COVID-19 IN LEBANON: DEMOGRAPHICS AND DISTRIBUTION

COVID-19 pandemic has emerged over more than 200 countries leading to more than 117 million infection cases and more than 2.6 million deaths. Lebanon is one of the countries affected by this disease especially in the second half of 2020 reaching its peak early this year. In this study, we studied the impact of multiple factors on this surge and analyzed the positive tests among different age groups over a period of one year (from March 2020 to February 2021). Data was collected from one medical center in Beirut where more than 20,000 PCR tests were done using RT-PCR method between March 2020 and February 2021 and analyzed the pattern of increase of the rate of positivity over this period. The SARS-CoV-2 positivity rate was 13% over a period of one year. The highest number of positive PCR tests was in patients aged between 20 and 39 years. Furthermore, the number of positive tests was low in the first 4 months, which was followed by a dramatic increase in July 2020 reaching a peak in January 2021. Lebanon is among the countries affected lately by the COVID-19 pandemic with most cases arising after August 2020 affected by the blast of Beirut and emergence of new variants resulting in higher positivity rate. Moreover, our data shows a distribution of age similar to other countries and suggest its role in the rapid increase of positivity rate

Antibiotic consumption and molecular epidemiology of ESBL-producing escherichia coli and klebsiella pneumoniae in a Lebanese hospital

The emergence of extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae represents a major challenge to public and animal health in many countries including Lebanon. Carriage of ESBLs confers resistance to β-lactam antibiotics and more than 200 different sub-types have been identified, all of which are primarily encoded by genes located on conjugative plasmids. Despite the high prevalence of ESBLs, there is still a paucity of information regarding the impact of ESBL plasmid carriage on the host bacterium and how the spread of antibiotic resistance relates to antibiotic use in hospital environments. Therefore, the aim of this study was, firstly, to characterise the genetic and phenotypic properties of ESBL-producing Escherichia coli and Klebsiella pneumoniae isolated from a hospital in Lebanon. Secondly, to assess the fitness of isolates harbouring different sub-types of ESBLs in order to better understand the influence of the plasmid on the host bacterium, and thirdly, to correlate hospital antibiotic consumption data calculated using ABC Calc software (in defined daily doses (DDD) per 100 bed days), with antimicrobial susceptibility profiles obtained over a three year period. A total of 140 isolates of E. coli and K. pneumoniae that were resistant to at least one 3rd- or 4th- generation cephalosporin were collected from the Centre Hospitalier Du Nord (CHN) in Lebanon, between 1st May 2011 and the 31st December 2012. ESBL-production was confirmed in all isolates using the double disk synergy assay and the E-test ESBL strip. Out of 140 isolates, 35 were also found to harbour a chromosomal AmpC β-lactamase, whereas none harboured the plasmidic gene. PCR analyses showed that all isolates harboured CTX-M type β-lactamase, with 74% also harbouring TEM and approximately 40% harbouring either SHV or OXA type β-lactamases. Most E. coli isolates belonged to phylogenetic group B2, and harboured genes important in iron uptake. PFGE analysis of both E. coli and K. pneumoniae indicated significant clonal diversity amongst the isolates. Analysis of the β-lactamase-encoding plasmids from selected isolates revealed the plasmids were conjugative and bore similarities to pEC_L8 and Inc group types. Plasmid curing studies indicated that ESBL plasmids influenced bacterial host cell fitness through altered carbon metabolism and generation time. Both positive and negative correlations were found between antibiotic consumption and the susceptibility of E. coli and K. pneumoniae to different types of antibiotics. This study highlights the diversity of ESBL-producing isolates found among members of the Enterobacteriaceae in Lebanon and supports the idea that horizontal transfer of CTX-M-15 harbouring ESBL plasmids, rather than clonal expansion of particular isolates, has occurred. Moreover, the use of β-lactam antibiotics and quinolones may promote their spread, and thus effective hospital infection control programs and more pragmatic antimicrobial usage is recommended

Antibiotic consumption and molecular epidemiology of ESBL-producing escherichia coli and klebsiella pneumoniae in a Lebanese hospital

