Epidemiology and Antibiotic Susceptibility Patterns of Carbapenem Resistant Gram Negative Bacteria Isolated from Two Tertiary Care Hospitals in North Lebanon: Carbapenem Resistant Gram Negative Bacteria in North Lebanon

Background. Antimicrobial resistance is a major public health problem worldwide. Numerous epidemiological studies reported that Lebanon is affected with high levels of antibiotic resistance. The aim of this study is to determine the prevalence and antibiotic susceptibility patterns of carbapenem resistant Gram negative bacteria in North Lebanon during the period 2015-2017. Methods. Carbapenem resistant Gram negative bacteria were isolated from patients referring to Nini hospital and Youssef hospital center. Identification and antibiotic susceptibility testing were performed through conventional tools according to the manufacturer’s recommended procedures and the recommendations of the European Committee on Antimicrobial Susceptibility Testing, respectively. Results. Overall, a total of 290 carbapenem resistant Gram negative bacteria were isolated. Escherichia coli was predominant and represented 39.3% of all isolates, followed by Pseudomonas aeruginosa (24.8%), Acinetobacter baumannii (22.8%), Klebsiella spp. (8.6%), Enterobacter spp. (6.6%), Pantoea spp. (1%), and Proteus vulgaris (0.3%). Our findings showed an alarming increase in the prevalence of carbapenem resistant bacteria every year. On the other hand, colistin, tigecycline, amikacin and fosfomycin remain the most effective agents against carbapenem resistant Gram negative bacteria. Conclusion. This study provided important new laboratory data that could support specialists in infectious diseases in North Lebanon to take the appropriate decision in the treatment of patients at risk for infections with carbapenem resistant Gram negative germs

Antibiotic Susceptibility of Salmonella spp., Shigella spp. and enteropathogenic Escherichia coli strains isolated from diarrheic children in Tripoli, North Lebanon

Background. – Enteric infections are a leading cause of diarrheal disease and death in infants and young children, particularly in the developing regions. The aim of this study is to determine the antibiotic susceptibility of three Enterobacteriaceae enteropathogens (Salmonella spp., Shigella spp. and enteropathogenic Escherichia coli (EPEC)) isolated from hospitalized diarrheic children in North Lebanon during the period of 7 years.Methods and Findings. – 172 Enterobacteriaceae enteropathogens strains were isolated from fecal or blood specimens of 158 hospitalized diarrheic children collected at Nini hospital in Tripoli, North Lebanon. Culture, identification and antibiotic susceptibility of strains were carried out through conventional tools according to standard protocols proposed by the REMIC group and the recommendations of the European Committee on Antimicrobial Susceptibility Testing. Out of 172, 158 (91.9%) Enterobacteriaceae enteropathogens strains were isolated from stool samples and only 14 (8.1%) were isolated from blood cultures. EPEC were predominant (78/172; 45.3%), followed by Salmonella spp. (64/172; 37.2%) and Shigella spp. (30/172; 17.5%). According to API identification and immunological serotyping reports of Salmonella isolates, Salmonella Typhi was the predominant serotype (32/64; 50%). During the study period, antibiotics susceptibility testing showed that around 50% and 25% of the isolates were resistant to ampicillin and extended-spectrum cephalosporins, respectively. Overall, Salmonella Typhi strains were the most susceptible to antibiotics.Conclusion. – Our study revealed a relatively high antibiotic resistance rate of EPEC, Shigella spp. and non-Typhi Salmonella strains among studied population. The findings of this study provide useful information to survey, prevent and control diarrheal disease and antimicrobial resistance in Lebanon

Diagnosis And Antimicrobial Treatment Of Bacterial Of Neisseria Gonorrhea Infections: Update Review Article

