Antimicrobial resistance and plasmid profiles of urinary Escherichia coli isolates from Jordanian patients

A.A. Shehabi, A.M. Mahafzah and K.Z. Al-Khalili

Department of Pathology and Microbiology, Faculty of Medicine, University of Jordan, Amman, Jordan.

ABSTRACT We investigated antimicrobial resistance patterns and plasmid profiles of uropathogenic Escherichia coli isolates from inpatients and outpatients at Jordan University Hospital in 2000 and 2001. E. coli accounted for 32.4% and 37.4% of all isolates respectively. The lowest susceptibility was for ampicillin (11%), cotrimoxazole (23%) and tetracycline (26%). The relative incidence of resistant isolates of E. coli to nalidixic acid, gentamicin, norfloxacin, cefuroxime and nitrofurantoin was significantly greater for inpatients than for outpatients (P < 0.05). A large, transferable R-plasmid of 28 kb was found in most E. coli isolates (67%) that were resistant to at least ampicillin, cotrimoxazole and tetracycline. This R-plasmid reservoir may contribute to the spread of multiple antibiotic resistance in our Region.

Eastern Mediteranean Health Journal Volume 10, No. 3, May 2004, Pages  322 – 328

 

Characterization of diarrhoeagenic Escherichia coli isolates in

Jordanian children.

 

Shehabi AA, Bulos NK, Hajjaj KG.

Department of Pathology/Microbiology, Faculty of Medicine, Jordan University Hospital, Amman, Jordan.

 
In a prospective study carried out among Jordanian children in Amman, a total of 73/250 (29.2%) stool specimens were positive for 1 or more diarrhoeagenic Escherichia coli strains using a multiplex polymerase chain reaction method. This study indicated that diarrhoeagenic E. coli isolates were found frequently more in stools of children with diarrhoea (34%) than without diarrhoea (23.1%), but without any significant difference (p > 0.05). The predominant diarrhoeagenic E. coli strains associated with diarrhoea were enteropathogenic E. coli (11.3%), followed by enterotoxigenic E. coli (9.8%) and enteroaggrative E. coli (9%), whereas in the control group these were 4.3%, 11.1% and 6%, respectively. Enteroinvasive E. coli strains (2.9%) were found only in stools of children with diarrhoea. This study revealed the absence of enterohaemorrhagic E. coli in both diarrhoeal and control stools, and found that diarrhoeagenic E. coli isolates were highly resistance to tetracycline (55%), co-trimoxazole (60%) and ampicillin (89%), which are commonly used antibiotics in Jordan.

 Scand J Infect Dis. 2003;35(6-7):368-71.

 

Investigation of Burkholderia cepacia nosocomial outbreak with high fatality in patients suffering from diseases other than cystic fibrosis.

Shehabi AA, Abu-Al-Soud W, Mahafzah A, Khuri-Bulos N, Abu Khader I, Ouis IS, Wadstrom T.

Department of Clinical Laboratories, Jordan University Hospital, Amman, Jordan.

Over a 1-y period, 26 inpatients at the Jordan University Hospital in Amman were detected with bacteraemia (23 cases) or respiratory tract colonized with B. cepacia (3 cases). A combination of genetic identification and molecular typing has proved that all cases were caused by a single epidemic strain of B. cepacia genomovar IIIa. Nosocomial infections could be documented in 21/26 (81%) patients, mostly with severe underlying or malignant diseases other than cystic fibrosis, but the source of infection was undetected. The overall mortality related to infection with B. cepacia was 42%. All B. cepacia isolates were resistant to ampicillin, amikacin, carbenicillin and gentamicin; and mostly susceptible to piperacillin, chloramphenicol, cotri-moxazole, tetracycline, ceftazidime, and tazocin (62-88%). This study demonstrates the nosocomial and high fatality of  genomovar IIIa in Jordanian patients suffering from diseases other than cystic fibrosis.

Scand J Infect Dis. 2004;36(3):174-8.

 

Prevalence of Clostridium difficile-associated diarrhoea among hospitalized Jordanian patients.

Shehabi AA, Abu-Ragheb HA, Allaham NA.

Department of Pathology, Microbiology and Forensic Medicine, Jordan University Hospital, University of Jordan, Amman, Jordan.

 

We investigated stool specimens of 400 patients at Jordan University Hospital (300 patients with clinical diarrhoea and 100 controls without diarrhoea) for the presence of Clostridium difficile or its toxin. We found a 9.7% prevalence rate of C. difficile or its toxin in stools of patients with diarrhoea. The prevalence of other potential enteric pathogens, such as Salmonella spp. (2.3%), Shigella spp. (1.0%) and Entamoeba histolytica (2.7%), was significantly less. Prevalence of C. difficile or its toxin in controls was 3.0%. Toxin A was detected in 93.1% of C. difficile-associated diarrhoea cases using an enzyme immunoassay. Our study indicates that C. difficile-associated diarrhoea is mostly observed among hospitalized patients aged > or = 50 years, in association with antimicrobial treatment.

East Mediterr Health J. 2001 Jul-Sep;7(4-5):750-5.

 

 

Oral candidosis in patients with removable dentures.

Dar-Odeh NS, Shehabi AA.

Department of Oral Surgery, Oral Medicine, and Periodontics, University of Jordan, Amman, Jordan.

 

The prevalence of Candida species with and without denture-related stomatitis were evaluated in 167 Jordanian patients. The study revealed that 47 (28%) of the patients with denture-related stomatitis were colonized with Candida species (clinical group). Candida albicans was responsible for most cases of denture-related stomatitis (72%), and it was the only species capable of secreting aspartic proteinases. The study also indicated that candidal colonization was not influenced by predisposing haematological deficiencies, as both the clinical and control patient groups showed comparable haematological parameters and the differences were not significant (P > 0.05). All Candida species isolates were 100% susceptible to amphotericin B, while these isolates were less susceptible (25-75%) to fluconazole.

