The impact of politics, security and health on the escalation of road traffic accidents and their consequences in Iraq for the period 2015-2020.

Background: This study aimed to detect the impact of politics, security and health on the escalation of road traffic accidents (RTAs) and their consequences in Iraq for the period 2015-2020. Methodology: The data of this cross-sectional study were obtained from the annual reports of RTA statistics from the Central Statistical Organisation of the Iraqi Ministry of Planning. The statistical analysis of data was done using the Statistical Package for the Social Sciences. Results: In this study, it was noted that the rate of RTAs, injuries and deaths increased from 16% to 19.5%, from 16.5% to 17.3% and from 16.2% to 20%, respectively, for the years 2015-2019, while the rates of RTAs, injuries and deaths in 2020 recorded a clear decrease compared to the rest of the years under study, and the rates were as follows: 14.8%, 14.4% and 14.1%, respectively. According to the types of traffic accidents, the rate of crashes recorded the highest rate of 51% in all years of the study compared to the run over, overturn and other unclassified accidents, which were 37%, 10% and 2%, respectively, and it was revealed that crashes, run over and other unclassified incidents increased from 5% to 20%, from 17% to 19% and from 18% to 26%, respectively, for the years 2015-2019, whereas all types of RTAs in 2020 were recorded the lowest rates compared to other years under study. Al-Basra, Baghdad, Al-Najaf and Babylon were recorded the highest rates of traffic accidents for the 6 years under study, with a rate of 13.3%, 11.7%, 11.1% and 10.4%, respectively. Conclusions: Although traffic accidents were not recorded in the years 2015, 2016 and 2017 for the governorates of Nineveh and Anbar due to the occupation of the terrorist Islamic State, traffic accidents maintained their levels due to internal migration. It was also noted that the rate of road accidents was the highest in 2019 compared to the years under study due to the liberation of occupied cities, the return of safety and the return of recording accident data again, while the year 2020 recorded a clear decrease in the rate of road accidents, especially in the first half of it due to the October protests that led to the suspension of all government institutions, universities and schools. The second reason for the decrease in the second half of 2020 is attributed to the lockdown of corona. It seems that the political, security, military and health factors have an effective impact on the traffic reality.

Extended-spectrum beta-lactamases among Klebsiella pneumoniae from Iraqi patients with community-acquired pneumonia.

OBJECTIVE: Beta-lactams resistance is a major clinical problem in treating pneumonia. This study aimed to detect the extended-spectrum beta-lactamases (ESBL) genes in Klebsiella pneumoniae among patients with community-acquired pneumonia (CAP) in Al-Najaf City, Iraq. METHODS: A total of 511 sputum samples were obtained from all suspected patients with CAP in Al-Najaf City, Iraq, from March 2020 to September 2020. Sputum samples were subjected to microbiological tests. The disk diffusion method was used to test antibiotic sensitivity. Production of ESBLs was identified using phenotypic and genotypic methods. RESULTS: The total prevalence of K. pneumoniae was 31.9% (163/511). Using CHROM agar, 41 (25.2%) isolates were ESBL producers. The imipenem 0.0% (n=0/41) and norfloxacin 0.0% (n=0/41) were the most effective antibiotics. The multiplex polymerase chain reaction showed that 46.3% (n=19/41) of isolates harbored ESBL genes. Out of 19 ESBL producers, 47.4% and 15.8% harbored blaCTX-M and blaSHV, respectively. While blaCTX-M and blaSHV genes were detected in 7 (36.8%) isolates, simultaneously. CONCLUSIONS: The imipenem and norfloxacin can be used in empirical treatment of K. pneumoniae isolates in Iraq. The emergence of K. pneumoniae strains harboring ESBL resistance genes necessitates the development of a regular surveillance program to prevent the spreading of these isolates more in Iraqi health care systems.

Extended-spectrum beta-lactamases among Klebsiella pneumoniae from Iraqi patients with community-acquired pneumonia

SUMMARY OBJECTIVE: Beta-lactams resistance is a major clinical problem in treating pneumonia. This study aimed to detect the extended-spectrum beta-lactamases (ESBL) genes in Klebsiella pneumoniae among patients with community-acquired pneumonia (CAP) in Al-Najaf City, Iraq. METHODS: A total of 511 sputum samples were obtained from all suspected patients with CAP in Al-Najaf City, Iraq, from March 2020 to September 2020. Sputum samples were subjected to microbiological tests. The disk diffusion method was used to test antibiotic sensitivity. Production of ESBLs was identified using phenotypic and genotypic methods. RESULTS: The total prevalence of K. pneumoniae was 31.9% (163/511). Using CHROM agar, 41 (25.2%) isolates were ESBL producers. The imipenem 0.0% (n=0/41) and norfloxacin 0.0% (n=0/41) were the most effective antibiotics. The multiplex polymerase chain reaction showed that 46.3% (n=19/41) of isolates harbored ESBL genes. Out of 19 ESBL producers, 47.4% and 15.8% harbored blaCTX-M and blaSHV, respectively. While blaCTX-M and blaSHV genes were detected in 7 (36.8%) isolates, simultaneously. CONCLUSIONS: The imipenem and norfloxacin can be used in empirical treatment of K. pneumoniae isolates in Iraq. The emergence of K. pneumoniae strains harboring ESBL resistance genes necessitates the development of a regular surveillance program to prevent the spreading of these isolates more in Iraqi health care systems.

