp (14.9%). With regard to fungal infection, there were 14.9% cases of yeast infection. The respiratory infection was the majority (42.5%), followed by blood infection (32%) and urine infection (25.5%). The analysis of antibiotics sensitivity results showed us that 44.4% of isolated Enterobacteriaceae were resistant to carbapenem, 16.66% were secretors of ESBL. We noted that 27.77% of Enterobacteriaceae were XDR. All isolates of Staphylococcus aureus were resistant to the methicillin. Conclusion: Bacterial co-infection may occur in patients hospitalized with COVID-19 and lead to high mortality. Gram-negative bacteria, especially Escherichia coli, S. maltophilia, and P. aeruginosa were the main bacteria, and the resistance rates of the major isolated bacteria were generally high. Keywords: COVID-19, co-infection, antibioresistance, Lebanon.
Objective: Emergence of COVID-19 infection and its persistence globally for three years in a row (2020-2022) entailed several modifications in healthcare services, among which drug prescribing was an important outcome. This review aims to highlight changing trends in azithromycin prescribing during pandemic years. Methods: PubMed database was systematically searched for combinations of the following keywords: Antibiotics; Antimicrobial resistance; Azithromycin; COVID-19. Results: A total of 12 articles were included in this review. All included studies demonstrated a notable increase in azithromycin consumption during COVID-19 pandemic in Spain, Brazil, USA, India, Croatia, and Jordan. Healthcare systems worldwide should be prepared to address anticipated outcomes of increased azithromycin use particularly possible changing trends in azithromycin resistance, and systemic side effects of the drug.
Background Vitamin D3 (1,25(OH)2 cholecalciferol) as a treatment for COVID 19 patients is being disputed, and a clear clinical benefit is not being confirmed. Methods A retrospective evaluation for COVID-19 patients who were treated with various cumulative doses of vitamin D. Data was extracted from the COVID-19 database, it included patients admitted to three hospitals in Amman, Jordan. Characteristics of patients were tabulated and compared for all-cohort, and propensity score index (PSI) adjustment, The comparison was based on two vitamin D strata ((≤ 149,000 i.u. and > 150,000 i.u.). Logistic regression analysis was utilized to predict recovery, the need for oxygen, and all-cause mortality for all-cohort, IPSW, and IPTW patients, based on vitamin D cumulative doses during their hospital stay. Results 1131 all-cohort and 768 PSI-adjusted patients were recruited. Except for antibiotics and antivirals, all other characteristics were balanced (P = NS). There were 1017 patients on vitamin D, 847 received cumulative ≤ 149,000 i.u., and 170 patients received cumulative dose ≥ 150,000 i.u. (Range 1000 – 385000). It was demonstrated that escalating cumulative doses of vitamin D did not contribute to the assessed outcomes; all-cohort patients (OR = 1.000, 95% C.I. 1.000 to 1.000), IPSW (OR = 1.000, 95% C.I. 1.000 to 1.000), and the IPTW (OR = 1.000, 95% C.I. 1.000 to 1.000). Conclusion In our patients’ cohorts, we could not demonstrate a beneficial effect for vitamin D therapy in COVID-19 patients for recovery, the need for home oxygen, and all-cause mortality, by hospital discharge.
Background: Citrobacter freundii is an infrequent hospital acquired pathogen to cause different types of disease in clinical settings. This pathogen is associated with wide range of infections causing unpredictably high mortality rate of 30-60%. Separation of this pathogen in health care settings is escalating and multidrug resistant strains are emerging. Therefore, this study aimed to detect antimicrobial resistance pattern and virulence genes among the isolated C. freundii. Methods: A total 500 samples (urine, stool, wound swab & pus, blood endotracheal aspirates and sputum) from patients with clinically suspected infections irrespective of age and sex were used in this study. Disc diffusion method was used to detect susceptibility pattern of antibiotics; colistin, tigecycline and fosfomycin susceptibility pattern was identified by minimum inhibitory concentration (MIC) method. Polymerase chain reaction (PCR) was done to detect potential virulence genes. Results: Among 27 isolated C. freundii, majority were resistant to amoxiclav (92.59%), trimethoprim-sulfomethoxazole (88.89%), cefotaxime and ceftazidime (85.19%) followed by ceftriaxone (81.48%), cefepime and ciprofloxacin (77.78%). MIC showed least resistance to colistin (29.63%), fosfomycin (11.11%) and tigecycline (7.41%). PCR was positive for via B gene (48.15%) and lt-A gene (25.93%). hly A, lt, lt-h genes showed negative results. Conclusion: Antibiotic resistance found in this study is quite worrisome as widespread resistance is seen among the bacteria isolated from human infection. Also, virulence genes play important role in C. freundii infection.