 Mycoses. 2003 Jun;46(5-6):187-91.

 

Common antimicrobial resistance patterns, biotypes and serotypes found among Pseudomonas aeruginosa isolates from patient's stools and drinking water sources in Jordan.

Shehabi AA, Masoud H, Maslamani FA.

Department of Pathology-Microbiology, Faculty of Medicine, University of Jordan, Amman, Jordan.

 

Pseudomonas aeruginosa was isolated in low rates from stool specimens of outpatients and inpatients (7% versus 12%) but in higher rates from chlorinated and nonchlorinated water sources (15% versus 44%), respectively in Jordan. The same biotype was recognized among 90% of P. aeruginosa isolates from patient's stools and water sources using specific biochemical profiles. Three serogroups belonging to 01, 06 and 011 accounted for the majority of these isolates in water (66%) and stools (78%), respectively. All P. aeruginosa isolates from water were highly susceptible (87%-100%) to piperacillin-tazobactam, amikacin, gentamicin, imipenem, aztreonam, ceftazidime and ciprofloxacin, whereas the isolates from stool were slightly less susceptible (81%-98%) to these antimicrobials. P. aeruginosa isolates from water and stool sources were almost equally highly resistant to tetracycline (86%-89%) and carbenicillin (88%-89%), respectively. One common small plasmid (15.4 kb) was detected in 14/25 (56%) of multidrug-resistant P. aeruginosa isolates from both water and stool. This study demonstrates certain common epidemiological characteristics including antimicrobial resistance pattern, biotypes and serotypes among P. aeruginosa isolates from patient's stools and drinking water sources in Jordan.

 J Chemother. 2005 Apr;17(2):179-83.

 

Proteus mirabilis clinical isolate harbouring a new variant

of Salmonella genomic island 1 containing the multiple

antibiotic resistance region

Ashraf M. Ahmed^1,2, Amjad I. A. Hussein³ and Tadashi Shimamoto1¹

¹Laboratory of Food Microbiology and Hygiene, Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima 739-8528, Japan; ²Department of Microbiology, Faculty of Veterinary Medicine, Kafr El-Sheikh University, Kafr El-Sheikh 33516, Egypt; ³Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8640, Japan

 

Objectives: A clinical isolate of Proteus mirabilis strain 18306, which displayed the multidrug resistance phenotype of Salmonella genomic island 1 (SGI1), was examined for the presence of this island including its multiple antibiotic resistance genomic region. Methods: P. mirabilis 18306 was isolated in March 2006 from a patient in Palestine with diabetic foot infection. Antibiotic susceptibility tests and various molecular techniques, including PCR, cloning and DNA sequencing were used for detection and characterization of SGI1 in P. mirabilis 18306. Results: P. mirabilis 18306 showed the typical multidrug resistance phenotype of SGI1 as it was resistant to ampicillin, chloramphenicol, streptomycin, sulphonamides and tetracycline, in addition to trimethoprim and nalidixic acid. Molecular characterization showed that P. mirabilis 18306 harboured a structure similar to SGI1, except that the aadA2 gene, which confers resistance to streptomycin and spectinomycin, of standard SGI1 had been replaced with dfrA15, which confers resistance to trimethoprim. Furthermore, the nucleotide sequence of the extrachromosomal circular form of SGI1 in P. mirabilis was found to be identical to that of Salmonella typhimurium DT104. However, PCR results showed that P. mirabilis 18306 was negative for the left and right junctions which represent the integration sites of SGI1 into Salmonella enterica chromosome. Hence, this new variant of SGI1 may be integrated at a different site into the chromosome of P. mirabilis 18306. Tn1826 derived class 2 integron, which carries only two gene cassettes, sat2 and aadA1, was also identified in this strain. Conclusions: In this study, we identified a new variant SGI1 containing the multiple resistance genomic region in a multidrug-resistant strain of. This is the first report for SGI1 in a genus other than Salmonella.

 

Genetic characterization of multidrug resistance in

Shigella spp. from Japan

Ashraf M. Ahmed,^{1, 3} Kimi Furuta, ² Kei Shimomura, ¹ Yoshio Kasama¹

and Tadashi Shimamoto¹

 

¹Laboratory of Food Microbiology and Hygiene, Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima 739-8528, ²Division of Biological Science, Hiroshima City Institute of Public Health, Hiroshima 733-8650, Japan, ³Department of Microbiology, Faculty of Veterinary Medicine, Kafr El-Sheikh University, Kafr El-Sheikh 33516, Egypt

 

This study characterized the genetic basis of antimicrobial resistance of a number of Shigella spp. isolated from humans from 2000 to 2004 in Hiroshima prefecture, Japan. A total of 26 isolates of Shigella spp. were included in this study. Antimicrobial susceptibility tests revealed high levels of resistance, especially to ampicillin, streptomycin, trimethoprim, tetracycline, nalidixic acid and ciprofloxacin. PCR and DNA sequencing were used for screening and characterization of antibiotic-resistance determinants. PCR sequencing analysis revealed the presence of only one type of class 1 integron in one isolate of Shigella sonnei. This class 1 integron was 1904 bp and contained two gene cassettes: a probable esterase/lipase (estX) and aadA1, which confers resistance to streptomycin and spectinomycin. Two types of class 2 integron were identified in this study. One was the classic type (2158 bp) and carried the three conserved resistance gene cassettes of the class 2 integron, dfrA1, sat1 and aadA1, which confer resistance to trimethoprim, streptothricin and streptomycin/spectinomycin, respectively. This type was detected in both Shigella sonnei (14 isolates) and Shigella flexneri (five isolates). The other type was shorter (1313 bp) and carried only two gene cassettes, dfrA1 and sat1. This integron was detected in a single isolate of Shigella sonnei. PFGE patterns showed limited diversity within clusters of the same species. Furthermore, an extended-spectrum β-lactamase gene, bla_OXA-30, which confers resistance to ampicillin, was characterized in all isolates of Shigella flexneri except the oldest strain, which was isolated in 2000. Southern blot hybridization and conjugation experiments showed that bla_OXA-30 was located in the chromosome.

