Anthrax is an endemic and undercharacterized zoonotic disease in the Middle East, including Jordan. Between 2018 and 2020, we conducted a comprehensive investigation of 13 confirmed anthrax outbreaks in Jordan, analyzing 822 samples from animal farm environments, including carcasses, asymptomatic livestock, and abiotic environmental surfaces. All samples were tested by qPCR targeting the chromosomal marker (ba177) and the plasmid marker pXO1 (pag). Among carcass samples, 75/195 (38.5%) were ba177-positive, of which 81% harbored the pXO1. Of specimens from live-animals and from environmental surfaces, 218/627 (35%) were positive by qPCR, likely reflecting environmental contamination during active outbreak periods. Serological analysis using anti-protective antigen (PA) ELISA revealed a high seroprevalence of 53% (75/141) among asymptomatic animals, indicating widespread sub-clinical exposure to B. anthracis antigens and previously undocumented endemicity. An integrated approach combining qPCR with ELISA demonstrated that 11% of seropositive animals with paired swab testing also yielded swab samples that were positive by qPCR, suggesting environment-to-host transition. Molecular strain typing using canonical SNP (canSNP) analysis identified the rare sublineage C.USA.A1055 within lineage C.Br.A1005 across two distinct outbreaks, suggesting the environmental persistence of this endemic lineage. Overall, our findings provide the first systematic molecular and serological surveillance baseline data for Jordan, demonstrating a complex genomic persistence and subclinical exposure landscape. This study suggests the need for enhanced surveillance strategies under the One Health framework to mitigate the risk of anthrax endemicity.

Background Anthrax remains a significant public and veterinary health concern in Jordan and the broader Middle East. Methods Between 2018 and 2021, we investigated 31 suspected outbreaks by collecting 1,094 samples from suspected anthrax-infected carcasses, the surrounding non-vaccinated asymptomatic livestock, and environmental surfaces. Of these, 956 samples were tested using qPCR for the chromosomal marker ba177 and the plasmid marker pag. Results A total of 349 samples (36%) were ba177-positive, and among these, 92% also carried pag, indicating the presence of fully virulent B. anthracis strains. In parallel, 141 blood serum samples from asymptomatic animals were tested using ELISA for antibodies against protective antigen (PA), with 53% testing seropositive. A subset of 93 animals tested by both qPCR and ELISA showed overlapping results, revealing a proportion of animals with both molecular and serologic evidence of exposure. These findings indicate that a significant number of apparently healthy animals had been exposed to B. anthracis, suggesting their possible role as carriers within affected herds. Further molecular typing using canSNP analysis identified two isolates belonging to the C.Br.A1005 lineage, a clade distinct from those previously reported in the region. This genetic insight points to the potential circulation of multiple B. anthracis lineages in Jordan and highlights the value of combining molecular and serological tools for anthrax surveillance and control. Conclusion By pinpointing the locations of Bacillus anthracis on farms, our findings will contribute to more effective control of anthrax and limit the spread of the pathogen both within agricultural settings and in surrounding natural environments. This information will ultimately enhance overall biosecurity measures.

INTRODUCTION:Escherichia coli and Klebsiella pneumoniae are common organisms associated with urinary tract infections. The COVID-19 pandemic has had a negative impact on antibiotics misuse globally. This study analyzed the antibiotic susceptibility for these two pathogens isolated from urine samples during the period of 18 months before and after the COVID-19 pandemic.METHODOLOGY:This retrospective study was conducted in Al-Karak government referral and teaching hospital in Jordan. The study included two groups; group A included urine samples from September 2018 to March 11, 2020, while group B from March 12, 2020 to August 2021. Samples were analyzed using the automated VITEK 2 system and the analysis of results was done using the WHONET version 5.6.RESULTS:A total of 642 E. coli and 113 K. pneumoniae were isolated and analyzed. The antibiogram showed a significant overall increase in antibiotic susceptibility of both bacteria during the pandemic period (group B). The sensitivity has significantly increased by 75% (15/20) and 50% (10/20) for all antibiotics used for E. coli and K. pneumoniae respectively. On the other hand, E. coli showed a significant increase in resistance to ceftriaxone (13.4%) and gentamicin (6.4%). A similar trend of an increase in resistance to gentamicin (17.4%) was also noticed among K. pneumoniae isolates.CONCLUSIONS:The antimicrobial susceptibility pattern for urine isolates showed an increased overall sensitivity and an increased resistance to ceftriaxone and gentamicin during the pandemic period. Our results highlight the need for revising and updating the antimicrobial stewardship programs post-COVID pandemic utilizing local data.

