International Medical Publisher Journals (iMedPub)
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Antimicrobial Resistance and Biofilm Formation of Pseudomonas aeruginosa: A short review article
Get PDFPseudomonas aeruginosa threatens patient’s care. It is considered as the most complicated health care associated pathogen to be eliminated from infection site. The biofilm forming ability of P. aeruginosa, being a major virulence factor for most pathogenic microorganism, protects it from host immunity and contribute to antibiotic resistance of this organism. It is estimated that about 80% of infectious diseases are due to biofilm mode of growth. Biofilm forming ability of bacteria imparts antimicrobial resistance that leads to many persistent and chronic bacterial infections. The world is becoming increasingly under the threat of entering the “post-antibiotic eraâ€, an era in which the rate of death from bacterial infections is higher than from cancer.
This review focus on P. aeruginosa biofilm forming ability; definition, developmental stages, and significance. In addition, the quorum sensing and the antibiotic resistance of this pathogen is discussed.
Keywords: Biofilm; bacterial adhesion; Pseudomonas aeruginosa; antimicrobial resistance; quorum sensing.
 
Microbiology, diseases, and epidemiology of Kingella kingae in young children: A short review
Get PDFKingella kingae is a Gram-negative coccobacilli and it is a member of the HACEK (Haemophilus species, Aggregatibacte actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and K. kingae). HACEK organisms are typically oropharyngeal commensals and have long been recognized as a cause of infective endocarditis in children and adults. K. kingae in difficult to be recovered from cultured pharyngeal samples due to its slow growth and the high presence of resident bacterial flora, however, the organism can be better detected using PCR tests. Based on our search in PubMed and other sources, we couldn't discover any study about K. kingae originated from any Arab country. Therefore, we wrote this review to draw the attention of our physicians and clinical microbiologists on the importance of this neglected group of organisms in clinical medicine. However, this review article aims to cover the most important diseases of K. kingae in the pediatric population
The Role of PCR in the Diagnosis of Dermatophytes in Onychomycosis
Get PDFBackground:
Onychomycosis is a critical medical problem. This fungal infection of the nails leads to disfigurement, pain and impaired quality of life. Given that it requires long-term expensive therapy; a proper diagnosis of this infection is greatly demanded. Hence, study aimed at investigating the different laboratory methods used in the identification of dermatophytes implicated in onychomycosis including conventional laboratory methods (KOH preparation), Culture and PCR (multiplex).
Subjects and Methods:
This cross-section study included sixty-one (61) patients [ 82% females and 18% males]. All collected samples were investigated using microscopic examination and cultivation of samples. In addition, DNA extraction and PCR amplification were evaluated.
Results:
Distal and lateral subungual onychomycosis(DLSO) was the most common clinical types of onychomycosis represented 70 % of total cases. Pain was the most common presenting symptoms. Among the studied group, the most common fungal infections encountered were chronic paronychia, tinea pads and tinea manum (37.7%, 16.4%, and 8.2%) respectively. The 67.2% of the studied group by PCR were +ve, by culture 60.7% were +ve and finally, 73.8% were +ve by direct smear. The sensitivity of PCR in the diagnosis of lesions was 100% specificity was 83.3% and accuracy was 93.4%.
Conclusion:
The dermatophyte responsible for a majority of cases of onychomycosis. However, the role of NDMs should not be ignored and this may be now a consideration in evaluating and treating onychomycosis. PCR is highly sensitive methods for diagnosis of fungal infection. The application of PCR technology directly to the clinical specimens will allow early and accurate diagnosis of onychomycosis. This will permit prompt and targeted initiation of antifungal therapy. So, it is recommended to be used in the rapid diagnosis of onychomycosis.
 
Compliance with antimicrobials de-escalation in septic patients and mortality rates: an old subject revisited
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To compare the recent de-escalations rates with a six-year earlier study, and mortality associated with de-escalation.
Methods
Settings
A prospective multicenter study including septic patients, all were on broad-spectrum antimicrobials (BSA). Excluded from the study patients on antimicrobial prophylaxis, and patients without a microbiological diagnosis, or bacteria were solely BSA-susceptible. The study team made recommendations for antimicrobials de-escalation to the treating physician(s) must an opportunity loomed.