J Med Microbiol (2006); 55: 1685-1691

 

 

Molecular characterization of integrons in non-typhoid

Salmonella serovars isolated in Japan: description

of an unusual class 2 integron

Ashraf M. Ahmed, Hiroyuki Nakano and Tadashi Shimamoto

 

Laboratory of Food Microbiology and Hygiene, Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8528, Japan.

 

Objectives: To characterize class 1 and class 2 integrons among non-typhoid Salmonella enterica serovars in Japan, and also to monitor the spread of the multidrug-resistant S. enterica serovar Typhimurium DT104. Methods: A total of 105 Salmonella isolates were included in this study. The broth microdilution method was used to determine the MIC values of a range of antibiotics for these isolates. PCR and DNA sequencing were used for screening and characterization of class 1 and class 2 integrons. Results: PCR sequencing analysis revealed the presence of seven profiles of class 1 integrons in addition to a new type of class 2 integron. The identified gene cassettes within class 1 integrons were as follows; aadA1, aadA2 and aadA5, which confer resistance to streptomycin and spectinomycin; aadB, which confers resistance to gentamicin, kanamycin and tobramycin; dfrA1 and dfrA17, which confer resistance to trimethoprim; bla_PSE-1, which confers resistance to ampicillin; catB3, which confers resistance to chloramphenicol; and sat1, which confers resistance to streptothricin. Two strains of the multidrug-resistant S. Typhimurium DT104 were characterized in this study. DNA sequencing of class 2 integrons identified one with an unusual array of gene cassettes, sat, sat1 and aadA1.

Conclusions: In this study, we characterized the antibiotic resistance gene cassettes within class 1 integrons in different isolates of non-typhoid Salmonella serovars, and we also identified a new type of class 2 integron.

J Antimicrob Chemother 2005; 55: 371-374

 

 

A variant type of Vibrio cholerae SXT element in a

multidrug-resistant strain of Vibrio. fluvialis

Ashraf M. Ahmed ^a, Sumio Shinoda ^b , Tadashi Shimamoto ^a

 

^aLaboratory of Food Microbiology and Hygiene, Graduate School of Biosphere Science, Hiroshima University, 1-4-4 Kagamiyama, Higashi-Hiroshima 739-8528, ^bGraduate School of Natural Science and Technology, Okayama University, Okayama 700-8530, Japan

 

Vibrio fluvialis strain H-08942 was isolated from an infant aged 6 months who was suffering from cholera-like diarrhea in India. This strain showed the typical multidrug-resistance phenotype of an SXT element. It was resistant to sulfamethoxazole (Su), trimethoprim (Tm), chloramphenicol (Cm) and streptomycin (Sm), in addition to other antibiotics such as ampicillin (Am), furazolidone (Fz), nalidixic acid (Na), and gentamicin (Gm). The SXT element is a Vibrio cholerae-derived integrative and conjugative element (ICE) that has also been referred to as a conjugative transposon. Our goal was to find a relationship between these resistant phenotypes and the presence of the SXT element in this unique strain. By using PCR, we detected the antibiotic resistance genes, the integrase gene and the attP attachment site of SXT element. Cloning and DNA sequencing results showed that both the SXT integrase gene and its attP site of V. fluvialis were similar but not identical to those of V. cholerae. The SXT integrase gene of V. fluvialis has a 99% identity to that of V. cholerae, and the attP site of SXT of V. fluvialis is variant and shorter (641 bp) than that of V. cholerae (785 bp). It was possible for the SXT of V. fluvialis to be transferred by conjugation to a laboratory strain of Escherichia coli. Here, we report the detection of a variant SXT element in species other than V. cholerae, with molecular characterization and analysis of its integrase gene and its attP site.

 

Molecular characterization of a multidrug-resistant

strain of enteroinvasive Escherichia coli O164

isolated in Japan

Ashraf M. Ahmed,¹ Shin-ichi Miyoshi, ² Sumio Shinoda² and Tadashi Shimamoto¹

¹Laboratory of Food Microbiology and Hygiene, Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima 739-8528, ²Graduate School of Natural Science and Technology, Okayama University, Okayama 700-8530, Japan

 

 

A plasmid-encoded class 1 integron carrying sat, a putative phosphoserine phosphatase gene and aadA2 from enterotoxigenic Escherichia coli O159 isolated in Japan

Ashraf M. Ahmed, Tadashi Shimamoto *

 

Laboratory of Food Microbiology and Hygiene, Graduate School of Biosphere Science, Hiroshima University, 1-4-4 Kagamiyama, Higashi-Hiroshima, Hiroshima 739-8528, Japan

 

 

New aminoglycoside acetyltransferase gene, aac(3)-Id, in a

class 1 integron from a multiresistant strain of Vibrio fluvialis

isolated from an infant aged 6 months

 

Ashraf M. Ahmed¹, Tomoko Nakagawa², Eiji Arakawa³, Thandavarayan Ramamurthy⁴,

Sumio Shinoda² and Tadashi Shimamoto1

 

¹Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima; ²Graduate School of Natural Science and Technology, Okayama University, Okayama; ³Department of Bacteriology, National Institute of Infectious Diseases, Tokyo, Japan; ⁴National Institute of Cholera and Enteric Diseases, Calcutta, India. 

