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.
Objective: nowadays resistant bacteria represent worldwide a public health problem leading in some cases to a stalemate without any possible treatment. Therefore early detection and identification of carbapenemase producing gram-negative bacteria (GNB) is of crucial importance. Consequently we conducted a study in a tertiary care hospital to analyze the resistance phenotype of the carbapenem resistant GNB (CRGNB). Methods: we collected all the CRGNB from September 2014 till January 2016, we took randomly 40/126 strains and performed a sensitivity test in addition to a real time multiplex PCR to detect the exact carbapenemase coding genes (bla SPC , bla IMP1, bla VIM , bla NDM , bla KPC , et bla OXA-48). The studied strains were: Escherichia coli (70%), Klebsiella pneumonia (20%), Enterobacter aerogenes (2,5%), Enterobacter cloacae (2.5%) et Klebsiella oxytoca (2.5%). Results: 100% of the studied strains were intermediate or resistant to ertapenem, 85% intermediate or resistant to imipenem and/or meropenem. 33 / 40 strains (82.5%) are bla OXA-48 positive et one strain (2.5%) is bla NDM positive. the OXA-48 were urinary strains of E coli. 6 / 40 strains (15%) did not express carbapenemase genes in molecular studies. Conclusion: we note a marked emergence of CPGNB especially bla OXA-48 with high resistance pattern leading to narrow therapeutic options. This requires a rapid detection of such strains of GNB so that to initiate quickly the right preventive and therapeutic measures to avoid hospital epidemics with disastrous consequences.
The aim of this project was to study the physico-chemical and antimicrobial properties of Jordanian honey and propolis in order to determine their potential as pharmaceutical preservation systems. This study undertook a physico-chemical analysis of several Jordanian honeys and one propolis type, in order to evaluate several physico-chemical properties including, pH and free acidity, moisture content, ash content and HydroxyMethylFurfural content in three honey samples, and total flavonoid content in the propolis sample. The antimicrobial activity of honey and propolis samples was then evaluated by determining the minimum inhibitory concentration (MIC) against Staphylococcus aureus ATCC 6538, Escherichia coli ATCC 8739, Pseudomonas aeruginosa ATCC 9027 and Candida albicans ATCC 10231. Subsequently, Honey 1 (H1) was selected for further study and combined with propolis to test their potential synergistic activity. Finally, a preservative effectiveness test was conducted in order to assess the possibility of using honey and propolis as natural preservatives in aqueous dosage forms, such as syrups. The results of this study showed that all the tested honey samples and propolis possessed significant antimicrobial activity against the standard test microorganisms, and that honey with propolis exhibited synergistic activity that enhanced their antimicrobial activity and resulted in up to 90% reduction in their MIC values. This study also confirmed that honey and propolis could be used as a natural preservative system for pharmaceutical formulae. Our results reveal the possibility of using honey-propolis mixtures as natural preservatives in oral aqueous pharmaceutical dosage forms and other local application products.
This article aims to provide a model by using cumulative cases for SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) outbreak in most major countries with focusing on the Jordanian experience and response in combating COVID-19. On March 2nd, 2020, Jordan reported the first confirmed cases of COVID‐19. Although, Jordan was among the first countries to implement highly strict preventive and control measures, the outbreak started around 1st October, 2020 (7 months later), after that there was a significant increase in the number of confirmed cases. However, there are always opportunities to learn from the global experience to improve the current national strategy.
