Nosocomial infection caused by methicillin-resistant Staphylococcus aureus in Palestine.

This report presents the prevalence of Palestinian isolates of methicillin-resistant Staphylococcus aureus (MRSA) in nosocomial infections and their antibiotic resistant pattern. A total of 321 clinical isolates of S. aureus were identified from different patients. The prevalence of methicillin resistance among S. aureus isolates was 8.7% (28 isolates). Resistance rates of MRSA to other antibiotics were as follows: 82.1% resistant to erythromycin, 67.9% to clindamycin, 64.3% to gentamicin, and 32.1% to ciprofloxacin. No co-trimoxazole- and vancomycin-resistant isolates were identified in this study. The proportion of methicillin resistance was highest among S. aureus isolates associated with upper respiratory specimens (42.8%); the proportion of methicillin resistance was 39.3% among skin ulcer isolates, 10.7% among urinary tract infection isolates, and lowest among isolates associated with blood and prostate discharge (3.6% each).

Hepatitis B surface antibody response of household contacts of hepatitis B virus carriers in Palestine.

To evaluate the effectiveness of hepatitis B virus (HBV) vaccination of household contacts of HBV carriers in Tulkarm district, Palestine, quantitative hepatitis B surface (anti-HBs) antibody response in 161 household contacts was measured after vaccination. A seroprotective anti-HBs response (titre > or = 10 IU/L) was elicited in all vaccinated subjects. Of these 2.5% had titres of 10-99 IU/L, 61.5% 100-999 IU/L and 36.0% > or = 1000 IU/L. The number of vaccination doses had no effect on the achievement of seroprotection. HBV infection was demonstrated in 13 cases and their anti-HBV titres were in the range 25-350 IU/L.

Hepatitis B surface antibody response of household contacts of hepatitis B virus carriers in Palestine

To evaluate the effectiveness of hepatitis B virus [HBV] vaccination of household contacts of HBV carriers in Tulkarm district, Palestine, quantitative hepatitis B surface [anti-HBs] antibody response in 161 household contacts was measured after vaccination. A seroprotective anti-HBs response [titre > or = 10 IU/L] was elicited in all vaccinated subjects. Of these 2.5% had titres of 10-99 IU/L, 61.5% 100-999 IU/L and 36.0% > or = 1000 IU/L.The number of vaccination doses had no effect on the achievement of seroprotection. HBV infection was demonstrated in 13 cases and their anti-HBV titres were in the range 25-350 IU/L

Molecular epidemiology of antibiotic-resistant Escherichia coli isolated from hospitalized patients with urinary tract infections in Northern Palestine.

Eighty isolates of Escherichia coli were collected in Northern Palestine throughout the 1996 to 2000 period from hospitalized patients with urinary tract infections (UTIs). Resistance rates were ampicillin, 65%; co-trimoxazole, 55%; cefuroxime, 10%; cefotaxime, 7.5%; ceftazidime, 2.5%; ciprofloxacin, 12.5%; gentamicin, 6.25% and amikacin, 1.25%. No imipenem-resistant isolates were identified. To determine whether this was due to intra-hospital transmission of resistant strains, clonal structure of 10 multiple-resistant isolates was examined by genomic DNA fingerprinting by enterobacterial repetitive intergenic concensus-polymerase chain reaction (ERIC-PCR) and all were clonally distinct. Thus, these strains are likely resistant due to convergent acquisition of resistance determinants by genetically unrelated uropathogenic strains rather than epidemic spread of resistant isolates.

Human cystic echinococcosis in the West Bank of Palestine: surgical incidence and seroepidemiological study.

The surgical incidence of cystic echinococcosis (CE) due to Echinococcus granulosus was investigated in hospitals of the West Bank, Palestinian Authority between January 1990 and December 1997. Serum samples from school-children in Yata town, which showed the highest surgical incidence, were tested for anti-hydatid antibodies. A total of 390 surgically confirmed cases were recorded throughout the 8-year period, with an overall mean annual surgical incidence (MASI) of 3.1 per 100,000. A high MASI of 4.9, 5.0 and 5.1 per 100,000 was found in Hebron, Jericho and Bethlehem Governorates, respectively. Yata town, Hebron governorate, showed the highest MASI, at 16.8 per 100,000. The highest incidence was found in age groups 11-20 and 21-30 years, at 27.4% and 21.5% of the total number of cases. While there was no significant gender difference in the number of cases in the age groups of 20 years or less, the male to female case ratio was 1:3.2-4.1 in the older age groups. The liver was the most common site of hydatid cysts in 69.9% of cases. Lung cysts were predominant in younger age groups (20 years or less). The seropositivity for CE in the school-children of Yata was 2.4% and 2.1% using enzyme-linked immunosorbent assay and the indirect haemagglutination test, respectively. CE is a significant endemic disease throughout the West Bank. The disease is acquired early in life and is more prevalent among females than males. Behaviour and life-style favour the spread of the disease.

Isolation and characterisation of Shiga toxigenic Escherichia coli strains from northern Palestine.