 

Objectives: To characterize the molecular basis of antibiotic resistance in a multidrug-resistant clinical isolate of Vibrio fluvialis H-08942. Patient and methods: V. fluvialis H-08942 was isolated from a hospitalized infant aged 6 months suffering from cholera-like diarrhoea in India in 2002. The broth microdilution method was used to determine the MICs of a range of antibiotics for this strain. PCR, DNA sequencing, Southern hybridization, cloning and expression were used to characterize the molecular basis of antibiotic resistances. Results: V. fluvialis H-08942 showed resistance to chloramphenicol, streptomycin, spectinomycin, co-trimoxazole, ampicillin, furazolidone, nalidixic acid and gentamicin. A class 1 integron that contains a novel aminoglycoside acetyltransferase gene, aac(3)-Id, and aminoglycoside adenyltransferase gene, aadA7, was characterized. The aac(3)-Id gene product was found to share 50%, 45% and 44% identity to AAC(3)-Ic, AAC(3)-Ia, and AAC(3)-Ib, respectively. Both aac(3)-Id and aadA7 genes were cloned and expressed in Escherichia coli. Phylogenetic analysis suggested that the aac(3)-Id represents a fourth evolutionary lineage in the aminoglycoside acetyltransferase genes. Southern hybridization showed that this integron is located in the chromosome. Conclusions: In this study we identified a new type of aminoglycoside acetyltransferase gene, aac(3)-Id. In addition, this is the first report of identification of antibiotic resistance genes and a class 1 integron in V. fluvialis.

J Antimicrob Chemother 2004; 53: 947-951

 

 

 

Incidence of resistance to imipenem among hospital strains of Pseudomonas aeruginosa and surveillance for bla_IMP gene

Fatma A. Amer, Eman M. El-Behedy, Heba A. Mohtady, Nana A. Mohamed, Hala E. Zanfaly*, Dalal E. M. Soud*, Salem Khalil**, Yasser A. El-Hendy***, Tarek M. El-Behedy,**** Eman El-Gendy*****

Microbiology and Immunology Department, Anaesthesiology Department*, Department of Urology**, Department of Medicine***, Department of Gynecolody and Obstetrics****, Faculty of Medicine,  Zagazig University,  Zagazig, Egypt

 

Background: P. aeruginosa is a troublesome pathogen that generally demonstrates resistance to various antimicrobial agents. Imipenem (IMP) is a carbapenem antibiotic, which has a strong activity against P. aeruginosa. However, IMP-resistant clinical isolates of P. aetuginosa emerged. Among mechanisms of resistance is the production of metallo- β- lactamases. Two metallo- β- lactamase genes, imp and vim, have been shown to encode the production of IMP- and VIM-type β- lactamases. IMP-type enzymes were the first acquired metallo β- lactamases to be identified and IMP-1 was the first member of the growing IMP-type enzymes' family to be detected. The current work was carried out to determine the incidence of resistance to IMP, among hospital strains fo P. aeruginosa isolated in Zagazig University Hospitals and to survey for the existence of bla_IMP gene encoding IMP-1 metallo β- lactamase among IMP-resistant isolates.

Methods: P. aeruginosa were isolated from cases of nosocomial infections in various departments. Identification was carried out by conventional methods and by API 20 NE. Disk diffusion method was used to determine susceptibility to IMP, and susceptibility of IMP-resistant strains to commonly prescribed antimicrobials. Surveillance for the bla_IMP gene was done by PCR methodology. The minimum inhibitory concentration (MIC) of IMP to IMP-resistant strains carrying bla_IMP gene was determined by agar-dilution method.

Results: 261 strains of P. aeruginosa were recovered. 31 strains were resistant to IMP as well as to multiple antimicrobial agents. bla_IMP gene of 741 bp size, was amplified from the chromosomal DNA of eight strains. 6 out of these 8 strains demonstrated high-level IMP reistance. The rest demonstrated moderate resistance. The majority of bla_IMP positive strains were from the intensive care unit (ICU) and they have the same antibiotic susceptibility profile.

Conclusions: Resistance to IMP has started to emerge. To our knowledge, this is the first report about detection bla_IMP gene from Egyptian isolates of P. aeruginosa. Perhaps, bla_IMP positive-ICU strains were representing an epidemic clone, producing an outbreak that was still in the beginning.

Joint Meeting of the 3 Divisions of the Internationa Union of Microbiological Societies 2005. San Francisco, California, USA.July 23-28, 2005. Abstract no. 136-B-785.

 

Antimicrobial susceptibility trends in Campylobacter jejuni and Campylobacter coli isolated from a rural Egyptian pediatric population with  diarrhea.
Putnam SD, Frenck RW, Riddle MS, El-Gendy A, Taha NN, Pittner BT, Abu-Elyazeed R, Wierzba TF, Rao MR, Savarino SJ, Clemens JD.
Enteric Disease Research Program, Naval Medical Research Center, Silver Spring, MD, USA.

Comparative and trend analysis was conducted on annual prevalence of antimicrobial susceptibility among Campylobacter jejuni and Campylobacter coli recovered from rural Egyptian children from 1995 through 2000. C. jejuni and C. coli demonstrated significant decreasing trends in ciprofloxacin susceptibility over the study period (p < 0.001 for both). In general, C. coli demonstrated a higher degree of susceptibility than C. jejuni, however, there was no statistical difference (p = 0.2) comparing the linear trends over the duration of the study. There was no indication of frank macrolide (erythromycin or azithromycin) resistance among any Campylobacter. Moreover, there were statistically significant positive trends in both the MIC(50) and MIC(90) values for the erythromycin and azithromycin during the study period, suggesting a possible decreasing trend in susceptibility among Campylobacter. This study demonstrated that antimicrobial susceptibility in Campylobacter has significantly decreased from 1995 through 2000 among pediatric diarrhea cases in rural Egypt.