Introduction: Streptococcus pneumoniae infections are a major cause of mortality and morbidity worldwide. In Jordan, pneumococcal conjugate vaccines (PCVs) are not included in the national vaccination program. Due to the current availability of several PCVs, including PCV-10, PCV-13, and PCV-15, along with PCV-20, currently undergoing pediatric approvals globally, the decision to introduce PCVs and their selection should be based on valid local data on the common serotypes of Streptococcus pneumoniae. Methods: This cross-sectional study aimed to identify the frequency of serotypes of Streptococcus pneumoniae in children aged below 5 years hospitalized with invasive pneumococcal diseases (IPDs), including pneumonia, septicemia, and meningitis, during the study’s duration in representative areas of Jordan. Serotyping for culture-positive cases was based on the capsular reaction test, known as the Quellung reaction. qPCR was conducted on the blood samples of patients with lobar pneumonia identified via X-ray or on cerebrospinal fluid for those with a positive latex agglutination test for Streptococcus pneumoniae. Results: This study was based on the analysis of the serotypes of 1015 Streptococcus pneumoniae cases among children younger than the age of 5: 1006 cases with pneumonia, 6 cases with meningitis, and 3 cases with septicemia. Only 23 culture-positive cases were identified in comparison to 992 lobar pneumonia cases, which were PCR-positive but culture-negative, with a PCR positivity rate of 92%. Serotypes 6B, 6A, 14, and 19F were the most common serotypes identified in this study, with prevalence rates of 16.45%, 13.60%, 12.12%, and 8.18%, respectively. PCV-10, PCV-13, PCV-15, and PCV-20 coverage rates were 45.32%, 61.87%, 64.14%, and 68.47%, respectively. Discussion: To the best of our knowledge, this is the largest prospective study from the Middle East and one of the largest studies worldwide showing the serotypes of Streptococcus pneumoniae. It reveals the urgency for the introduction of a PCV vaccination in Jordan, utilizing recently developed vaccines with a broader serotype coverage.

BACKGROUND:The availability of COVID-19 vaccines worldwide necessitates measuring healthcare workers' (HCWs') willingness to recommend or receive these vaccines. Therefore, we conducted a local study in Jordan to assess HCWs' willingness to recommend or receive a third dose of a COVID-19 vaccine and the predictors of such a decision. A cross-sectional study investigated Jordanian HCWs' willingness regarding a third dose of a COVID-19 vaccine using a self-administered online questionnaire through WhatsApp, a mobile phone application. A total of 300 HCWs participated in the current study. Of these HCWs, 65.3% were physicians, 25.3% were nurses, and 9.3% were pharmacists. HCWs' overall willingness regarding a third vaccine dose was 68.4% (49.4% certainly and 19.0% probably), whereas the overall willingness of HCWs to recommend a third dose to their patients was 73.3% (49.0% certainly and 24.3% probably). Males had significantly higher willingness than females (82.1% vs. 60.1%, p < 0.05). Physicians reported more willingness than nurses and pharmacists. HCWs' willingness was not significantly affected by direct contact with a patient infected with COVID-19 or by a personal history of COVID-19 infection. Only 31% of HCWs were certainly willing to recommend the vaccine to their patients with chronic diseases, and only 28% of the participants were certainly willing to recommend it to people aged 65 or older. HCWs' willingness to receive a third dose of a COVID-19 vaccine is limited in Jordan. This has affected their certainty in recommending this vaccine to their patients or people older than 60. Decision-makers and health-promotion programs in Jordan should focus on addressing this public health problem.