Antimicrobial resistance is a serious threatening problem associated with high morbidity and mortality. The majority of pathogenic bacteria show multiple drug resistance patterns. Thus, treatment of infections caused by those bacteria become ineffective. This paper evaluates, investigates, and discusses the existing situation of antimicrobial resistance in Gaza Strip, Palestine. The data of this review considered the published articles over the period 2002-2021. Search was conducted using Google scholar, Researchgate, and PubMed search engines. Thirty five articles were included. This review discussed studies done on antibiotic resistant bacteria found in a wide range of environments including clinical samples, foods, poultry, costal water, hospital wastewater, and hospital environments. The reported dissemination and spread of antibiotic resistant bacteria is influenced by several factors like inappropriate and unwise use of antibiotics as well as the un-regulated access of these antibiotics to the environment. Palestine is in urgent need to develop, strengthen, and implement antimicrobial stewardship policy, standard treatment guidelines, a local plan for containment and reduction of antimicrobial resistance, and research related to public health aspects of antimicrobial resistance at the community and hospital level. Keywords; Antimicrobial resistance, Gaza strip, Palestine
Background: Kingella kingae and Neisseria meningitides are gram-negative bacteria, causing several life-threatening diseases and considered as opportunistic pathogens in the upper respiratory tract of healthy carriers. The detection of these both bacteria species is difficult in routine culture methods. Objective: This study aimed to find the occurrence rate of K. kingae and N. meningitides colonizing upper respiratory tract of young Jordanian children, and to determine the antimicrobial susceptibility profile of the isolates. Methods: A total of 300 samples of throat and nasal swabs were collected from out- patients Jordanian children aged between 6 months and 5 years, who were admitted to Pediatrics' clinics department at the Jordan University Hospital and Al-Bashir Hospital over the period October 2018 through January 2019. Samples were cultured for detection K. kingae and Neisseria species including specially N. meningitides. Their suspected growth was identified and tested using microbiology culture methods and polymerase chain reaction (PCR) method. Additionally, DNA was extracted directly from one 100 samples and was investigated only for K. kingae using real- time PCR assay. Results: This study showed the absence of K. kingae in all cultured samples, while Neisseriaspecies was detected in 21 (7 %)including one N. meningitides isolate(0.3%). The results of antibiotic susceptibility testing indicated presence of few percentage of Neisseria species isolates resistant 100 % to clindamycin, oxacillin and vancomycin, whereas all were susceptible for chloramphenicol (100%)levofloxacin and gentamycin , and less to ampicillin(90.6%) and erytromycin ( 85.7%), respectively. Conclusion: This study shows the absence of K. kingae and the rare occurrence of N. meningitides colonizing the upper respiratory tract of young Jordanian children over the 4-month period of study.
Ceftazidime-avibactam (CZA) has been introduced as a novel drug to essentially combat the rising trends of carbapenem resistant Enterobacteriaceae. In the absence of in vitro data about the activity of this drug against carbapenem resistant (CR) Escherichia coli and Klebsiella pneumoniae in Lebanon, this study was warranted.
Urinary tract infection is a public health problem worldwide. E. coli and klebsiella are among the main etiologic for UTI in Gaza Strip. The growing variations in resistance among uropathogens to antimicrobials is multifactorial and varies globally. It greatly reduces/limits or complicate treatment option. Aims: To determine the pattern of antimicrobial resistance and multidrug resistance among uropathogens at governmental hospitals. Methods: We analyzed the data of 11,890 urine samples processed in governmental hospitals in the Gaza Strip, Palestine during 2019. The percentage of resistance was calculated for uropathogens, and then multidrug resistance was calculated according to “CDC” definition. Results: Of 11,890 urine samples, 2910 (24.5%) showed significant growth. Escherichia coli was isolated