Emergence of fluoroquinolone-resistant Streptococcus pneumoniae in Lebanon: a report of three cases

The global emergence of Streptococcus pneumoniae resistance to fluoroquinolones is alarming and has grown to be a cause for significant concern worldwide. We report the first three cases of levofloxacin resistant S. pneumoniae isolates in a tertiary medical center in Beirut, Lebanon. Judicious use of antimicrobial agents is imperative to limit the spread of such resistant strains

Profile of opportunistic infections in HIV-infected patients at a tertiary care center in Lebanon

According to statistics published in December 2007 by the National AIDS Program, Lebanon is home to 1056 individuals infected with HIV. Little is known about the clinical profile of opportunistic infections [OIs] and AIDS defining illnesses [ADIs] and their relative contribution to the morbidity and mortality of HIV-infected patients in Lebanon. The aim of this study is to describe the spectrum of OIs and ADIs in HIV-infected patients diagnosed and/or treated at the American University of Beirut Medical Center [AUBMC] in Lebanon. Data on various OIs and ADIs were collected from the medical records of patients with HIV infection who were diagnosed or received their medical care at AUBMC from 1984 to January 2008. Eighty-nine HIV-infected patients were included in the analysis. The incidence of ADIs was 72% [64/89]. The most commonly diagnosed OIs were cerebral toxoplasmosis [21%], followed by fungal infections [17%]. The majority of ADIs [75%] occurred when the CD4 count was below 200 cells/mm3. Clinical guidelines for the prevention of OIs in HIV-infected individuals have been developed on the basis of natural history data collected in industrialized countries. Our results can be used to define local priorities for opportunistic infection prophylaxis

Epidemiology of Hiv infection in Lebanon data from 1985 - 2005

Lebanon is considered among the countries where the HIV epidemic is still in its early phase of spread. Little information is available on the magnitude of the problem due to the lack of an efficient surveillance system. In this review, we report on the epidemiology of HIV infection in Lebanon, based on limited data generated by the Lebanese National AIDS Control Program [NAP]. By May 2005, a cumulative number of 813 cases had been diagnosed. The most prevalent mode of HIV transmission in Lebanon is heterosexual exposure accounting for around 50% of the cases. Two hundred ninety-six patients [36.4%] fulfilled the AIDS case definition. Despite the availability of highly active antiretroviral therapy [HAART] provided by the Ministry of Health, the disease burden of HIV infection remains unknown in this country

Glycopeptide and oxacillin activity against Staphylococcus aureus isolates at a tertiary care center in Lebanon

Worldwide reports have noted the emergence of glycopeptides-intermediate Staphylococcus aureus [GISA]. However, data from Lebanon is lacking. We conducted a study to determine the minimum inhibitory concentrations [MICs] for oxacillin [OXA], vancomycin [VAN] and teicoplanin [TEC] against consecutive clinical isolates of S. aureus at a tertiary care center in Lebanon. The categorization of isolates as susceptible, intermediately-resistant, or resistant was based on the OXA agar screen plate [OS] and the 1 /micro g OXA disk diffusion [OD] according to the National Committee for Clinical Laboratory Standards [NCCLS] guidelines. The MICs of OXA, VAN and TEC against these isolates were determined using the E-test. We tested 147 S. aureus isolates, 108 of which were methicillin-resistant [MRSA] and 39 methicillin-susceptible [MSSA]. The rar ges of MICS [micro g/ml] among MRSA and MSSA isolates respectively were: OXA 1.5 >/= 256 and 0.19-3; VAN 1-3 and 1.5-3; TEC 0.094-3 and 0.19-2. The MIC50/90 [micro g/ml] for MRSA versus MSSA isolates were, respectively 24/

Febrile neutropenia in cancer patients in a tertiary care medical center in Lebanon: microbial spectrum and outcome

We prospectively analyzed the episodes of febrile neutropenia at the American University of Beirut Medical Center. One hundred and four episodes were studied in 64 patients over a period of 15 months: 81 [78%] with leukemia, 11 [10.5%] with lymphoma, 3 [2.8%] with multiple myeloma, and 9 [8.6%] with solid tumors. Bacteremia was confirmed in 30 episodes [29%], of which 18 [60%] were caused by gram-negative bacilli and 12 [40%] by gram-positive cocci. The predominant organisms were E. coli [9], coagulase negative staphylococci [CNS] [6], Pseudomonas aeruginosa [5], and S. aureus [4]. In seven episodes [6.7%] urinary tract infections were diagnosed, 6 with E. coli. Sputum cultures were positive in eight episodes [7%], 2 with P. aeruginosa and 2 with methicillin resistant S. aureus. All patients were started empirically on antibacterial agents. In twenty-one episodes, a single antibiotic was started, ceftazidime being the most commonly used agent. In most cases, however, 2 or 3 antibacterial agents were started empirically. Antifungal therapy with amphotericin B [11] or fluconazole [20] was added because of persistent fever despite broad antibacterial coverage. Thirteen patients died [20%], 6 of them had bacteremia; 2 with gram-negative bacilli, and 4 with gram-positive cocci. Except for one, all patients had been started, at the onset of the fever, on antimicrobial agents to which the isolated microorganisms turned out to be susceptible.Our results show that infections with gram-negative bacteria continue to predominate unlike what has been reported recently from European and North American trials.A trend toward a higher mortality of infections caused by gram-positive cocci was noted

Current status and changing trends of antimicrobial resistance in Lebanon

Antimicrobial resistance among microorganisms has been on the rise worldwide including Lebanon. Several surveillance programs have been initiated to monitor the patterns of resistance due to the deleterious consequences on patients management.Thus, knowledge about the local antimicrobial resistance patterns is essential for epidemiologic aspects as well as clinical practice. In this context, the current status and changing trends of antimicrobial resistance in Lebanon are addressed covering the most relevant bacterial, mycobacterial and fungal pathogens

Antibiotic prophylaxis

The use of antibiotic prophylaxis has long been established to prevent the development of invasive infections. In many settings, it is currently considered to be the standard of care to administer antibiotics prior to surgical procedures. The aim is to decrease the load of organisms at the site of manipulation and therefore minimize the appearance of local as well as distant infection. With the increasing number of antimicrobial agents available on the market, physicians are often faced with a dilemma when trying to decide which agent to use. This review addresses the current recommendations of antimicrobial prophylaxis in surgical procedures, in the prevention of infective endocarditis, as well as the prophylaxis required following exposure to highly infective bacteria