 

Cost-effectiveness of different treatment strategies for tuberculosis in Egypt and Syria.

Vassall A, Bagdadi S, Bashour H, Zaher H, Maaren PV.

KITHEALTH, Royal Tropical Institute, Amsterdam, The Netherlands.

SETTING: The National Tuberculosis Programmes in Egypt and Syria. OBJECTIVES: To calculate the costs and effectiveness of alternative ways of implementing TB control in Egypt and Syria, in order to illustrate the factors influencing the cost-effectiveness of TB treatment in middle-income countries. DESIGN: We compared the costs and cure rates in Egypt and Syria of the World Health Organization recommended directly observed treatment, short-course (DOTS) strategy and alternative strategies. The study included costs both to the health services and to the patient. RESULTS: In Egypt and Syria, the cost-effectiveness of DOTS implemented through the primary health care (PHC) system was respectively $258 and $243 per patient cured. This compares to a cost per patient cured of $297 (Egypt) and $693 (Syria) for alternative strategies implemented through specialist clinics. In Egypt, when DOTS is implemented through specialist chest clinics it costs $585 per patient cured. Hospitalisation costs either $1490, $1621 or $1699 per patient cured, depending on treatment delivery in the continuation phase. CONCLUSION: This study demonstrates that the move towards DOTS integrated at the PHC level has substantially improved the effectiveness of TB treatment in Egypt and Syria, without substantially increasing costs. An analysis of the different costs and effectiveness of the variety of TB treatment strategies has enabled both National Tuberculosis Programmes to expand DOTS and implement it in a way that takes into account limited resources and local health systems.

Int J Tuberc Lung Dis. 2002 Dec;6(12):1083-90.

 

Trends of multiple-drug resistance among Salmonella serotype typhi isolates during a 14-year period in Egypt.

Wasfy MO, Frenck R, Ismail TF, Mansour H, Malone JL, Mahoney FJ.
United States Naval Medical Research Unit Number 3, FPO AE 09835-0007, USA.

 

A total of 853 isolates of Salmonella serotype typhi recovered from patients with typhoid fever who were admitted to a major infectious disease hospital in Cairo, Egypt, from 1987 through 2000 underwent antibiotic susceptibility testing to determine multiple-drug resistance. The observed resurgence of chloramphenicol susceptibility (P=.002) may suggest reuse of this drug for the treatment of typhoid fever in Egypt.

Clin Infect Dis. 2002 Nov 15;35(10):1265-8. Epub 2002 Oct 28.

 

 

Identification of clinical criteria for group A-beta hemolytic streptococcal pharyngitis in children living in a rheumatic fever endemic area.

Bassili A, Barakat S, Sawaf GE, Zaher S, Zaki A, Din Saleh EE.
Medical Research Institute, Faculty of Medicine, Alexandra University, Egypt.

            A cross-sectional study was conducted over a 1-year period (1 January-31 December 2000) during which cases suffering from uncomplicated tonsillopharyngitis were recruited from the private and public health services in Alexandria. The objective was to determine the prevalence of group A-beta haemolytic streptococci (GABHS) among children suffering from tonsillopharyngitis and to identify the clinical criteria predicting GABHS pharyngitis in children. A total of 578 children aged between 1 and 15 years with a mean of 6.3 +/- 3.7 years, presenting with sore throat were enrolled in the study. Demographic data and presenting signs and symptoms for each patient were recorded on a standardized form and a throat swab was taken using the filter paper technique. The overall prevalence of GABHS was 17 per cent and the highest isolation rate was reported in children aged 10-15 years. Non-GABHS comprised 11.9 per cent of the total isolates. The most prevalent of them were group C and G streptococci. The highest frequency of both GABHS and non-GABHS was in early spring. Significant predictors of GABHS pharyngitis were: age 10-15 years, the presence of dysphagia, vomiting, pharyngeal exudate, and scarlatiniform rash. Watery eyes and/or rhinitis had a protective value against the diagnosis of GABHS pharyngitis, while fever was considered to be a non-specific finding in cases with GABHS pharyngitis. Antibiotic sensitivity test showed higher sensitivity to both penicillin and erythromycin. Only 1 per cent of the GABHS isolates showed resistance to cephadroxil. We concluded that a syndrome of signs and symptoms could be used as a clinical predictor for the diagnosis of GABHS pharyngitis.

J Trop Pediatr. 2002 Oct;48(5):285-93.

 

Induction of leukaemia in chloramphenicol-treated toads.
el-Mofty MM, Abdelmeguid NE, Sadek IA, Essawy AE, Aleem EA.

Department of Zoology, Faculty of Science, University of Alexandria, Alexandria, Egypt.

 

Chloramphenicol has been associated with the development of aplastic anaemia. As it is still widely used in Egypt, we studied its effect on 100 Egyptian toads (Bufo regularis) given a dose of chloramphenicol of 5 mg/40 g body weight for 12 weeks. We found it induced numerous, severe ultrastructural changes in almost all types of leukocytes. These changes were similar to those induced by the chemical carcinogen 7,12-dimethylbenz(a)anthracene in 100 toads used as the carcinogen control group, and similar to those in leukocytes reported in humans with leukaemia. We recommend regulations be applied on the use of this antibiotic in countries where it is still widely used.

East Mediterr Health J. 2000 Sep-Nov;6(5-6):1026-34.