One month after its detection in Jordan, B.1.1.529 is constituting about 60% of all confirmed COVID-19 infections causing a rise in the daily cases in the country. Herein, we report on 500 omicron-infected cases to get a better understanding of this variant and its behavior in different geographies.

BackgroundDiabetes mellitus (DM) is a common metabolic disorder that significantly affects public health. Diabetic foot ulcer (DFU) is one of the serious complications of diabetes. DFU has a wide spectrum of bacterial isolates comprising Gram-positive, Gram-negative, aerobic bacteria and anaerobes. In the last two decades there has been an increase in the multidrug-resistant isolates (MDR).Materials and methodsThis cross-sectional prospective observational study was conducted in southern Jordan among patients with DFU. The included variables are sociodemographic and clinical information. Isolates from swab culture of ulcers and antimicrobial susceptibility pattern are also recorded.ResultsA total of 64 diabetic patients with DFU were included in this study. Most patients included in the study were males with male-to-female ratio of (2.2:1). The mean age was 54 years (SD ± 10.7). The mean duration of DM was 16.4 years (SD ± 7.5) and the mean HbA1c was 9.9% (SD ± 2.1). Neuropathy and anemia were noted in 72% and 44% of patients, respectively. The most frequent bacterial isolates were gram negative bacteria accounts for 29 isolates (45.3%). About 37.5% (24) of bacterial isolates showed MDR pattern. Previous antibiotic use in the last 30 days showed significant association with MDR bacteria (p-value <0.05). Previous history of amputations, presence of neuropathy, renal impairment, retinopathy, presence of anemia, limited joint mobility and presence of foot deformity were significantly associated with Wagner's grade ≥ three.ConclusionMany factors affect and increase the risk of having high grade diabetic foot ulcer. The most frequent bacterial isolates from diabetic foot ulcers were gram negative bacteria. High rates of MDR in this study reflect the loose implementation of regulations in Jordan regarding antibiotics dispensing.

Background: Population-based serosurveillance is a cornerstone to furthering our understanding of the COVID-19 pandemic at the community levels. In Jordan, four waves (phases) of seroprevalence epidemiological investigations were conducted using representative population-based national samples. This study aims to estimate the population-based seropositivity, herd immunity, and vaccination coverage at the fourth wave. Methods: Multistage sampling technique was implemented to recruit a nationally representative sample for the fourth wave of the seroprevalence investigation (June to August 2021). Electronically collected data utilized a questionnaire on background demographics, chronic diseases, and COVID-19 vaccination history. Also, blood samples were collected to detect the presence of total AntiSARS-CoV-2 IgM and IgG using Wantai/ELISA assays. Prevalence estimates were presented using percentage and 95% Confidence Results: There were 8821 participants included in this study, with a mean age of 31.3 years, and 61.7% were females. COVID-19 national seroprevalence and vaccination coverage estimates were 74.1% (95% C.I.: 73.1-74.9%) and 38.4% (95% C.I.: 37.1-39.6%), respectively. Among children, seroprevalence estimates were similar to unvaccinated adults. Among COVID-19 adults, 57.2% were vaccinated. Among vaccinated participants, 91.5% were seropositive, while among unvaccinated, 63.2% were seropositive. By age group, seroprevalence ranged between 53.0% and 86.9%. Seroprevalence estimates were significantly different by gender, vaccination status and dose, and residence. Conclusion: The reported interplay between seropositivity and vaccination coverage estimate seems insufficient to provide herd immunity levels to combat new variants of SARS-CoV-2. Children and healthcare workers seem to be an epidemiologically influential group in spreading COVID-19. As the globe is still grappling with SARS-CoV-2 infection, national seroepidemiological evidence immunity.

