Antimicrobial resistance patterns among Acinetobacter baumannii isolated from burn intensive care unit in Tripoli, Libya

Background: Acinetobacter baumannii is a troublesome and increasingly problematic healthcare-associated pathogen, especially in critical care unit. These organisms have a capacity for long-term survival in the hospital environment. Aim: This study aimed to investigates the drug resistance patterns of Acinetobacter baumannii strains isolated from burn ICU (BICU). Method: The antibiotic susceptibility of 176 isolates to imipenem, meropenem, gentamicin, ciprofloxacin, fusidic acid, amikacin, trimethoprim, cefepime, ceftazidime, ceftriaxone, cefotaxime, and amoxicillin-calvulanic acid was determined by disk agar diffusion test. Findings: The overall proportion of A. baumannii isolates among all clinical isolates has increased slightly throughout the study from 3.5% to 4.2%. Carpabenem remained the antimicrobial most active antibiotic against A. braumannii isolates compared with other antibiotics, during the two years there was an increase in resistance from 50.6% to 71.3% to imipenem (P<0.01), and meropenem from 50.6% to 74.5% (P<0.01). ICU isolates exhibited significantly higher level of resistance to imipenem (71.6%) and meropenem (73.4%) compared with non-ICU strains (42.6% and 44.6% respectively) (P<0.01). Conclusion: In conclusion, the high prevalence of multidrug resistance A. baumannii (97.7%) and increased resistance to imipenem and meropenem in our unit might be due to long hospital stay, intubation, surgery and previous antibiotic prescription. It would seem that practices to prevent cross-transmission are more important in controlling resistance

Prevalence of Device-associated Nosocomial Infections Caused By Gram-negative Bacteria in a Trauma Intensive Care Unit in Libya

Objectives: Device-associated nosocomial infections (DANIs) have a major impact on patient morbidity and mortality. Our study aimed to determine the distribution rate of DANIs and causative agents and patterns of antibiotic resistance in the trauma-surgical intensive care unit (ICU). Methods: Our study was conducted at Abusalim Trauma Hospital in Tripoli, Libya. All devices associated with nosocomial infections, including central venous catheters (CVC), endotracheal tubes (ETT), Foley’s urinary catheters, chest tubes, nasogastric tubes (NGT), and tracheostomy tubes, were removed aseptically and examined for Gram-negative bacteria (GNB). Results: During a one-year study period, 363 patients were hospitalized; the overall mortality rate was 29%. A total of 79 DANIs were identified, the most common site of infection was ETT (39.2%), followed by urinary catheters (19%), NGTs (18%), tracheostomy tubes (11%), CVCs (10%), and chest tubes (3%). The most frequently isolated organisms were Klebsiella pneumonia, Acinetobacter baumannii, and Pseudomonas aeruginosa (30%, 20%, and 14%, respectively). Extremely high resistance rates were observed among GNB to ampicillin (99%), cefuroxime (95%), amoxicillin-clavulante (92%), and nitrofurantoin (91%). Lower levels of resistance were exhibited to amikacin (38%), imipenem (38%), and colistin (29%). About 39% of the isolates were defined as multi-drug resistant (MDR). Overall, extended spectrum β-lactmase producers were expressed in 39% of isolates mainly among K. pneumonia (88%). A. baumannii isolates exhibited extremely high levels of resistance to all antibiotics except colistin (100% sensitive). In addition, 56.3% of A. baumannii isolates were found to be MDR. P. aeruginosa isolates showed 46%–55% effectiveness to anti-pseudomonas antibiotics. Conclusion: High rates of DANI’s and the emergence of MDR organisms poses a serious threat to patients. There is a need to strengthen infection control within the ICU environment, introduce surveillance systems, and implement evidence-based preventive strategies