Sexually transmitted infections (STIs) are caused by a wide spectrum of bacteria, viruses and parasites. These agents can be easily transmitted during any direct genital or oral sexual contact. Recently, World Health Organization (WHO), reported that more than 1 million STIs  are acquired every day worldwide,  Each year, there are an estimated 357 million new infections with 1 of 4 STIs: chlamydia, gonorrhoea, syphilis and trichomoniasis. There are few studies and official reports published on the prevalence of STIs in most Arab countries. However, few new recent studies showed increased prevalence of certain STIs in some Arab countries

Mycobacterium tuberculosis spoligotypes circulating in the Syrian population: A retrospective study

AbstractObjectivesTo characterize by spoligotyping clinical isolates of Mycobacterium tuberculosis (MTB) collected between July 2003 and October 2005 from all Syrian provinces (muhafazat).MethodsAll isolates (n=96) were cultured and identified by biochemical characteristics. DNA extracts of these samples were amplified by PCR and genotyped by spoligotyping.ResultsTwelve patterns were identified: 46.8% of the strains belonged to T 1 family; 20.8% to LAM 9; 10.4% to CAS; 9.3% to Haarlem 3; 4.1% to Haarlem 1; 2.1% to Family 34; and 1% to each of Family 36, EAI 5, LAM 1, LAM 8, T 3, and X 3 families. The noticeable absence of the Beijing family was not consistent with the patterns reported in most neighboring countries.ConclusionA more inclusive study of the Syrian population is necessary to more accurately identify most of the prevailing families in the country

First data on antimicrobial susceptibility patterns of Moraxella catarrhalis isolates in Lebanon

Background. Moraxella catarrhalis is an important bacterial pathogen. Although national data have shown an increase in the levels of antimicrobial resistance in clinical settings in Lebanon, there is a lack of data regarding this human pathogen. This study aimed to determine for the first time the antimicrobial susceptibility profiles of M. catarrhalis isolates in Lebanon. Methods. A total of 34 M. catarrhalis strains were isolated from clinical specimens during the period from November 2010 to March 2019. Bacterial identification was carried out using matrix assisted laser desorption ionization–time of flight mass spectrometry. Antibiotic susceptibility of all isolates was performed according the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Results. A total of 34 non-duplicated M. catarrhalis strains were isolated from nose (n=19), ear (n=7), sputum (n=5), blood (n=1), eye (n=1), and throat (n=1) of patients referred to Nini Hospital in Tripoli, North governorate of Lebanon. Regarding antibiotic susceptibility rates, the percent susceptibility is 100% to the majority of antibiotics, except ampicillin (7.4%), trimethoprim-sulfamethoxazole (85.3%), nalidixic acid (85.3%), and ciprofloxacin (97.1%). Conclusion. To our knowledge, this study is the first investigation regarding the antimicrobial susceptibility patterns of M. catarrhalis isolates in Lebanon. In addition to the high level of resistance to ampicillin, our findings showed the emergence of resistance to trimethoprim-sulfamethoxazole, nalidixic acid and ciprofloxacin. Even if this study provides useful information to develop effective empirical treatment, we recommend the implementation of reliable diagnostic tools to guide appropriate treatment

Genotypic detection of rifampicin-resistant M. tuberculosis strains in Syrian and Lebanese patients

SummarySettingThe incidence of multi- and extensively drug-resistant TB cases is increasing in many countries. Resistance to rifampicin is widely considered a surrogate marker for multiple drug resistant TB. No efforts have been made to identify and quantify the drug-resistant genotypes in the Syrian and Lebanese communities.ObjectiveThe genotypic characterization of rpo B mutations in the rifampicin drug-resistance region (RRDR) of resistant Mycobacterium tuberculosis isolates in Syrian and Lebanese patients.DesignThe pyrosequencing technique was applied to DNA derived from the M. tuberculosis isolates of 56 patients.ResultsRRDR sequencing identified 97 modified codons representing 35 different mutations; 31 (34%) of the 97 modifications were novel and have not been previously reported. The changes were mostly within codons 531 (37/97: 38%), 533 (28/97: 29%) and 526 (9/97: 9%). Additionally, 30 (54%) isolates had multiple codon changes.ConclusionThis study indicates the importance of the RRDR hotspot region for the detection of rifampicin resistance in MTB clinical isolates from Syrian and Lebanese patients. However, new mutations and mutations in other locations within the RRDR were also observed. The vast majority (95%) of the studied isolates from this pool of patients contained mutations in codons 531 and/or 533