The COVID-19 pandemic made it clear to the world that better preparedness for future pandemics is paramount. This study aims to explore how the 2018 Jordan's Pandemic Influenza Preparedness (PIP) assessment plan (conducted utilizing a standardized tool of the CDC National Inventory of Core Capabilities for Pandemic Influenza Preparedness and Response) reflected on the initial COVID-19 response. A qualitative, single intrinsic case study design, utilizing interpretivist approach, was utilized to interview subject-matter experts and explore the potential reflection of PIP assessment on COVID-19 response. Utilizing a mini-Delphi approach, the interviews aimed at generating an in-depth understanding of how the Jordan's PIP risk assessment reflects on the country's response to COVID-19. The following 12 core capabilities, along with their reflections on COVID-19, were assessed: country planning, research and use of findings, communications, epidemiologic capability, laboratory capability, routine influenza surveillance, national respiratory disease surveillance, outbreak response, resources for containment, community-based interventions to prevent the spread of influenza, infection control (IC), and health sector pandemic response. Jordan's experience and preparedness for influenza may have served as a crucial guide to establishing success in COVID-19 control and mitigation. Surveillance, outbreak, and research activities were very well established in Jordan's PIP, whereas surge capacity in human capital and health facility were identified as two high-risk areas. However, the limitation in these two areas was met during the COVID-19 response. Still, human capital suffered fatigue, and there was an evident lack of laboratory testing plans when COVID-19 cases increased. Jordan's experience with PIP may have served as a guide for establishing successful COVID-19 control and mitigation. The established PIP principles, systems, and capacities seem to have reflected well on fighting against COVID-19 in terms of more efficient utilization of available surveillance, laboratory, outbreak management, and risk communications. This reflection facilitated a better mitigation and control of COVID-19.

Background and Objectives: Dentists are at higher risk of acquiring corona virus disease -19 (COVID-19). + The objective of the study is to assess the level of knowledge regarding COVID-19 among dentists and to evaluate the implementation of the infection prevention protocol. Materials and Methods: An online questionnaire was administered to 188 Jordanian dentists. The questionnaire was composed of three sections: demographic and professional data, knowledge of COVID-19 and the implemented infection prevention protocol. Results: The overall knowledge of COVID -19 common symptoms was high (<90%) among all participants. However, knowledge of specialists or who received infection prevention education regarding uncommon symptoms was significantly higher than others (p-value ≤ 0.05). About one-third of all participants correctly identified the scientific name of the causative virus (SARS-CoV-2) with no significant statistical difference. Most participants agreed that the infection prevention protocol is easy to read but the items are scarce. Female dentists were more likely to advise others to use the protocol (p-value = 0.01), and dentists with postgraduate education in infection prevention within the last three years answered that they will follow the protocol strictly (p-value = 0.03). Specialists and those who received postgraduate infection prevention education showed more knowledge regarding the specific measures for infection prevention. Conclusion: The overall knowledge of COVID-19 was high among dentists. Infection control protocol for dentists was easy to read and comprehensive but the items required to implement it such as personal protective equipment are scarce. This is expected considering the worldwide high demand on such items.

Introduction: The use of Electronic Cigarettes (ECs) has been increased over the last years but their long term effects on health and microbiota has not yet been explored fully. Aim: To examine the oral and nasal microbial profile and antibiotics susceptibility in the ECs users, smokers and non-smokers and to assess the microbial contamination of the ECs juice. Materials and Methods: Nasal and oral swabs were collected from 30 non-smokers, 30 tobacco smokers and 30 from candidates who have been using ECs for more than six months. Nasal Methicillin Susceptible Staphylococcus aureus (MSSA) and Methicillin Resistant Staphylococcus aureus (MRSA), and oral Streptococcus viridans and Candida albicans were isolated and identified using standard laboratory methods. ECs juice was also cultured to test for microbial presence and the antibiogram for all isolated bacteria was carried out by disc diffusion or broth dilution methods according to Clinical and Laboratory Standard Institute (CLSI) guidelines. The statistical analysis was performed with Stata Statistical Software: Release 13. Results: MSSA was isolated from 9 (30%) non-smokers, 5 (16.7%) ECs users and 2 (6.7%) smokers, respectively. Only 1 (3.3%) MRSA was isolated from a smoker. Streptococcus viridians was detected in 14 (46.7%) non-smokers, 9 (30%) ECs user and 5 (16.7%) smokers. Candida albicans was isolated from 7 (23.3%) smokers, 3 (10%) ECs users and in 1 (3.3%) non-smokers. When both groups of ECs users and smokers were compared to non-smokers; the statistical intergroups difference in carriage of MSSA and Streptococcus viridans using Chi-Square test was only significant in the smokers group (p-value <0.05), while the difference in carriage of MRSA and Candida albicans in both ECs users and smokers was not statistically significant compared to non-smokers (p-value <0.05). The cultures of ECs juices showed no growth. The highest resistance among MSSA isolates was for fusidic acid (43.8%) and the least was for mupirocin and linezolid (0%). Among Streptococcus viridans, the highest resistance was to penicillin (68%) and the least was for vancomycin (7.1%). Conclusion: The effect of ECs on carriage of MSSA and Streptococcus viridans commensals was not significant compared to non-smokers. Therefore, ECs might be less harmful on microbiota compared to tobacco smoking.