æREVIEW ARTICLE Antimicrobial resistance in Libya: 1970 2011

Resistance to antimicrobial agents is a major health problem that affects the whole world. Providing information on the past state of antimicrobial resistance in Libya may assist the health authorities in addressing the problem more effectively in the future. Information was obtained mainly from Highwire Press (including PubMed) search for the period 1970 2011 using the terms ‘antibiotic resistance in Libya’, ‘antimicrobial resistance in Libya’, ‘tuberculosis in Libya’, and ‘primary and acquired resistance in Libya ’ in title and abstract. From 1970 to 2011 little data was available on antimicrobial resistance in Libya due to lack of surveillance and few published studies. Available data shows high resistance rates for Salmonella species in the late 1970s and has remained high to the present day. High prevalence rates (54 68%) of methicillinresistant Staphylococcus aureus (MRSA) were reported in the last decade among S. aureus from patients with burns and surgical wound infections. No reports were found of vancomycin-resistant S. aureus (VRSA) or vancomycin-intermediate-resistant S. aureus (VISA) using standard methods from Libya up to the end of 2011. Reported rates of primary (i.e. new cases) and acquired (i.e. retreatment cases) multidrug-resistant tuberculosis (MDR-TB) from the eastern region of Libya in 1971 were 16.6 and 33.3 % and in 1976 were 8.6 and 14.7%, in western regions in 1984 1986 were 11 and 21.5 % and in the whole country in 2011 were estimated at 3.4 and 29%, respectively. The problem of antibiotic resistance is very serious in Libya. Th

Multidrug resistance and extended-spectrum β-lactamases genes among Escherichia coli from patients with urinary tract infections in Northwestern Libya

Introduction: Multidrug resistance (MDR) and emergence of extended-spectrum β-lactamases (ESBLs) that mediate resistance to β-lactam drugs among Escherichia coli and other uropathogens have been reported worldwide. However, there is little information on the detection of ESBLs genes in E. coli from patients with urinary tract infections (UTIs) in the Arab countries using polymerase chain reaction (PCR), and in Libya such information is lacking. Methods: All patients attending Zawiya Teaching Hospital in Zawiya city between November 2012 and June 2013 suspected of having UTIs and from whom midstream urine samples were taken as part of the clinical workup were included in this prospective study. Samples were examined for uropathogens by standard bacteriological procedures. VITEK-2 automated microbiology system was used to identify the isolated uropathogens and determine the susceptibility of E. coli and Klebsiella spp. isolates to antimicrobials. In addition, phenotypically ESBLs-positive E. coli isolates were tested for ESBLs genes by PCR. Results: The present study enrolled 1,790 patients with UTIs. Uropathogens were found in 371 (20.7%) urine specimens examined. Mixed pathogens were detected in two specimens with 373 total pathogens isolated. E. coli and Klebsiella spp. were the predominant uropathogens at 55.8% (208/373) and 18.5% (69/373), respectively. Other pathogens were detected in 25.7% (96/373) of urine samples. Of the E. coli and Klebsiella spp. tested, 69.2 and 100% were resistant to ampicillin, 6.7 and 33.3% to ceftriaxone, and 23.1 and 17.4% to ciprofloxacin, respectively. MDR (resistance to ≥3 antimicrobial groups) was found in 69 (33.2%) of E. coli and in 29 (42%) of Klebsiella spp. isolates. ESBLs were detected phenotypically in 14 (6.7%) of E. coli and in 15 (21.7%) of Klebsiella spp. isolates. Thirteen out of the 14 phenotypically ESBL-positive E. coli were positive for ESBL genes by PCR. blaTEM gene was detected in seven isolates, blaOXA gene in 10 isolates and blaCTX-M gene in six isolates. blaSHV gene was not detected in the present study. Conclusion: The isolation of MDR ESBL-producing uropathogens undoubtedly will limit the choices clinicians have to treat their patients with UTIs. Therefore, there is an urgent need for surveillance studies on antimicrobial resistance and prevalence of ESBLs among uropathogens to guide the clinical treatment of UTIs in Libya in the future

Diversity of Sequence Types and Impact of Fitness Cost among Carbapenem-Resistant Acinetobacter baumannii Isolates from Tripoli, Libya

We investigated the molecular epidemiology of 21 carbapenem-resistant Acinetobacter baumannii isolates from Libya and assessed their relative fitness. Core genome multilocus sequence typing (MLST) revealed five interhospital transmission clusters. Three clusters were associated with the international clones (IC) IC1, IC2, and IC7. Carbapenem-resistance was associated with bla(OXA-23), bla(GES-11), or bla(NDM-1). Compared to that of A. baumannii DSM 30008, the doubling time was similar over 10 h, but after 16 h, half the isolates grew to higher densities, suggesting a fitness advantage

