Genetic and antibiotic susceptibility profiles of drug-resistant Acinetobacter baumannii in Lebanon

Objectives To determine the population structure and antimicrobial sensitivity profile of carbapenem-resistant A. baumannii isolates in Lebanon. Materials and Methods Thirty-two isolates of A. baumannii were collected between Jan-June 2011 from three distant hospitals in Lebanon. Molecular identification was done by partial rpoB sequencing. The antibiotic susceptibility testing was determined by agar disc diffusion. MICs for imipenem, meropenem, colistin, tigecycline and sulbactam were also determined for imipenem resistant strains. Genetic testing was performed using MLST. Results Thirty isolates were identified as A. baumannii according to the molecular identification which 24 exhibited imipenem resistance. Sensitivity profiles [sensitive vs. intermediate vs. resistant] of these isolates were 0%vs.12.5% vs.87.5% for meropenem, 8.3%vs.54.2%vs.37.5% for tigecycline and 8.3%vs.8.3%vs83.4% for sulbactam. All isolates (100%) were sensitive to colistin. All isolates (except one) belonged to international clone 2. Conclusion Extensively drug resistant A. baumannii pauses a major risk for patients in Lebanon and with the absence of an effective antimicrobial treatment, tight infection control and rational antibiotic use are mandatory to prevent further aggravation of the antibiotic resistance in this country

Characterization of resistance genes to macrolides, lincosamides and streptogramins (MLS) among clinical isolates of Staphylococcus aureus in North Lebanon

Background. – Staphylococcus aureus is one of the most significant pathogens causing significant morbidity and mortality. Moreover, the incidence of MLS-resistant Staphylococcus aureus infections continues to grow globally.Objective. – The aim of this study is to examine the expression of resistance of Staphylococcus aureus (S. aureus) isolates to MLS and the prevalence of genes involved in this resistance by PCR.Methods. – 38 strains of S. aureus MLS-resistant (resistant at least for one macrolide) were isolated in the sector of microbiology at Nini Hospital in North Lebanon. The disk diffusion method was used to determine the phenotype of the MLS resistance. The resistance genes involved were detected by PCR using specific gene primers for ermA, ermB, ermC, msrA, linA, mefA, vat and vgb genes.Results. – A total of 55.3% of the isolates were positive for inducible phenotype (iMLSB), 15.8% for the constitutive phenotype (cMLSB), 23.7% for MSB phenotype and 5.2% for L phenotype. The ermC gene was the most prevalent (52.6%), while ermA, ermB, msrA and linA genes were observed with lower prevalence. However, a combination of several of these genes was detected. The vgb, vat and mefA genes were not detected in any of the clinical isolates.Conclusion. – To our knowledge, this study is the first investigation regarding characterization of MLS resistance genes in clinical isolates of S. aureus in Lebanon. The study revealed a high prevalence of the inducible resistance to lincosamides (iMLSB phenotype) and the most prevalent resistance determinants was ermC

Teleclinical Microbiology: An Innovative Approach to Providing Web-Enabled Diagnostic Laboratory Services in Syria

Objectives: Telemedicine can compensate for the lack of health care specialists in response to protracted humanitarian crises. We sought to assess the usability of a teleclinical microbiology (TCM) program to provide diagnostic services in a hard-to-reach region of Syria. Methods: A semimobile station was equipped with conventional micrograph and macrograph digital imaging systems. An electronic platform (Telemicrobiology in Humanitarian Crises, TmHC) was created to facilitate sharing, interpreting, and storing the results. A pilot study was conducted to identify the bacterial species and antimicrobial susceptibility pattern of 74 urinary clinical isolates. An experience survey was conducted to capture the feedback of 8 participants in the program. Results: The TmHC platform (https://sdh.ngo/tmhc/) enabled systematic transmission of the laboratory records and co-interpretation of the results. The isolates were identified as Escherichia coli (n = 61), Klebsiella pneumoniae (n = 12), and Proteus mirabilis(n = 1). All the isolates were multidrug resistant. The performance of our TCM module was rated 4 (satisfying) and 5 (very satisfying) by 6 and 2 users, respectively. Data security of and cost-effectiveness were the main perceived concerns. Conclusions: Although we encountered several context-related obstacles, our TCM program managed to reach a highly vulnerable population of 4 million people confined in the northwest region of Syria.publishedVersio

Current molecular methods in epidemiological typing of Acinetobacter baumannii

International audienc

The Acinetobacter baumannii website (Ab-web): a multidisciplinary knowledge hub, communication platform, and workspace