Background: Healthcare workers (HCWs) and medical students can be asymptomatic carriers in transmitting methicillin resistant and susceptible Staphylococcus aureus (MRSA and MSSA). Studying epidemiological and antibiotic susceptibility data is necessary to limit the spread of infections, help with treatment and understand the transmission dynamics of MSSA and MRSA. Our study assessed the rate of MSSA and MRSA nasal carriage and its antibiogram among medical students in basic and clinical years at the University of Jordan. Methods: A total of 210 nasal swabs were randomly collected from participants. MSSA and MRSA were identified by culture, biochemical and other phenotypical analysis methods. Antibiotic susceptibility was determined by the disc diffusion method. Results: The nasal carriage of MSSA was 6.6% and 11.4% and that of MRSA was 1.9% and 2.8% among basic and clinical years, respectively. There was no significant difference for the nasal carriage of MSSA and MRSA among basic and clinical year students (p value ≥ 0.05). MSSA resistance ranged between 25% and 33% for trimethoprim-sulfamethoxazole, tetracycline and ciprofloxacin. For MRSA, the highest resistance was to trimethoprim-sulfamethoxazole and tetracycline (67% to 100%), followed by gentamicin and ciprofloxacin (33% to 67%), in all participants in the study. Conclusion: The difference in the carriage rates of MSSA and MRSA among basic and clinical students was statistically insignificant. The continuous awareness and implementation of infection control procedures and guided patient contact are recommended. The results might also suggest that healthcare workers could be victims in the cycle of MRSA nasal carriage, a theory that needs further study.

Objective: To evaluate the frequency, antibiotic resistance, toxigenicity of Methicillin-resistant Staphylococcus aureus (MRSA) in food chain workers at our institution. Methodology: A total of 160 nasal swabs were collected from food chain workers in Al-karak district in the south Jordan. MRSA and its toxigenicity were detected using cultural and molecular methods. Antibiotic susceptibility was determined by the disc diffusion method. Results: The frequency of MRSA was 18.7% (n=30). There was a significant difference for nasal carriage of MRSA by recent hospitalization workers (p=0.008) or having a family member who was a healthcare worker (p=0.001). Isolates were highly resistant to fusidic acid (33%) followed by rifampicin (17%) and gentamicin (7%). All MRSA isolates were resistant to Cefoxitin. Among S. aureus enterotoxins, SEA was the most commonly reported enterotoxin gene from the isolates, followed by SEH, SED, SEC, SEE, and SEJ, respectively. Conclusion: Food handlers were a potential source for MRSA infection and food poisoning out breaks might be attributed to the carriage of the toxigenic MRSA strains. More hygienic restrictions and infection prevention plan must be applied in food industry to ensure the good food handling and storage.