The emergence of extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae represents a major challenge to public and animal health in many countries including Lebanon. Carriage of ESBLs confers resistance to β-lactam antibiotics and more than 200 different sub-types have been identified, all of which are primarily encoded by genes located on conjugative plasmids. Despite the high prevalence of ESBLs, there is still a paucity of information regarding the impact of ESBL plasmid carriage on the host bacterium and how the spread of antibiotic resistance relates to antibiotic use in hospital environments. Therefore, the aim of this study was, firstly, to characterise the genetic and phenotypic properties of ESBL-producing Escherichia coli and Klebsiella pneumoniae isolated from a hospital in Lebanon. Secondly, to assess the fitness of isolates harbouring different sub-types of ESBLs in order to better understand the influence of the plasmid on the host bacterium, and thirdly, to correlate hospital antibiotic consumption data calculated using ABC Calc software (in defined daily doses (DDD) per 100 bed days), with antimicrobial susceptibility profiles obtained over a three year period. A total of 140 isolates of E. coli and K. pneumoniae that were resistant to at least one 3rd- or 4th- generation cephalosporin were collected from the Centre Hospitalier Du Nord (CHN) in Lebanon, between 1st May 2011 and the 31st December 2012. ESBL-production was confirmed in all isolates using the double disk synergy assay and the E-test ESBL strip. Out of 140 isolates, 35 were also found to harbour a chromosomal AmpC β-lactamase, whereas none harboured the plasmidic gene. PCR analyses showed that all isolates harboured CTX-M type β-lactamase, with 74% also harbouring TEM and approximately 40% harbouring either SHV or OXA type β-lactamases. Most E. coli isolates belonged to phylogenetic group B2, and harboured genes important in iron uptake. PFGE analysis of both E. coli and K. pneumoniae indicated significant clonal diversity amongst the isolates. Analysis of the β-lactamase-encoding plasmids from selected isolates revealed the plasmids were conjugative and bore similarities to pEC_L8 and Inc group types. Plasmid curing studies indicated that ESBL plasmids influenced bacterial host cell fitness through altered carbon metabolism and generation time. Both positive and negative correlations were found between antibiotic consumption and the susceptibility of E. coli and K. pneumoniae to different types of antibiotics. This study highlights the diversity of ESBL-producing isolates found among members of the Enterobacteriaceae in Lebanon and supports the idea that horizontal transfer of CTX-M-15 harbouring ESBL plasmids, rather than clonal expansion of particular isolates, has occurred. Moreover, the use of β-lactam antibiotics and quinolones may promote their spread, and thus effective hospital infection control programs and more pragmatic antimicrobial usage is recommended

Carriage of beta-lactamase-producing Enterobacteriaceae among nursing home residents in north Lebanon

Background: Multidrug-resistant (MDR) Enterobacteriaceae can cause severe infections with high morbidity, mortality, and health care costs. Individuals can be fecal carriers of these resistant organisms. Data on the extent of MDR Enterobacteriaceae fecal carriage in the community setting in Lebanon are very scarce. The aim of this study was to investigate the fecal carriage of MDR Enterobacteriaceae among the elderly residents of two nursing homes located in north Lebanon. Methods: Over a period of 4 months, five fecal swab samples were collected from each of 68 elderly persons at regular intervals of 3–4 weeks. Fecal swabs were subcultured on selective media for the screening of resistant organisms. The phenotypic detection of extended-spectrum beta-lactamase (ESBL), AmpC, metallo-beta-lactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC) production was performed using the beta-lactamase inhibitors ethylenediaminetetraacetic acid, phenylboronic acid, and cloxacillin. A temocillin disk was used for OXA-48. Multiplex PCRs were used for the genotypic detection of ESBL and carbapenemase genes, and sequencing was performed to identify CTX-M-15. The medical records of each subject were reviewed on a regular basis in order to assess the risk factors associated with MDR Enterobacteriaceae fecal carriage. Results: Over the study period, 76.5% of the recruited elderly persons were at least one-time carriers. A total of 178 isolates were obtained. Phenotypic testing revealed that 91.5% of them were ESBL producers, 4% were AmpC producers, 2.8% were co-producers of ESBL and AmpC, and 1.7% were co-producers of OXA-48 and ESBL. Recent antibiotic intake was found to be the only independent risk factor associated with the fecal carriage of MDR Enterobacteriaceae. Conclusions: The high prevalence of MDR Enterobacteriaceae detected in this study and the emergence of carbapenem resistance is alarming. Efficient infection control measures and antibiotic stewardship programs are urgently needed in these settings in order to limit the spread of resistant strains