most frequently (1743; 59.9%), followed by Klebsiella spp. (725; 24.9%), Pseudomonas spp. (123; 4.2%), Streptococcus spp. (98; 3.4%), Staphylococcus aureus (41; 1.4%). Microorganisms resistance was high against Ampicillin (92.4%) and Amoxicillin (91.1%), Co-Trimoxazole (68.2%), Cefalexin (64.9%), Doxycycline (61.9%), Nalidixic acid (53.6%), Cefuroxime (53.0%), Ceftriaxone (48.9%), Ceftazidime (43.1%), Ciprofloxacin (36.9%), Gentamicin (25.8%), Amikacin (3.2%). The resistance of microorganisms in males is higher than females. Multidrug resistance was detected in 37% of E. coli and 53% in Klebsiella spp. Conclusion: Resistance is high and variable among uropathogens isolated from patients in Gaza strip. Both age and gender are risk factors in both infection and resistance pattern. The multidrug resistance percentage is growing remarkably in Gaza Strip. Keywords: Uropathogens, Resistance, Urinary tract infection, Multidrug resistance, Gaza strip, Palestine
Background: The study aims to evaluate the antibacterial activity of Trigona honey against S. pneumonia. Methods: The effect of Trigona honey on S. pneumonia investigated using agar well diffusion, MIC, MBC, biofilm formation and RT-qPCR. Results: Trigona honey samples showed the larger zones of inhibition against S. pneumonia, 22.2±0.4 at 100% concentration. Trigona honey possessed the lowest MIC, MBC, MIC50 and MIC90 against S. pneumoniae, 25%, 30%, 12.5% and 25% (w/v) respectively. Trigona honey permeated established biofilms of S. pneumonia, resulting in significant decreased the cells from the biofilm. RT-qPCR revealed that the expression of genes amiF, ftsY, mvaS, pnpA, argG, mvd1, purN, miaA and pbp2a were upregulated, glcK, marR, prmA and ccpA were downregulated after exposure to honey. Conclusion: Trigona honey demonstrated the highest antibacterial activity against S. pneumoniae. By limiting study in vitro on Trigona honey, we infer that Trigona honey impacts on S. pneumoniae.
Background: The purpose of this study was to investigate antibacterial activity of three varieties of Malaysian honey; Tualang honey (TH), Gelam honey (GH), and Acacia honey (AH) against Escherichia coli. Methods: The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the honey samples against E. coli were determined by the broth microdilution assay in the presence and absence of catalase enzyme. The mode of inhibition of honey samples against E. coli was investigated by the effect of time on viability. Impacts of the honeys on the expression profiles of the selected genes of E. coli were examined using RT-qPCR analysis. Results: The results showed that TH and GH honey possessed lowest MIC and MBC values against E. coli with 20% and 25% (w/v) respectively. Highest MIC and MBC values were observed by AH honey against E. coli with 25% (w/v) and 50% (w/v) values respectively. Among the tested honeys, TH and GH exhibited the highest total antibacterial activity and the highest levels of peroxide-dependent activity. Time–kill curve demonstrated a bactericidal rather than a bacteriostatic effect; with a 2-log reduction estimated within 540 min. Viable cells were not recovered after 9 hours exposure to MIC of all honey-treated. The RT-qPCR analysis showed that all honey-treated cells share a similar overall pattern of gene expression, with a trend toward reduced expression of the virulence genes of interest. Conclusion: This study demonstrates that Malaysian honey have the potential to be effective inhibitor and virulence modulator of E. coli via multiple molecular targets.
The coronavirus disease 2019 (COVID-19) have devastated the globe and continues to be a protracted saga. In the absence of specific efficacious medical remedies, efforts to encounter and contain this emerging virus concentrated on vaccine production. A plethora of novel vaccines has been under development by major companies in different countries. To date, around 60 vaccines are in clinical trials with many other ones continuously added to the evolving pipeline. The variety in their corresponding designed platform and phases, warrants to tackle and understand what is being presented in the literature and launched in the market. Thus, this study is intended to enlighten and educate the medical community by reviewing the different vaccine platforms, and briefly explaining their mechanism of action with an emphasis on those that reached most advanced stages.