The World Health Organization declared COVID-19 as a pandemic on the 11th of March 2020. Since then, many efforts are being carried out to contain the virus. Knowledge and attitude of people should be directed towards strict preventive practices in order to halt the spread of the virus. The aim of the current cross-sectional study is to assess the knowledge, practice and attitude of university students from medical and non-medical colleges in Jordan using a structured questionnaire involving a total number of 592 students. A positive response regarding the overall knowledge about the symptoms of COVID-19 was observed in more than 90% of the students. In response to the attitude and practice, a good number of students nearly 99.7% agreed that hand washing is necessary for prevention of infection whereas 68.4% believed that mask wearing would prevent the infection. Around 6-7% students considered the virus as a stigma hence would not visit hospital. Also, around 10% students believed that their religious beliefs and body immunity might protect them from infection. More dangerously, 20.6% and 19.2% students believed antibiotics and smoking to be a protective measure against the infection respectively. Also, 96.8% do avoid hand shaking, 98.8% wash their hands and 93.3% use alcoholic rub, 95.8% cough or sneeze in a tissue and dispose it in waste bin, 51% will drink ginger with honey and 42.7% eat garlic for infection prevention. The main sources of knowledge were social media, internet and television. No significant difference was noticed between medical and non medical colleges. Thus, there is a need for more detailed and directed measures and awareness campaigns to improve the knowledge, attitude and practice in some critical aspects to contain the virus.

Helicobacter pylori (H. pylori) can cause gastritis, peptic ulcer diseases and gastric carcinoma. Endoscopy as the gold standard method of diagnosis is an invasive procedure that might not be suitable in all scenarios. Therefore, this first study in Jordan aimed to assess the non-invasive 13C urea breath test (UBT) and stool antigen test for diagnosis of H. pylori infection and the successfulness of eradication therapy as alternatives for endoscopy. Hence, a total of 30 patients attending the endoscopy units at Alkarak teaching hospital were asked to complete a questionnaire with demographic and clinical data. They were then tested for H. pylori using 13C UBT and H. pylori stool antigen before having endoscopy. Another 30 patients who were positive for H. pylori by endoscopy were tested using both tests 6 weeks post eradication therapy. Results showed that the rate of H. pylori detection using endoscopy was 56.7% (17/30). Heartburns (82.3%, p value = 0.019), epigastric pain (88.2%, p value = 0.007) and vomiting (70.5%, p value = 0.02) were the most significant symptoms. Family history of peptic ulcer diseases was significantly associated with an increased risk for having a H. pylori positive result (p value = 0.02). Compared to endoscopy, the sensitivity of 13C UBT for the diagnosis of H. pylori was 94.1% (16/17), while it was 76.5% (13/17) for the stool antigen test. The specificity of both tests was equal (76.9%). However, the positive predictive and negative predictive values (84.2% and 90.9%) for 13C UBT were higher than those (81.3% and 71.4%) for the stool antigen test. The accuracy of 13C UBT was 86.7% compared to 76.7% for the stool antigen test. There was an 87% agreement (20 patients out of 23) between both tests when used to assess success of the eradication therapy. In conclusion, the 13C UBT was found to be more sensitive and accurate than the stool antigen test when used for diagnosis; furthermore, it has a comparable outcome to the stool antigen test in assessing the successfulness of the eradication treatment.

Background: Endometrial and cervical carcinomas are the most common gynecologic malignancies in Western world and many countries. The human papillomavirus (HPV) high-risk genotypes are associated with cervical carcinoma (CC). Chlamydia trachomatis (C. trachomatis), the most common sexually transmitted bacterial infection worldwide, considered a cofactor for HPV infection and CC. Information on HPV infection rate and type distribution among Jordanian women having CC is currently limited and unavailable among those with endometrial carcinoma. Therefore, the present study aimed to provide an updated estimate on HPV infection rate and its high-risk genotypes' distribution among Jordanian women by comparing data from invasive cervical carcinoma (ICC) to normal cervical tissues. Similarly, assessment of HPV infection rate was extended to the endometrial tissues. C. trachomatis infection was investigated as well to explore its possibility as HPV cofactor for induction of such carcinomas. Methods: Total DNA was extracted from 144 formaldehyde-fixed paraffin-embedded cervical and endometrial tissue, equally divided between age-matched control and carcinoma cases. Polymera se chain reaction (PCR) was used for general detection of HPV-DNA, high risk HPV-16 and 18 genotypes and C. trachomatis DNA using specific primers. Results: HPV infection was detected in 91.7% and 61.1% of cervical cancer patients and controls, respectively. Likewise, it was higher among cases (47.2%) than controls (13.8%) in endometrial biopsies. Significantly higher HPV infection rates were found among ICC and endometrial control biopsies of women >50 years. Out of 33 HPV positive ICC cases, single HPV-16 infections were detected in 69.7% compared to HPV-18 (15.2%), while HPV-16/18 co-infections were only found in three (9%) samples. C. trachomatis was not detected in all studied groups. Conclusion: The present study has successfully provided an updated estimate on HPV infection rate among Jordanian women with and without ICC and endometrial carcinoma. In addition, a lack of co -infection was observed between HPV and C. trachomatis in both cancer types. (C) 2019 The Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences.