Molecular Characterization and resistance of H. influenzae isolated from Nasopharynx of Students in North Lebanon

Introduction: Haemophilus influenzae is an important cause of respiratory infections,including acute otitis media, sinusitis, and chronic bronchitis, which arepreceded by asymptomatic H. influenzae colonization of the human pharynx. Theaim of this study is to investigate the rate of H.influenzae nasopharyngeal colonizationamong students ages 2 to 3 years.Material and methods: A total of 21 isolates of clinical H. influenzae wereisolated from 87 nasopharyngeal specimens of children between April and June2011. The isolates were identified by using molecular techniques (PCR), biotypeswere determined by using the following tests: ornithin decarboxylase, urease andtryptophanase, and capsular typing was performed by SAST by using polyclonaland specific b antisera (Difco-BD®-USA).The prevalence of β -lactams resistance, β-lactamase production, the level of macrolideresistance was recorded for each strain by using disc diffusion and E-teststrip methods and chromogenic cephalosporin test (cefinase). β -lactams resistancegenes (blaTEM and blaROB) were determined using PCR.Results: 42.8 % of the H. influenzae isolates were type b, and biotypes I, II andIII were the majority, whereas biotypes IV, VI and VIII was not found. The majorityof capsule type b was belonged to biotype II. Antibiotics susceptibility showedthat 19% of the isolates were resistant to ampicillin and produced type TEM-1β-lactamase.Conclusion: This study shows the carriage rate of H. influenzae in North Lebanonchildren. The incidence of resistance rate of 19% to ampicillin signals an importantwarning to the future prophylaxis use of beta-lactam in treatment of H. influenzaeinfections in Lebanon

Prevalence and antibiotic susceptibility of ear pathogens isolated from patients in Tripoli, north of Lebanon

Background. Urinary tract infection (UTI) is a severe public health problem. However, infected patients are usually treated empirically without preceding culture or antibiotics susceptibility testing, which may increase the antibiotic resistance level. The aim of this study is to determine the prevalence and antibiotic susceptibility patterns of common bacterial uropathogens isolated in Akkar governorate, North Lebanon. Methods. Spot midstream from urine samples from 9662 patients presenting UTI symptoms who came to Youssef Hospital Center located in Akkar governorate, were collected in sterile plastic cups. Culture, identification and antibiotic susceptibility testing were performed through conventional tools according to the manufacturer’s recommended procedures and the recommendations of the European Committee on Antimicrobial Susceptibility Testing. Results. Overall, a total of 1009 bacterial uropathogens were isolated. Escherichia coli was predominant and represented 72.5% of all isolates , followed by Klebsiella pneumoniae (8.2%), Enterococcus spp. (5.5%), Pseudomonas aeruginosa (4.5%), Proteus spp. (3%), Enterobacter spp. (2%), Staphylococcus aureus (2%), Streptococcus agalactiae (1.6%), Staphylococcus saprophyticus (0.4%), Acinetobacter baumannii (0.2%) and Providencia rettgeri (0.1%). Moreover, the mean antibiotic resistance rates of isolates was relatively high, but similar to previous investigations reported in our country. Conclusion. To our knowledge, this is the first investigation reporting epidemiological data regarding the prevalence and antibiotic susceptibility patterns of uropathogens isolated from patients in Akkar governorate. Our data indicated the urgent need of a strategic plan to tackle antibiotic resistance, particularly in deprived regions with poor healthcare structures such as Akkar governorate. DOI: http://dx.doi.org/10.3823/80

Co-infection in patients with COVID-19 in Tripoli Northern Lebanon: germs involved and antibiotic sensitivity profile.

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