Background To study resistance rates of multidrug-resistant bacteria (MDR) for new Cephalosporines before their widespread use in Jordan. Methods During September 2019 - May 2020, MDR-bacteria were prospectively collected from microbiology laboratories of three hospitals, susceptibility of the extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL), K. pneumoniae-carbapenemases strains (KPC), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant P. aeruginosa (CRPa), carbapenem-resistant A. baumannii (CRAb), and Methicillin-resistant Staphylococcus aureus (MRSA) were tested. Demographic details for patients were identified. Antimicrobials evaluated were ceftazidime-avibactam, ceftolozane-tazobactam, and ceftobiprole medocaril. Results Non-duplicate 263 MDR clinical isolates were collected from sterile sites; ESBL (128), P. aeruginosa (57), MRSA (37), KPC (22), A. baumannii (11), and CRE (n = 8). The age was dominated by the older age group (Age > 64, Pearson R = 0.985, R2 = 0.969, P = 0.000). Males were 143 and females 107 (P < 0.000). There were (194) isolate from the wards and (55) were from the ICUs. Sources were urine (96), blood (36), soft tissues (49), abdomen (24), URT (14), and osteo-skeletal (12). Clinical diagnoses were: UTI (90). Bacteremia (36), SSTI (45), IAI (23), pneumonia (17), URTI (13), osteomyelitis (11), and diabetic foot (6). The susceptibility of the ESBL-producing bacteria was 100% for meropenem, 99% for ceftazidime-avibactam, and 90% for ceftolozane/tazobactam. P. aeruginosa was, 73% for ceftazidime-avibactam, 62% susceptible to ceftolozane/tazobactam, 62% for meropenem, and 45% to ceftobiprole. CRE was 38% susceptible to ceftazidime-avibactam and KPC 15%, while ceftolozane-tazobactam susceptibility was zero, and 14% for CRE, and 0% for Ceftobiprole Medocaril. A. baumannii was 13% susceptible to ceftazidime-avibactam, meropenem 9%, and 2% for ceftolozane/tazobactam Conclusion Ceftazidime-avibactam and ceftolozane/tazobactam may be useful alternatives for the treatment of ESBL-producers and P. aeruginosa, though the MDR-bacteria demonstrated some resistance to the newly introduced agents before their widespread use in the country.
In the United States, the total number of confirmed reported cases of Covid-19 had reached 1.36 million with a total death of 80,574 and a total confirmed recoveries of 210,000 cases. Significant efforts have been invested to flatten the curve and control new cases appearing in the societies. Meanwhile, the governments has imposed a lockdown with the objective of controlling the transmission of the virus. The re-opening of societies is challenging and might involve threats, many of them remain unseen. We describe here a dynamic scenario to un-locking and re-opening societies using an evidence-based design, suggested by an algorithm of screening using RT-PCR and antibodies in a large population.
Antimicrobial resistance is a global public health challenge, which has accelerated by the overuse of antibiotics worldwide. Increased antimicrobial resistance is the cause of severe infections, complications, longer hospital stays and increased mortality. Steps must be taken to reverse the damage that has already been done and prevent further resistance from developing. This work will examine the context and societal situations that led to this acceptance of antibiotic overuse and misuse seen in both health care professionals and the public, the biochemical and genetic pathways that allow a microbe to develop drug resistance, the consequences that could follow if this trend of antibiotic overuse is allowed to continue and the various methods and solutions that have been suggested to prevent and reverse this problem.
Objective The purpose of this cross-sectional study conducted in different private and public sector hospitals of the major cities of Nepal and Pakistan was to compare and evaluate the antibiotic prescribing patterns. Methodology The data was collected based on prescriptions received from different hospitals of Lahore, Pakistan and Kathmandu, Nepal without much interaction with the patients. Results Out of a total of 272 patients, 111 (40.8%) patients from Nepal and 161 (59.19%) patients from Pakistan were prescribed with 447 antibiotics. In both countries, out of total antibiotics prescribed, 42.30% were 3rd generation cephalosporins. Also, in Pakistan and Nepal, out of all the indications, 49.2% of the antibiotics were given in medical prophylaxis. Conclusion In Pakistan, the antimicrobial prescription rate is comparatively higher than Nepal, and in both countries, there is a need of proper implementation of antibiotic prescribing guidelines for the prescription of antibiotics and the administration of antibiotics in medical prophylaxis.