We sought to detect and determine the genetic diversity of carbapenemase-producing Enterobacteriaceae (CPE) isolated from clinical specimens in Amman, Jordan. From five hospitals, a total of 2,759 isolates had antimicrobial susceptibilities determined via Vitek II, of which 28 (1%) were carbapenem resistant. Species identifications were determined via matrix-assisted laser desorption ionization time-of-flight mass spectrometry and carbapenemase gene detection via real-time PCR indicated that 23 (82.1%) isolates were Klebsiella pneumoniae (OXA-48-like, n = 7; NDM, n = 14; OXA-48-like and NDM, n = 2), four (14.2%) were Enterobacter cloacae complex (NDM, n = 3 and VIM, n = 1), and one (3.5%) was Escherichia coli (NDM). Sequencing of carbapenemase gene amplicons from a subset of isolates identified blaNDM-1, blaOXA-48, and blaVIM-4 alleles. Strain typing detected seven different K. pneumoniae variable number tandem repeat types, consistent with mostly sporadic occurrences along with limited clonal spread. E. cloacae complex isolates were diverse by pulsed-field gel electrophoresis, with a maximum relatedness of 70%. Plasmid restriction fragment length polymorphism (pRFLP) revealed four distinct profiles associated with NDM-encoding plasmids that were positive for replicons of the FII(K)/FIB or FIB incompatibility (Inc) groups via PCR-based replicon typing. OXA-48-encoding IncL/M plasmids differed by two pRFLP bands. The results show diverse CPE produce OXA-48 and NDM-1 enzymes in Jordan and that the carbapenemase genes are distributed on diverse plasmids in Jordanian hospitals, with some limited evidence for related clusters occurring, emphasizing the need for strict infection control measures.

Background: Helicobacter pylori (H. pylori) infection has been associated with gastritis, gastric ulcer, mucosa-associated lymphoid tissue lymphoma and gastric cancer. The prevalence of H. pylori virulence genes have been studied in different populations and from different sources of samples but their prevalence has not been studied in dental plaque in Jordanian people; therefore, the aim of this study was to determine the genotypes of H. pylori isolated from dental plaque samples. Methods: Dental plaque samples were collected from 60 Jordanian volunteers. The genotypes of H. pylori virulence genes including the cytotoxin-associated gene A (cagA) and the vacuolating toxin (vacA) were determined using polymerase chain reaction (PCR). Results: The cagA gene was detected in 14 (23.3%) samples, while vacA was detected in all volunteers enrolled in this study (100%). The most prevalent vacA alleles were m2 and s1 in 54 (90%) and 55 (91.7%) of volunteers, respectively. Compared to the other combinations including the most virulent vacA genotype s1/m1 which was detected in 11 (18.2%) of volunteers, the most prevalent vacA allelic combinations were s1/m2 and s2/m2 in 56 (93.3%) and 27 (45%) of volunteers, respectively. Conclusions: These results indicate a significant carriage of virulent H. pylori strains among Jordanian people in their dental plaques, which increases the possible transmission of these strains among them. In addition, the studying of the genotypic pattern of H. pylori virulence genes in the dental plaque could represent an essential tool for infection prevention and predicting the severity and prognosis of H. pylori gastric infection.