Carbapenemases and extended-spectrum beta-lactamases producing ă Enterobacteriaceae isolated from Tunisian and Libyan hospitals

International audienceIntroduction: The aim of the study was to investigate the prevalence of ă extended-spectrum beta-lactamase (ESBL) and carbapenemase production ă among clinical isolates of Enterobacteriaceae recovered from Tunisian ă and Libyan hospitals. ă Methodology: Bacterial isolates were recovered from patients in ă intensive care units and identified by biochemical tests and MALDI-TOF. ă Antibiotic susceptibility testing was performed by disk diffusion and ă the E-test method. ESBL and carbapenemase activities were detected using ă standard microbiological tests. Antibiotic resistance-encoding genes ă were screened by PCR and sequencing. Clonal relationships between ă Klebsiella pneumoniae strains were carried out using multi-locus ă sequence typing (MLST). ă Results: A total of 87 isolates were characterized, with 51 and 36, ă respectively, identified as E. coli and K. pneumoniae. Overall the ă resistance prevalence was high for aminoglycosides (> 60%), ă fluoroquinolones (> 80%), and extended-spectrum cephalosporins (> ă 94%), and was low for imipenem (11.4%). Among this collection, 58 ă strains (66.6%) were ESBL producers and 10 K. pneumoniae strains ă (11.4%) were carbapenemase producers. The antibiotic ă resistance-encoding genes detected were blaC(TX-M-15) (51.7%), ă bla(TEM-1) (35.6%), several variants of bla(SHV) (21.8%), and ă bla(OXA-48) (11.4%). The MLST typing of K. pneumoniae isolates revealed ă the presence of multiple clones and three novel sequence types. Also, ă close relationships between the OXA-48-producing strains from Tunisia ă and Libya were demonstrated. ă Conclusions: This study is the first paper describing the emergence of ă carbapenemase-and ESBL-producing Enterobacteriaceae, sensitive to ă colistin, isolated in Tunisia and Libya. Active surveillance and testing ă for susceptibility to colistin should be implementing because resistance ă to colistin, mainly in Klebsiella, has been recently reported worldwide

Early detection of metallo-beta-lactamase NDM-1-and OXA-23 ă carbapenemase-producing Acinetobacter baumannii in Libyan hospitals

International audienceAcinetobacter baumannii is an opportunistic pathogen causing various ă nosocomial infections. The aim of this study was to characterise the ă molecular support of carbapenem-resistant A. baumannii clinical isolates ă recovered from two Libyan hospitals. Bacterial isolates were identified ă by matrix-assisted laser desorption/ionisation time-of-flight mass ă spectrometry (MALDI-TOF/MS). Antibiotic susceptibility testing was ă performed using disk diffusion and Etest methods, and carbapenem ă resistance determinants were studied by PCR amplification and ă sequencing. Multilocus sequence typing (MLST) was performed for typing ă of the isolates. All 36 imipenem-resistant isolates tested were ă identified as A. baumannii. The bla(OXA-23) gene was detected in 29 ă strains (80.6%). The metallo-beta-lactamase bla(NDM-1) gene was ă detected in eight isolates (22.2%), showing dissemination of ă multidrug-resistant (MDR) A. baumannii in Tripoli Medical Center and ă Burn and Plastic Surgery Hospital in Libya, including one isolate that ă co-expressed the bla(OXA-23) gene. MLST revealed several sequence types ă (STs). Imipenem-resistant A. baumannii ST2 was the predominant clone ă (16/36; 44.4%). This study shows that NDM-1 and OXA-23 contribute to ă antibiotic resistance in Libyan hospitals and represents the first ă incidence of the association of these two carbapenemases in an ă autochthonous MDR A. baumannii isolated from patients in Libya, ă indicating that there is a longstanding infection control problem in ă these hospitals. (C) 2016 Elsevier B.V. and International Society of ă Chemotherapy. All rights reserved