Shiga toxigenic Escherichia coli (STEC) isolates from symptomatic and asymptomatic patients in northern Palestine in 1999 were screened for serotype O157 and characterised for virulence genes by multiplex PCR assay. Of the 176 STEC isolates, 124 (70.5%) were of serotype O157. All these isolates carried the gene for Shiga toxin type 1 (stx,) and 112 (90.3%) carried stx2. The intimin encoding gene locus eae was detected in 16 isolates (12.9%) and the enterohaemolysin encoding gene, hlyA, in 18 (14.5%). Statistical analysis showed a significant association between the presence of eaeA and hlyA, either alone or combined with stx1 and stx2 genes in O157 isolates from symptomatic infection. ERIC-PCR analysis of DNA from 80 serotype O157 isolates revealed three major clonal populations.

Accumulation of the proteolytic marker peptide ubiquitin in the trophoblast of mammalian blastocysts.

Ubiquitination is a universal protein degradation pathway in which the molecules of 8.5-kDa proteolytic peptide ubiquitin are covalently attached to the epsilon-amino group of the substrate's lysine residues. Little is known about the importance of this highly conserved mechanism for protein recycling in mammalian gametogenesis and fertilization. The data obtained by the students and faculty of the international training course Window to the Zygote 2000 demonstrate the accumulation of ubiquitin-cross-reactive structures in the trophoblast, but not in the inner cell mass of the expanding bovine and mouse blastocysts. This observation suggests that a major burst of ubiquitin-dependent proteolysis occurs in the trophoblast of mammalian peri-implantation embryos. This event may be important for the success of blastocyst hatching, differentiation of embryonic stem cells into soma and germ line, and/or implantation in both naturally conceived and reconstructed mammalian embryos.

High incidence of penicillin resistance amongst clinical isolates of Streptococcus pneumoniae in northern Palestine.

One hundred and thirteen consecutive isolates of Streptococcus pneumoniae were collected in Nablus, Palestine between March and Aug. 1997 from children with acute lower respiratory tract infections. Resistance rates were: penicillin 88%, cefuroxime 85%, erythromycin 63%, tetracycline 45%, chloramphenicol 27% and ofloxacin 2%. Resistances to erythromycin and cefuroxime were significantly associated with penicillin resistance. Ofloxacin may be useful against pneumococci resistant to traditional antimicrobial agents. Factors associated with penicillin resistance included hospitalisation and previous use of beta-lactam antibiotics.

The use of SDS polyacrylamide gel electrophoresis of periplasmic proteins to subtype Pseudomonas aeruginosa pyocin type 10/b clinical isolates.

The periplasmic protein banding patterns (PPBPs) of thirteen strains of Pseudomonas aeruginosa pyocin type 10/b implicated in two nosocomial outbreaks in the neonatal unit of Rafeidia Hospital, Nablus, Palestine, were examined. In addition, five strains from sporadic cases from the same unit occurring in 1996 and 1997 were also studied. Despite different sources of the strains, PPBPs generated by PAGE suggested a clonal nature of the strains obtained during each of the two outbreaks. Although they had very similar PPBPs, the two outbreak clones were not identical. In contrast, sporadic strains of P. aeruginosa pyocin type 10 appeared to be much more heterogeneous than those of the two outbreaks. PPBP analysis appeared to be a useful tool that may be of value for epidemiological purposes.

Analysis of neomycin, kanamycin, tobramycin and amikacin resistance mechanisms in gentamicin-resistant isolates of Enterobacteriaceae.

Twenty-four gentamicin-resistant isolates of Enterobacteriaceae, obtained from the clinical laboratories of three health centres in Nablus, Palestine, were tested for susceptibility to neomycin, kanamycin, tobramycin and amikacin. Resistance rates were 29.2% for neomycin, 58.3% for kanamycin, 45.8% for tobramycin and 8.3% for amikacin. Fourteen (58.3%) isolates were noted to be multiresistant, i.e., resistant to gentamicin and two or more other aminoglycosides; resistance to gentamicin, kanamycin and tobramycin was the most common pattern of multiple resistance. This pattern implies the involvement of adenyltransferase ANT(")-I activity. Plasmid profiles and curing experiments suggested a plasmid localisation of gentamicin, neomycin, kanamycin and tobramycin resistance genes. However, a chromosomal location is proposed for plasmid-deficient strains. Cross-resistance in two isolates to all aminoglycosides tested suggested membrane impermeability to aminoglycosides as the mechanism of resistance.

Gentamicin resistance in clinical strains of Enterobacteriaceae associated with reduced gentamicin uptake.

Seven strains of Enterobacteriaceae resistant to gentamicin obtained as representatives of the predominant resistance profiles in the clinical laboratories of Rafeidia and Al-Watani Hospitals in Nablus (Palestine) were included. Five strains showed a broad aminoglycoside resistance profile but contained no evidence of gentamicin acetylation, adenylation, or phosphorylation. Gentamicin uptake in two tested strains was significantly reduced, compared to that of gentamicin-sensitive E. coli (MIC, 0.5 microgram/mL). These strains are likely resistant due to a relative reduction of the amount of gentamicin and other aminoglycosides entering the bacterial cell. Two strains showed evidence of adenyltransferase ANT(2")-I activity.