Results
182 patients were available for analysis. De-escalation was achieved in 43 (24%) patients. The clinical diagnoses, comorbidities, commonly used antimicrobials, the microbiological diagnoses were not different between the two groups (patients with and without de-escalation). Logistic regression analysis showed no correlation between bacterial species and de-escalation (Nagelkerke R2 = 0.076). Relapsing sepsis and reinfection were not different (P > 0.05). The in-hospital mortality rates for the de-escalated patients were lower (P = 0.015), not on day 30 (P = 0.354). The length of the ICU stay and ward stay were not different (P >0.05), but more de-escalated patients were discharged home from the ICU (P = 0.034), however, patients without de-escalation were discharged more from the ward (P = 0.002).
Conclusion
De-escalation rates increased within six years from 6.7% - 24% (P = 0.000), with added benefits of shorter ICU stay and less in-hospital mortalit
The Etiology of Viral Lower Respiratory Tract Infections at a Tertiary Hospital in Jordan over Five Years
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Lower respiratory tract infection (LRTI) is the most common condition treated in primary care and is considered the third leading cause of death worldwide. The objective of our study is to determine the etiological agents that cause viral LRTI in Jordan, aiming to help physicians to choose the appropriate treatment strategy.
Materials and Methods
We conducted a retrospective study on patients who were admitted with the diagnosis of LRTI between January, 2011 and January, 2016. We used Fast-track Diagnostics (FTD)® Respiratory 21 Kit (Fast-track Diagnostics, Luxembourg) real-time PCR to determine the viral etiology of LRTI, and we investigated pandemic H1N1 2009 swine flu virus using rapid test PCR.
Results
This study involved 495 patients with a mean age of 57.79 ± 18.43 years. The causative agents were identified in 157 patients out of 495 patients (31.7%). FTD real-time PCR was done for 170 patients, and the test was positive for seasonal Influenza A virus in 7.1% of patients, influenza B in 4.1%, RSV in 4.7%, metapneumovirus in 4.1%, adenovirus in 4.1%, corona 229E/NL63 in 4.1%, parainfluenza virus in 7.6%, and rhinovirus in 3.5%. The percent of cases who were positive for pandemic H1N1 2009 swine flu virus was 4.2%. The rate of ICU admission was 16.8%, and the mortality rate of LRTI was as low as 3.64%.
Conclusions
Viral LRTI is more common in winter season in Jordan, especially in January. Remarkably, Influenza A and Parainfluenza viruses were the main viral causative agents for LRTI in our study
Carbapenems Resistance among Gram Negative Bacteria Isolated from Poultry Samples in Gaza - Palestine
Get PDFBackground: Food is fundamental for everyone’s life. Therefore, the safety of food we consume is a priority. Gram-negative bacteria are important and common cause of human infections and could be transmitted through food handling and consumption. Carbapenemase-producing Gram-negative (CRGN) bacteria are becoming a global threat. Infections caused by CRGN are hard to cure because the carbapenems are last resort drugs for treatment. The main objective of this research is to determine the occurrence of Carbapenem-resistance among Gram-negative bacteria from poultry samples.
Results: Two hundred twenty samples (chicken litters, water, chicken feed, and intestinal content) were collected from slaughterhouses, farms, and homes from different locations in Gaza strip. Samples were cultured onto MacConkey and Blood agar plates. Gram negative isolates were identified using conventional techniques. Disk diffusion method (based on CLSI recommendations) was used to determine the antimicrobial susceptibility against 14 antimicrobials including two carbapenems (Meropenem and imipenem). Carbapenemase production was detected by the Modified Hodge Test (MHT). The Multiple Antibiotic Resistance (MAR) index for each isolate was calculated.