 

Antimicrobial susceptibilities of clinical isolates of Haemophilus influenzae and Moraxella catarrhalis collected during 1999-2000 from 13 countries.

Turnak MR, Bandak SI, Bouchillon SK, Allen BS, Hoban DJ.

Lilly Research Laboratories, Lilly Corporate Center, DC 6061, Indianapolis, IN 46285, USA.

OBJECTIVE: To determine antimicrobial activity against Haemophilus influenzae and Moraxella catarrhalis. METHODS: A central laboratory performed NCCLS susceptibility testing for all isolates and beta-lactamase and capsular serotype determinations for H. influenzae. RESULTS: A total of 2712 H. influenzae and 1079 M. catarrhalis were collected. H. influenzae susceptibilities were >90% for amoxicillin/clavulanate, cefaclor, loracarbef, cefprozil, cefuroxime, ciprofloxacin, azithromycin and clarithromycin and were <80% for trimethoprim/sulfamethoxazole and ampicillin. 19.3% were beta-lactamase positive. The most common serotype was type-b (5.6%); 86.1% were nontypeable. M. catarrhalis had MIC90 within therapeutic range for all antimicrobials except ampicillin. CONCLUSION: The conclusion of the study is that antimicrobials, except ampicillin and trimethoprim/sulfamethoxazole, remain good empiric choices against H. influenzae and M. catarrhalis.

Clin Microbiol Infect. 2001 Dec;7(12):671-7.

 

Honey, a prospective antibiotic: extraction, formulation, and stability.
Zaghloul AA, el-Shattawy HH, Kassem AA, Ibrahim EA, Reddy IK, Khan MA.
School of Pharmacy, Al-Azhar University, Nasr City, Cairo, Egypt. Texas Tech University Health Science Center, Amarillo, TX, USA.

            Old and recent reports show that honey has beneficial effects on the skin as antiseptic for wounds, burns and ulcers and as a healing promoter. Many investigators confirmed the usefulness of honey in the treatment of skin infections as well as internal diseases. The factors behind these effects are not completely explained. The aim of this study is: a) to investigate the antimicrobial activity of crude honey, b) to separate the fractions responsible for its activity, c) to formulate the honey extract as semisolid dosage forms, d) to study its release, and e) to determine its stability. The results showed that the ethylacetate honey extract showed antibacterial, anticandida and antifungal effects at low concentration. The release of honey extract from different ointment bases was depending on the constituents of the base, and its stability was found to be temperature and base dependent.

Pharmazie. 2001 Aug;56(8):643-7.

 

Characterization of IS6110 restriction fragment length polymorphism patterns and mechanisms of antimicrobial resistance for multidrug-resistant isolates of Mycobacterium tuberculosis from a major reference hospital in Assiut, Egypt.

Abbadi S, Rashed HG, Morlock GP, Woodley CL, El Shanawy O, Cooksey RC.
Division of AIDS, STD, and TB Laboratory Research, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

 

We evaluated 25 Mycobacterium tuberculosis isolates from patients at a major Egyptian reference hospital in Assiut, Egypt, who had been treated for at least 1 year for tuberculosis. Typing patterns (IS6110) were diverse, and multidrug resistance was found among 11 (44%) of the isolates. Mutations associated with antimicrobial drug resistance were found in rpoB, katG, rpsL, and embB in the resistant isolates.

J Clin Microbiol. 2001 Jun;39(6):2330-4.

 

Isolation and antibiotic susceptibility of Salmonella, Shigella, and Campylobacter from acute enteric infections in Egypt.

Wasfy MO, Oyofo BA, David JC, Ismail TF, el-Gendy AM, Mohran ZS, Sultan Y, Peruski LF Jr.

U.S. Naval Medical Research Unit No. 3, Cairo, Egypt.

 

          While Campylobacter, Salmonella, and Shigella remain major contributors to acute enteric infections, few studies on these pathogens have been conducted in Egypt. From January 1986 to December 1993, 869 Salmonella, Shigella and Campylobacter strains were isolated from stool specimens from 6,278 patients, presenting to the Abbassia Fever Hospital, Cairo, Egypt, with acute enteric infections. Salmonella predominated, totalling 465 isolates, followed by Shigella with 258 isolates, and Campylobacter with 146 isolates. Of the Shigella isolates, 124 were Shigella flexneri, 49 were Sh. sonnei, 47 were Sh. dysenteriae (mainly serotype 1, 2, and 3), and 38 were Sh. boydii. Campylobacter spp. comprised 92 Campylobacter jejuni and 54 C. coli isolates. Isolation of Salmonella was highest during the months of February-March, June-July, and October-November, while that of Shigella was maximal from July to October. Isolation of Campylobacter increased during May-June and again during August-October. Although Salmonella was sensitive to amikacin, aztreonam, ceftriaxone, and nalidixic acid, it was, however, resistant to erythromycin, streptomycin, ampicillin, chloramphenicol, and tetracycline. Shigella (> 80%) was sensitive to amikacin, ceftriaxone, cephalothin, sulphamethoxazole-trimethoprim (except Sh. sonnei), aztreonam, and nalidixic acid. Resistance (> 50%) was noted only for ampicillin, chloramphenicol, and tetracycline. C. jejuni and C. coli were resistant to cephalothin, aztreonam, and streptomycin. Some of the above antibiotics were employed to characterize the Egyptian isolates, but did not have any clinical utility in the treatment of diarrhoea. Significant differences (p < 0.05) were observed in the resistance profiles of Shigella and Salmonella between late 1980s and early 1990s. The results suggest the use of fluoroquinolones or a third-generation cephalosporin as an empirical treatment of enteric diseases. However, alternative control strategies, including the aggressive development of broadly protective vaccines, may be more effective approaches to curbing morbidity and mortality due to acute enteric infections.