Acinetobacter baumannii is a Gram-negative bacterium increasingly implicated in hospital-acquired infections and outbreaks. Effective prevention and control of such infections are commonly challenged by the frequent emergence of multidrug-resistant strains. Here we introduce Ab-web (https://www.acinetobacterbaumannii.no), the first online platform for sharing expertise on A. baumannii. Ab-web is a species-centric knowledge hub, initially with ten articles organized into two main sections, ‘Overview’ and ‘Topics’, and three themes, ‘epidemiology’, ‘antibiotic resistance’, and ‘virulence’. The ‘workspace’ section provides a spot for colleagues to collaborate, build, and manage joint projects. Ab-web is a community-driven initiative amenable to constructive feedback and new ideas

Etude du réservoir d'Acinetobacter baumannii au Liban

A. baumannii est une bactérie principalementresponsable d’infections nosocomiales. Ce travail vise àétudier l'épidémiologie moléculaire de souches cliniquesd'origine hospitalière et de souches isolées hors de toutcontexte hospitalier au Liban.Nous avons analysé des souches isoléesd'hôpitaux, 66 % étaient résistantes aux carbapénèmeset le gène blaOXA-23-like étant prépondérant. Le typage parmulti locus sequence typing (MLST) a révélé laprédominance du ST2. Dix-sept autres ST(s), dont 6nouveaux, ont par ailleurs été identifiés. Nous avonsréalisé une analyse épidémiologique plus approfondiede 42 souches d'origine nosocomiale. Les résultats ontmontré la présence d'un seul clone chez 28 souchesréparties à Tripoli et à Beyrouth. L'épidémiologie extrahospitalièrea été étudiée sur des prélèvementscollectés dans le Nord du Liban. 42 souches ont étéidentifiées dans l' environnement et chez des animaux.Contrairement aux souches cliniques, les souchesétaient sensibles aux antibiotiques. Les résultats dutypage par MLST ont montré la présence de 36 ST(s),dont 24 nouveaux. Le séquençage du gène blaOXA-51-likea identifié 34 variants, dont 21 nouveaux.Ce travail a permis de montrer que le Liban étaitun pays à forte endémie d’A. baumannii résistants auxcarbapénèmes. Nous avons ainsi mis en évidence queles clones circulant dans l'environnement étaientglobalement différents de ceux isolés lors d’infectionschez l’homme. Cette étude montre qu'il n'y a pas de liendirect entre les souches cliniques et l'environnementextra-hospitalier mais qu'il existe une nichepotentiellement animale qu'il conviendrait d'explorer pardes études plus larges et détaillées.A. baumannii is a bacterium responsible fornosocomial infections. This work aims to study themolecular epidemiology of hospital-acquired strainsand strains isolated outside the hospital setting inLebanon.We analyzed strains isolated in hospitals, 66%were resistant to carbapenems and blaOXA-23-like wasthe dominant. Typing by multi locus sequence typing(MLST) revealed the predominance of ST2.Seventeen other ST (s), including 6 new, were alsoidentified. We conducted a more thoroughepidemiological analysis of 42 strains of nosocomialorigin. The results showed the presence of a singleclones spread to Tripoli and Beirut. Extra hospitalepidemiology was studied on samples collected innorthern Lebanon. 42 strains have been identified inthe environment and in animals. Unlike clinicalstrains, the strains were susceptible to antibiotics.The results of MLST typing showed the presence of36 ST(s), including 24 new ones. The sequencing ofblaOXA-51-like gene identified 34 variants, including 21new ones.This work has shown that Lebanon is acountry with high endemicity of A. baumannii resistantto carbapenems. We have thus demonstrated that theclones circulating in the environments were generallydifferent from those isolated during infections inhumans. This study shows that there is no direct linkbetween clinical strains and extra hospitalenvironment but a potentially animal niche that shouldbe explored by broader and detailed studies

Cutaneous leishmaniasis in north Lebanon: re-emergence of an important neglected tropical disease

Background: Cutaneous leishmaniasis (CL) is the most prevalent neglected tropical disease among externally displaced people in the Middle East. In recent years, the Lebanese population has increased >30%, mainly due to a mass influx of Syrian migrants, thousands of them carrying CL, among other infectious diseases. Here we revisit the current CL prevalence among refugees in northern Lebanon. Methods: This cohort study was conducted at the Al Bashaer Medical Center in north Lebanon between January and June 2017. A total of 48 randomly selected suspected CL patients were clinically diagnosed by dermatologists and samples were obtained for microscopic examination and molecular identification by polymerase chain reaction restriction fragment length polymorphism. The treatment response to antimonials wasassessed each week and was followed for up 6 months. Results: Leishmania tropica was the predominant species (91.7%) followed by Leishmania major (8.3%). Confirmed cases were treated with one to two courses of antimonials and healing was usually achieved after receiving a second course of treatment. Importantly, we show evidence of possible local CL transmission by indigenous sandflies in three separate patients who had no history of recent travel to Syria. Conclusions: This highlights the urgent necessity to implement preventive disease strategies to avoid further dispersion of L. tropica CL in north Lebanon