GERMS

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Open AccessArticle

Soil Contamination by Toxocara canis and Human Seroprevalence in the Attica Region, Greece

by Vasilios Papavasilopoulos, Vassiliki Pitiriga, Konstantinos Birbas, John Elefsiniotis, Gerasimos Bonatsos and Athanasios Tsakris

GERMS 2018, 8(3), 155-161; https://doi.org/10.18683/germs.2018.1143 - 3 Sep 2018

Cited by 19

Abstract

Background: Toxocara canis is one of the most widespread public health and economically important zoonotic parasitic infections humans share with canids, mainly dogs. Human infection occurs by the accidental ingestion of embryonated eggs or larvae from a range of wild and domestic paratenic [...] Read more.

Background: Toxocara canis is one of the most widespread public health and economically important zoonotic parasitic infections humans share with canids, mainly dogs. Human infection occurs by the accidental ingestion of embryonated eggs or larvae from a range of wild and domestic paratenic hosts. The aim of the present study was to examine the soil contamination of public places by the parasitic ova and to estimate serologically the prevalence of T. canis human infection in the Attica region, Greece. Methods: In this region, public areas are permanently inhabited by dogs, mostly stray dog population that is hardly kept down to a manageable level. A total of 1,510 soil samples were collected from 33 public places of six regional units of Attica from March 2014 to April 2014 and ova were detected using a microscopic assay. In addition, sera were collected from 250 residents, routinely active in the sampled areas, and tested for T. canis IgG antibodies using an enzyme immunoassay. Results: T. canis eggs were isolated from 31 (94%) of the examined public areas. Of the total samples, T. canis ova were recovered from 258 samples, suggesting an overall T. canis ova contamination of 17.2%. The areas of higher socioeconomic status presented lower percentages of soil contamination in a statistically significant level, compared to the areas of lower socioeconomic status. T. canis IgG seropositivity was detected in 40 (16%) serum samples. Similar rates were established among T. canis seropositivity and soil contamination within the same geographical areas. The proportion of seropositive samples in the group of children was significantly higher compared to the proportion of adults (48% versus 8%, p < 0.001). Conclusion: The level of environmental T. canis contamination as well as human infection found in the Attica region calls for a greater awareness towards this public issue. Preventing measures should be implemented to control the spread of this parasitic infection. Full article

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Open AccessArticle

Carbapenem Resistance Among Clinical and Environmental Gram-Negative Isolates Recovered from Hospitals in Gaza Strip, Palestine

by Rawan H. Rida, Nahed A. Al Laham and Abdelraouf A. Elmanama

GERMS 2018, 8(3), 147-154; https://doi.org/10.18683/germs.2018.1142 - 3 Sep 2018

Cited by 12

Abstract

Background: The world is threatened by the ongoing emergence of carbapenem resistant organisms, which are contributing to increasing morbidity and mortality rates. The main objective of this study was to highlight carbapenem resistance among clinical and environmental Gram-negative bacteria (GNB) isolates. Methods: A [...] Read more.

Background: The world is threatened by the ongoing emergence of carbapenem resistant organisms, which are contributing to increasing morbidity and mortality rates. The main objective of this study was to highlight carbapenem resistance among clinical and environmental Gram-negative bacteria (GNB) isolates. Methods: A cross-sectional study wherein 210 clinical isolates, 150 environmental swabs, and 110 air samples were collected from three major hospitals in Gaza strip: Al-Shifa, AlNaser and the European Gaza hospitals. The study lasted for seven months (September 2016 to March 2017). All isolates/samples were cultured and identified using conventional bacteriological methods. All GNB isolates were tested for their antimicrobial susceptibility using the disk diffusion method. Modified Hodge Test (MHT) was performed to investigate carbapenemases production. Results: The overall percentage of carbapenem resistance among GNB was (30/247) 12.1%. Resistance to imipenem was (20/247) 8.1% while resistance to ertapenem and meropenem was (8/226) 3.5% and (2/247) 0.8%, respectively. The intensive care units exhibited the highest resistance rate 9/17 (52.9%). Carbapenem resistance among Enterobacteriaceae was (30/226) 13.2% while in Pseudomonas it was (0/21) 0%. Klebsiella spp. was the most resistant to carbapenems 13/90 (14.4%), followed by E. coli (9/91) 9.8%. Seven isolates out of 30 (23.3%) were positive for MHT. All Enterobacteriaceae isolates had a multiple antibiotic resistance (MAR) index higher than 0.2, while those of Pseudomonas had an average of 0.2. GNB were isolated from 19/110 (17.2%) and 21/150 (14%) of air and environmental samples, respectively. Conclusion: The resistance found, after a recent introduction of carbapenem use in Gaza, shows the need for policies to prevent misuse and overuse of carbapenems, the need for infection control procedures and screening policies for carbapenem resistance on a routine basis. Full article