J Health Popul Nutr. 2000 Jun;18(1):33-8.

 

A clinical decision rule for management of streptococcal pharyngitis in low-resource settings.

Steinhoff MC, Walker CF, Rimoin AW, Hamza HS.

Department of International Health, Bloomberg School of Public Health, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.

 

BACKGROUND: Most of the world's children live in regions where laboratory facilities are not available. In these regions, clinical prediction rules can be useful to guide clinicians' decisions on antibiotic therapy for streptococcal pharyngitis, and to reduce routine presumptive antibiotic therapy for all pharyngitis. METHODS: Prospective cohort study to assess diagnostic signs and develop a prediction rule. Bivariate and multivariate analyses were used to develop clinical rules. Participants were 410 children in Cairo, Egypt, aged from 2 to 12 y, presenting with complaint of sore throat and whose parents provided consent. Main outcome measures included presence of signs and symptoms, and positive group A beta hemolytic streptococcal (GABHS) culture. RESULTS: 101 (24.6%) children had positive GABHS culture. Pharyngeal exudate, tender or enlarged anterior cervical lymph nodes, season, absence of rash, or cough or rhinitis were associated with positive culture in bivariate and multivariate analyses. Three variables (enlarged nodes, no rash, no rhinitis), when used in a cumulative score, showed 92% sensitivity and 38% specificity in these children. CONCLUSIONS: The proposed three-variable clinical prediction rule for GABHS may be useful when diagnostic laboratories are not available. In this setting, the rule identified more than 90% of true cases. Compared to universal treatment of all pharyngitis, the rule will reduce antibiotic use in GABHS-negative cases by about 40%.

Acta Paediatr. 2005 Aug;94(8):1038-42.

 

Eremophilane-type sesquiterpene derivatives from Senecio aegyptius var. discoideus.
El-Hamd H Mohamed A, Ahmed AA.

Department of Chemistry, Aswan-Faculty of Science, South Valley University, Aswan, Egypt.

 

Investigation of a CH(2)Cl(2) extract of the aerial parts of Senecio aegyptius var. discoideus afforded nine eremophilane compounds, of which six are new (1-6), namely, 1beta-hydroxy-8alphaH-eremophil-7(11),9-dien-8beta,12-olide (1), 1beta,8alpha-dihydroxyeremophil-7(11),9-dien-8beta,12-olide (2), 1beta-hydroxy-8alpha-methoxyeremophil-7(11),9-dien-8beta,12-olide (3), 1-oxo-8alpha-methoxy-10alphaH-eremophil-7(11)-en-8beta,12-lactam (4), 1beta,10beta-epoxy-8alpha-hydroxyeremophil-7(11)-en-8beta,12-olide (5), and 1beta,10beta-epoxy-8alpha-methoxyeremophil-7(11)-en-8beta,12-olide (6). The structures of 1-6 were elucidated by spectroscopic methods and by comparison with literature data. The antibacterial activity of the isolated compounds was tested against Bacillus cereus and a Serratia sp.

J Nat Prod. 2005 Mar;68(3):439-42.

 

Phenotypic profiles of enterotoxigenic Escherichia coli associated with early childhood diarrhea in rural Egypt.

Shaheen HI, Khalil SB, Rao MR, Abu Elyazeed R, Wierzba TF, Peruski LF Jr, Putnam S, Navarro A, Morsy BZ, Cravioto A, Clemens JD, Svennerholm AM, Savarino SJ.

U.S. Naval Medical Research Unit Number 3, Cairo, Egypt.

Enterotoxigenic Escherichia coli (ETEC) causes substantial diarrheal morbidity and mortality in young children in countries with limited resources. We determined the phenotypic profiles of 915 ETEC diarrheal isolates derived from Egyptian children under 3 years of age who participated in a 3-year population-based study. For each strain, we ascertained enterotoxin and colonization factor (CF) expression, the O:H serotype, and antimicrobial susceptibility. Sixty-one percent of the strains expressed heat-stable enterotoxin (ST) only, 26% expressed heat-labile enterotoxin (LT) alone, and 12% expressed both toxins. The most common CF phenotypes were colonization factor antigen I (CFA/I) (10%), coli surface antigen 6 (CS6) (9%), CS14 (6%), and CS1 plus CS3 (4%). Fifty-nine percent of the strains did not express any of the 12 CFs included in our test panel. Resistance of ETEC strains to ampicillin (63%), trimethoprim-sulfamethoxazole (52%), and tetracycline (43%) was common, while resistance to quinolone antibiotics was rarely detected. As for the distribution of observed serotypes, there was an unusually wide diversity of O antigens and H types represented among the 915 ETEC strains. The most commonly recognized composite ETEC phenotypes were ST CS14 O78:H18 (4%), ST (or LTST) CFA/I O128:H12 (3%), ST CS1+CS3 O6:H16 (2%), and ST CFA/I O153:H45 (1.5%). Temporal plots of diarrheal episodes associated with ETEC strains bearing common composite phenotypes were consistent with discrete community outbreaks either within a single or over successive warm seasons. These data suggest that a proportion of the disease that is endemic to young children in rural Egypt represents the confluence of small epidemics by clonally related ETEC strains that are transiently introduced or that persist in a community reservoir.

J Clin Microbiol. 2004 Dec;42(12):5588-95.

 

Predictors of treatment failure among tuberculosis patients under DOTS strategy in Egypt.
Morsy AM, Zaher HH, Hassan MH, Shouman A.

National Tuberculosis Control Programme, Ministry of Health and Population, Cairo, Egypt.

