Browsing by Author "Shallouf, Mohamed"

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    Carbapenem resistance expressed by Gram-negative bacilli isolated from a cohort of Libyan patients
    (BioMed Central, 2016) Shallouf, Mohamed; Abrantes, Pedro Miguel dos Santos; Africa, Charlene W.J.
    Background and objectives: Carbapenem-resistant Enterobacteriaceae (CRE) and other Gram-negative bacteria are among the most common pathogens responsible for both community and hospital acquired infection. The global spread of cephalosporinases in Enterobacteriaceae has led to the increased use of carbapenems resulting in the emergence and rapid spread of CRE. This has become an alarming public health concern, yet the condition in Libya remains unclear. The aim of this study was to obtain a better understanding of CRE strains prevalent in Libyan patients by investigating their phenotypic characteristics and antibiograms. Methods: Gram-negative bacterial species were collected from Misrata Central Hospital, Misrata Cancer Centre and Privet Pathology Laboratories. Clinical samples and swabs were obtained from hospitalised and non-hospitalised patients and from mechanical ventilation and suction machines. Patients who had received antibiotic therapy for at least three days prior to the study were excluded. The identification and characterization of the isolated species were achieved using the growth characteristics on MacConkey and blood agar, spot tests and API 20E or API 20NE biochemical testing systems. Screening for carbapenem resistance was performed using the disk diffusion method with carbapenem 10 μg and cephalosporin 30 μg disks and minimum inhibitory concentrations (MIC) determined using the Sensititre Gram-negative Xtra plate format (GNX2F). All strains demonstrating resistance or reduced susceptibility to one of the four carbapenems were subjected to carbapenememase activity detection using the RAPIDEC CARBA NP test, Modified Hodge test and carbapenem inactivation methods. Results: A total of one hundred and forty isolates representing fourteen bacterial species were isolated from 140 non-duplicated specimens. Clinical specimens included urine samples (96/140, 68.57%), sputum (15/140, 10.71%), surgical wound swabs (18/140, 12.85%), foot swabs from diabetes mellitus (DM) patients (6/140, 4.29%), ear swabs (3/140, 2.14%) and wound swabs (2/140, 1.43%). Thirty-four (24.29%) isolates demonstrated resistance to at least one of the four carbapenems with Klebsiella pneumoniae representing 73.53% (25 isolates) of all carbapenem resistant species, followed by 8.82% for Pseudomonas aeruginosa (3 isolates), 5.88% for both Proteus mirabilis (2 isolates) and Escherichia coli (2 isolates) and 2.94% for both Citrobacter koseri (1 isolate) and Rahnella aquatilis (1 isolate). The other isolates were either susceptible or cephalosporinase producers. Conclusion: This study has revealed the high rate of carbapenem resistance amongst Libyan patients and emphasizes the crucial need for accurate screening, identification and susceptibility testing to prevent further spread of nosocomial and community acquired resistance. This may be achieved through the establishment of antibiotic stewardship programmes along with firm infection control practices.
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    Colistin, Carbapenem and Cephalosporin-resistant Klebsiella pneumoniae reported from Misrata, Libya
    (Medpharm Publications, 2017) Shallouf, Mohamed; Abrantes, Pedro Miguel dos Santos; Fielding, Burtram Clinton; Africa, Charlene Wilma Joyce
    Background: National surveillance of antimicrobial resistance has become a mandatory approach to control the spread of antimicrobial resistance and for the establishment of antibiotic treatment guidelines. In this study, clinical isolates of K. pneumoniae were phenotypically investigated for the presences of Colistin and beta-lactams resistance. Methods: Clinical samples were obtained from hospitalized (n=140) and non-hospitalized patients (n=60) in Misrata, Libya. Identification of the isolated species was achieved using the VITEK 2 compact system. Screening for Carbapenem and Cephalosporin-resistance was performed using the disk diffusion method with Carbapenem (10µg) and Cephalosporin (30µg) disks and Minimum Inhibitory Concentration (MIC) determined by VITEK 2. Colistin resistance was determined using both Sensititre Gram-negative Xtra plate format (GNX2F) and VITEK 2. Carbapenemase activity was detected using the RAPIDEC CARBA NP, Modified Hodge test, Carbapenem inactivation method, MAST Combi Carba plus kit (D73C) and Meropenem combined disk test. ESBL and AmpC production was confirmed using Sensititre ESBL confirmatory plates (ESB1F), modified double disk synergy test MDDST, MAST ESBL detection kit D67C, AmpC & ESBL detection kit D68C along with AmpC detection kit D69C. Results and conclusion: Of the 200 clinical isolates, 85 (42.5%) were K. pneumoniae of which 54 (63.52%) demonstrated resistance to at least one of the Carbapenems, 16 (18.82%) were ESBL or AmpC producers and 2 (2.35%) were Carbapenem and Colistin resistant. 13 (21.25%) isolates were susceptible to all antibiotics tested except Ampicillin and Augmentin.