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Open AccessArticle

Hypervirulent Klebsiella pneumoniae as a Hospital-Acquired Pathogen in the Intensive Care Unit in Mansoura, Egypt

by Rasha El-Mahdy, Ghada El-Kannishy and Hassan Salama

GERMS 2018, 8(3), 140-146; https://doi.org/10.18683/germs.2018.1141 - 3 Sep 2018

Cited by 30

Abstract

Introduction: Hypervirulent Klebsiella pneumoniae (hvKP) are variants of K. pneumoniae that come up worldwide. hvKP is known in community-acquired infections but little is known about its role in hospital-acquired (HA) infections. The aim of this study was to evaluate the frequency of hvKP [...] Read more.

Introduction: Hypervirulent Klebsiella pneumoniae (hvKP) are variants of K. pneumoniae that come up worldwide. hvKP is known in community-acquired infections but little is known about its role in hospital-acquired (HA) infections. The aim of this study was to evaluate the frequency of hvKP among HA K. pneumoniae infections in the intensive care unit (ICU) and to compare virulence and antibiotic susceptibility between hvKP and classical K. pneumoniae (cKP). Methods: String test, biofilm formation, serum bactericidal assay, capsular polysaccharide genes (K1, K2, K5, K20, K54, K57), virulence genes: rmpA, rmpA2, iucA, iroB and antimicrobial susceptibility were assessed in HA K. pneumoniae strains isolated from the ICU in Mansoura, Egypt. Results: Probable hvKP represented 4 out of 65 (6.2%) K. pneumoniae. K1 and K2 genes were present in 2 and 1 isolate respectively in probable hvKP. rmpA genes were significantly associated with hvKP; at the same time biofilm production and serum resistance were not significantly associated with the hypervirulent group. There was no significant difference between hvKP and cKP strains in terms of resistance pattern. Conclusion: hvKP in critically ill patients from the ICU may form a new threat especially in the presence of antibiotic resistance. Although the validity of the string test in detecting metastatic Klebsiella is questionable, it is a simple and easy test that can be done in any laboratory indicating the presence of this organism. Serotypes and genomic background may provide helpful and confirmatory tools to diagnose hvKP.

Full article

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Open AccessArticle

Vancomycin Resistance Among Staphylococcus aureus Isolates in a Rural Setting, Egypt

by Nada ElSayed, Medhat Ashour and Amira Ezzat Khamis Amine

GERMS 2018, 8(3), 134-139; https://doi.org/10.18683/germs.2018.1140 - 3 Sep 2018

Cited by 34

Abstract

Introduction: With the increased occurrence of methicillin resistant S. aureus (MRSA), the consumption of vancomycin, the drug of choice, has also increased. As a consequence, strains of S. aureus resistant to vancomycin have started to emerge. This study aimed to evaluate the level [...] Read more.

Introduction: With the increased occurrence of methicillin resistant S. aureus (MRSA), the consumption of vancomycin, the drug of choice, has also increased. As a consequence, strains of S. aureus resistant to vancomycin have started to emerge. This study aimed to evaluate the level of vancomycin resistance among clinical and nasal S. aureus isolates in a rural town in Egypt. Methods: This cross-sectional study was held in the general hospital at the rural town of Kafr Eldawar in Egypt, during the period from January 2013 to January 2014. S. aureus isolates were collected from clinical samples and from nasal swabs. Results: Two hundred S. aureus isolates were collected, 80 (40%) from clinical samples and 120 (60%) from nasal carriage samples. Vancomycin resistant S. aureus (VRSA) was only detected in clinical samples, all collected from the outpatient clinic. Eleven VRSA isolates (13.8% of total S. aureus clinical isolates) and one strain of vancomycin-intermediate S. aureus (from nasal carriage) were detected. VRSA isolates were most resistant to ciprofloxacin (90.9%) and erythromycin (81.8%). Five isolates were resistant to all tested antibiotics: ciprofloxacin, clindamycin, erythromycin, linezolid, oxacillin, penicillin and trimethoprim-sulfamethoxazole. MRSA was found to constitute 43.8% of clinical S. aureus isolates. The MRSA colonization rate among community individuals was 43.6%, 42.9% among healthcare workers and 51.4% among patients. Conclusion: The prevalence of VRSA was high in clinical samples suggesting that there is a high level of VRSA strains in Egypt that goes undetected since most laboratories only use disk diffusion for detection of vancomycin resistance. Full article