 

Treatment failure is a serious problem facing some national tuberculosis (TB) control programmes. Irregularity of treatment is a factor that can lead to treatment failure. A case-control study was carried out in TB centres in Egypt during April 2001-December 2002 aimed at investigating the predictors of treatment failure. We interviewed 119 people with treatment failure and an equal number of cured cases (controls) and their families regarding sociodemographic characteristics, information about TB, information about drugs, treatment compliance, family support and patient-family interaction. Significant risk factors for treatment failure were non-compliance to treatment, deficient health education to the patient, poor patient knowledge regarding the disease and diabetes mellitus as co-morbid condition.

East Mediterr Health J. 2003 Jul;9(4):689-701.

 

Antimicrobial susceptibility trends among Escherichia coli and Shigella spp. isolated from rural Egyptian paediatric populations with diarrhoea between 1995 and 2000.

Putnam SD, Riddle MS, Wierzba TF, Pittner BT, Elyazeed RA, El-Gendy A, Rao MR, Clemens JD, Frenck RW.

Enteric Disease Department, Naval Medical Research Center, Silver Spring, MD, USA.

 Antimicrobial susceptibility testing was performed on 3,627 isolates of Escherichia coli and 180 isolates of Shigella spp. collected in rural locations from 875 Egyptian children with diarrhoea between 1995 and 2000. The cumulative rates of resistance for E. coli and Shigella spp. were high (respectively, 68.2% and 54.8% for ampicillin, 24.2% and 23.5% for ampicillin-sulbactam, 57.2% and 42.5% for trimethoprim-sulphamethoxazole, and 50.9% and 75.4% for tetracycline). Non-enterotoxigenic E. coli (NETEC) isolates had a consistently higher level of antimicrobial resistance than did enterotoxigenic E. coli (ETEC) isolates. Trend testing showed significant decreases in resistance to ampicillin, ampicillin-sulbactam and tetracycline among all E. coli isolates. Increasing rates of resistance were observed for trimethoprim-sulphamethoxazole in ETEC isolates and Shigella spp., but not in NETEC isolates. Low levels of resistance were observed for all other antimicrobial agents tested. Overall, high levels, but decreasing trends, of resistance to commonly used antimicrobial agents were detected among isolates of E. coli and Shigella spp. from children in rural Egypt.

Clin Microbiol Infect. 2004 Sep;10(9):804-10.

 

Tuberculosis in Egyptian kidney transplant recipients: study of clinical course and outcome.

el-Agroudy AE, Refaie AF, Moussa OM, Ghoneim MA.

Urology and Nephrology Center, University of Mansoura, Mansoura, Egypt.

BACKGROUND: Tuberculosis (TB) is an important infection encountered post-transplantation especially in developing countries, with high incidences of morbidity and mortality. In this report, we study the risk factors and impact of TB on the outcome of kidney transplantation. METHODS: Of 1200 live-donor Egyptian kidney transplantations, 45 (3.8%) patients developed post-transplant TB. Of these, five had had TB pre-transplantation and 40 were male. The mean age was 32.6 +/- 10.5 years. Primary immunosuppression treatment for 39 (86.7%) patients was cyclosporine (CsA). RESULTS: The mean time interval between transplantation and TB diagnosis was 49.8 +/- 41.5 (range 2-180) months. In 86.7% of patients, TB was diagnosed one year post-transplantation. Urinary TB was the most common form (53%), while pleuropulmonary TB accounted for 38%. All post-transplant TB patients received a triple anti-tuberculous therapy (rifampicin, ethambutol and INH) with a favorable response in all but two patients who needed another 24-month course. Hepatotoxicity was seen in 11 patients, eight were mild with normalization after temporary withdrawal of rifampicin, and three cases were severe, but mortality was not attributable to hepatocellular failure. Twelve patients died, 11 of them due to unrelated causes. Chronic rejection occurred in more than half of the patients (55.6%), of whom 24 (96%) were CsA-treated, which can be attributed to rifampicin/CsA interaction. More than 35% of TB patients lost their graft as a result. Pre-transplant tuberculosis patients had a comparable post-transplant course. CONCLUSIONS: TB is a common infection in renal transplant recipients with a peak incidence occurring one year post-transplant. Chronic rejection is a serious complication that had a negative impact on the graft survival, especially in CsA-treated recipients. INH prophylaxis is safe in pre-transplant TB. The post-transplantation outcome in the pre-transplant tuberculosis patients is no different from non-TB patients.

J Nephrol. 2003 May-Jun;16(3):404-11.

 

Does the diagnosis of trachoma adequately identify ocular chlamydial infection in trachoma-endemic areas?

Bird M, Dawson CR, Schachter JS, Miao Y, Shama A, Osman A, Bassem A, Lietman TM.

F I Proctor Foundation, University of California, San Francisco, California 94143, USA.
 

We evaluated the validity of clinically determined active trachoma as a surrogate for chlamydial eye infection in 1059 children from the Egyptian arm of the Azithromycin in the Control of Trachoma study. Participants were determined to be "clinically active" if they had >or=5 follicles or intense inflammatory infiltration on the tarsal conjunctiva. Conjunctival swabs were tested using ligase chain reaction (LCR) to detect chlamydial DNA. Of clinically active children aged 1-10 years, 31% did not have infection, as determined by LCR. Conversely, 31% of infected children were not clinically active; 78% of clinically active children aged 1-5 years were infected, versus 17% of those aged 11-15 years. The proportion of clinically active children who were infected decreased from 67% before treatment to 10% 14 months after mass azithromycin treatment. Clinically active trachoma is not always a reliable marker of infection, particularly in teenagers and after treatment.

J Infect Dis. 2003 May 15;187(10):1669-73. Epub 2003 Apr 30.