Escherichia species were the most frequent isolates (39.5%), followed by non-lactose fermenting Enterobacteriaceae (29.5%), other lactose fermenting Enterobacteriaceae (29%). The lowest frequency was for non-fermenting Gram-negative bacilli (4.8%). Most isolates were resistant to most antimicrobial agents tested. A prominent exception was observed with meropenem, and amikacin with only 4% resistance. 41 isolates (34.7%) were resistance to imipenem. High level of intermediate results was detected for imipenem (45.2%). Among 124 isolates, 44 carbapenem-resistant (35.5%) were detected. None of the five meropenem resistant isolates and only five out of the 43 imipenem resistance isolates tested positive for carbapenemase production. Most isolates showed resistance to three or more antibiotics and are regarded as multidrug resistant strains. MDR isolates were present in 117 isolates (94.3%) with MARI index (higher than 0.3).
Conclusion: Resistance to carbapenems as well as to other antimicrobials was high among GNB isolates as indicated by the MAR index. Concerned authorities should consider these alarming finding and implement an immediate monitoring program for poultry. Cross contamination, prevention measures should also be promoted and implemented
Relevance of vancomycin suceptibility on patients outcome infected with Staphylococcus aureus
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Staphylococcus aureus is a serious pathogen with high rates of complications. We aim to study the susceptibility and outcome of S. aureus infection.
Methods:
A retrospective multicentre study conducted in three hospitals, Amman - Jordan. Between June 2013 and March 2014 laboratory records were reviewed for culture-positive samples growing S. aureus, also, medical records for the patients were reviewed for the demographic data, predisposing conditions, vancomycin MIC level and outcome. Inpatients and outpatients were included, a case was classified as either hospital-associated (HA), community-associated (CA), or healthcare-associated (HCA). Data were entered as excel sheets and were statistically analysed using SPSS version 22.
Results:
A total of 127 patient (46% MRSA) were culture-positive for S. aureus from different sources were collected. Eighty (63%) were inpatients. High resistance rates to non β-lactam antimicrobials were recorded. Glycopeptides agents were the antibiotics of choice for the treatment of infections caused by MRSA strains. Complications rates were higher for patients with MRSA infections including mortality, but hospital stay was longer for MSSA.
Conclusion
MRSA rates were high though it lately appeared plateauing in Jordan. There is a value for knowing vancomycin MICs for S. aureus as it has its own implications for outcomes, though most outcomes evaluated were significantly worse with MRSA infection
Impact of misuse of antimicrobial agents on egg bitterness
Get PDFA hundred raw eggs samples randomly selected from Aswan university residence restaurant due to students' complain of bitter taste presence in the table eggs served to them during breakfast. The samples were examined physically and chemically for antibiotic residues and vitamins A, D3 levels concentration by Spectrophotometer. The result showed that all interior egg quality traits were normal except the presence of small blood spots in 5 eggs yolk, bitter taste were present in 18 eggs yolk, antimicrobial residues were detected in 19 eggs yolk and 4 eggs white. Antimicrobial residues positive samples were examined quantitatively by HPLC for Doxycycline (DC) residues presence. The results showed that 100% of examined samples having DC residues with means concentrations of 35±1.46 and 97±4.46 ppb for eggs white and yolk respectively. The mean levels of vitamin A and D3 in eggs yolk were 447±5.49 µg/100g and11±1.35 µg/100g respectively. The paper concludes that the high concentrations of Vitamins and Doxycycline may be the cause of bitter taste of egg
Pseudomonas aeruginosa a common opportunistic pathogen in Jordan: A review article.: Pseudomonas aeruginosa
No full textPseudomonas aeruginosa is widely present in many diverse environments. It can be found in various living sources, including water, plants, intestinal tract of human and animals, and most importantly hospital environment. The organism is an important cause of nosocomial infections, such as septicemia and pneumonia, life-threatening infections in immunocompromised persons, and chronic infections in cystic fibrosis patients. Recent studies reported that hospitalized patients infected with multidrug resistance (MDR) P. aeruginosa have increased hospital length of stay and mortality. This short review focus on the current common occurrence and antimicrobial susceptibility pattern of P. aeruginosa in Jordan
First data on antimicrobial susceptibility patterns of Moraxella catarrhalis isolates in Lebanon
Get PDFBackground. 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