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Open AccessArticle

High Frequency of Mycoplasma pneumoniae Among Patients with Atypical Pneumonia in Tehran, Iran

by Maryam Arfaatabar, Farzaneh Aminharati, Ghasem Azimi, Abbas Ashtari, Seyed Ali Pourbakhsh, Ensieh Masoorian and Mohammad Reza Pourmand

GERMS 2018, 8(3), 126-133; https://doi.org/10.18683/germs.2018.1139 - 3 Sep 2018

Cited by 10

Abstract

Introduction: Mycoplasma pneumoniae is a major cause of atypical community-acquired pneumonia (CAP) with a prevalence range of 15–20% and up to 40% in adults and children, respectively. In Iran, the recorded frequency ranges between 1–6.15%. We aimed to investigate the frequency of M. [...] Read more.

Introduction: Mycoplasma pneumoniae is a major cause of atypical community-acquired pneumonia (CAP) with a prevalence range of 15–20% and up to 40% in adults and children, respectively. In Iran, the recorded frequency ranges between 1–6.15%. We aimed to investigate the frequency of M. pneumoniae among patients with atypical pneumonia acquired from the community. Methods: Over a period of 5 months between January and June 2017, 520 patients with suspected CAP, who had been to the hospital outpatient clinics of Tehran University, were enrolled in this study. Throat swab specimens were obtained from 110 outpatients who presented with symptoms of atypical pneumonia. M. pneumoniae was identified via culture and biochemical tests, such as fermentation of glucose and arginine, hemolysis, and hemadsorption. For confirmation, PCR was performed to amplify the gene fragment coding for p1 adhesin. Results: The major and minor clinical signs of the patients were dyspnea (67.3%) and nausea (15.5%), respectively. Out of 110 specimens, 25 (22.7%) and 29 (26.4%) isolates were identified to be M. pneumoniae via culture and molecular assay, respectively. Comparing the results of the two methods, the PCR showed better sensitivity and rapidity for the detection of M. pneumoniae. There was a high congruence between culture and the PCR assay; kappa level was ‘almost perfect’ (κ = 0.90). Conclusion: This is the first report of high frequency of M. pneumoniae in our region. This finding can serve as baseline information for further investigation and confirmation of the potential epidemics of M. pneumoniae pneumonia in our community. Full article

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Open AccessArticle

Incidence of Methicillin Resistant Staphylococcus aureus (MRSA) in Burn Intensive Care Unit: A Systematic Review

by Tahir Mehmood Khan, Yee Leng Kok, Allah Bukhsh, Learn-Han Lee, Kok-Gan Chan and Bey-Hing Goh

GERMS 2018, 8(3), 113-125; https://doi.org/10.18683/germs.2018.1138 - 3 Sep 2018

Cited by 38

Abstract

Background: Burn victims admitted in burn intensive care units (ICU) are at a high risk of nosocomial infections generated by methicillin resistant Staphylococcus aureus (MRSA). This systematic review aims to estimate the incidence of MRSA among burn patients admitted to the ICU setting, [...] Read more.

Background: Burn victims admitted in burn intensive care units (ICU) are at a high risk of nosocomial infections generated by methicillin resistant Staphylococcus aureus (MRSA). This systematic review aims to estimate the incidence of MRSA among burn patients admitted to the ICU setting, with an emphasis on the incidence rate and antibiotic resistance profile of the MRSA strains. Methods: A systematic literature search was performed in five electronic databases limited to publication dates from 1^st January 2000 until 31^st August 2017. After screening n = 481 articles, n = 21 were found to meet the inclusion criteria of this systematic review. Results: Results from the meta-analysis revealed that the risk for MRSA isolates in the burn ICU was 55.0% higher (OR 0.55, 95%CI 0.32–0.94). Therefore, timely testing, appropriate hygiene practice and suggested wound care must be practiced while handling such patients. Conclusion: Further studies are needed to identify the risk factors of MRSA infections among burn patients and to develop new antimicrobial agents for MRSA infections. Full article

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Open AccessEditorial

Antimicrobial Stewardship in Spain: Programs for Optimizing the Use of Antibiotics (PROA) in Spanish Hospitals

by Juan P. Horcajada, Santiago Grau, José Ramón Paño-Pardo, Antonio López, Antonio Oliver, José M. Cisneros and Jesús Rodriguez-Baño

GERMS 2018, 8(3), 109-112; https://doi.org/10.18683/germs.2018.1137 - 3 Sep 2018

Cited by 8 | Viewed by 1

Abstract

Antimicrobial stewardship (AMS) activities are intended for the optimization of antimicrobial use in the clinical setting [...] Full article

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GERMS, Volume 8, Issue 3 (09 2018) – 7 articles , Pages 109-161

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