Virulence traits and plasmid-mediated quinolone resistance among Aggregatibacter actinomycetemcomitans from Iraq: Low rate of highly virulent JP2 genotype.

Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) is an important causative agent of periodontitis acting by employment of a series of virulence factors. Our aim was to evaluate the virulence traits and plasmid-mediated quinolone resistance of A. actinomycetemcomitans isolates in Iraq. A total of 1580 samples were collected from dental caries (n = 1190) and periodontitis (n = 390) among which 200 samples were positive. The antibiotic susceptibility pattern and biofilm formation were performed. The antibiotic resistance and virulence determinants were screened using polymerase chain reaction (PCR) technique. The ltx3 and ltx4 primers were used for identification of highly virulent JP2 type. A. actinomycetemcomitans was identified among dental caries (n = 114) and periodontitis (n = 86) samples. The JP2 type was identified in six periodontitis samples. Sixty (30% of) isolates were multidrug-resistant (MDR). Eighty-four (42% of) A. actinomycetemcomitans isolates formed strong biofilms and 44% of them had moderate-level biofilms. The detected virulence genes included ltxA (96%), cdtB (64%), qseB (62%), qseC (58%) and rcpA (58%). There was a significant relation between the existence of ltxA (42%, p = 0.041) and rcpA (64%, p = 0.022) genes and the biofilm formation. The JP2 genotype was identified in six adolescents with periodontitis. The rate of qnrA, qnrB, qnrC, qnrD, qnrS and aac(6')-Ib-cr plasmid-mediated quinolone resistance genes included 22%, 18%, 16%, 16%, 14% and 0%, respectively. The qnrA (66.7%) and qnrB (53.4%) genes were significantly detected higher in MDR strains. Herein, A. actinomycetemcomitans from dental caries and periodontitis had relatively high rate of resistance to ß-lactams but low resistance levels to quinolones. Moreover, most of the resistant isolates carried the qnrA-S genes. A majority of them had ltxA gene, half of them contained all the virulence genes and JP2 genotype was found in six isolates from periodontitis. Furthermore, half of the isolates produced biofilms which was significantly related to the ltxA and rcpA genes. Screening of virulence genes and antibiotic resistance pattern determination contribute to the control, diagnosis and eradication of these isolates.

Analysis of deaths and injuries related to road traffic crashes in al-najaf governorate of iraq from 2017 to 2019.

BACKGROUND: This study aimed to determine the rates of road traffic injuries and deaths as well as the factors affecting their levels in the Al-Najaf governorate for 3 years (2017-2019). MATERIALS AND METHODS: Data were collected and analysed from the annual report of traffic crashes statistics of the Iraqi Ministry of Planning/Central Statistical Organisation. Al-Najaf governorate was selected as the study model for the period between 2017 and 2019. This selection was based on its urban growth, important location and standing for religious tourism. RESULTS: Of the 8824, 9852 and 10,753 crashes reported in Iraq in 2017, 2018, and 2019, Al-Najaf governorate recorded 1057 (12%), 1041 (10.6%) and 1148 (10.7%), respectively. The percentage of injuries in Al-Najaf governorate to the total of injuries in Iraq decreased as follows: (11.9%), (10.2%) and (9.9%) for 2017, 2018 and 2019 respectively, while the mortality rate decreased as follows: (8.4%), (7.7%) and (7.1%), respectively. The number of deaths and injuries on main roads and highways was higher. Besides, the rates of injuries and deaths among males were higher than in females. Driving at excessive speed was the most statistically significant factor leading to a high proportion of deaths and injuries. CONCLUSION: This study showed a decrease in the deaths and injuries caused by road traffic crashes during the 3 years 2017-2019 in the Al-Najaf Governorate, Iraq. It seems that driving rules and regulations need to be revised so that they can have more deterrent power in preventing injuries and deaths from driving accidents.

Biofilm Formation and Virulence Determinants of Klebsiella oxytoca Clinical Isolates from Patients with Colorectal Cancer.

OBJECTIVE: Biofilm formation has made the therapy of bacterial infections more difficult. The objective our study was assessment of pan-drug-resistant (PDR) Klebsiella oxytoca pathogenicity and virulence factors causing AAHC in patients with colorectal cancer (CRC). MATERIALS AND METHODS: Among a total of 300 healthy and 300 patients with antibiotic-associated hemorrhagic colitis (AAHC) and CRC, 200 K. oxytoca were identified during May 2015-January 2019. The virulence properties and biofilm formation among the isolates were investigated by phenotypic, PCR, and real-time PCR (RT-qPCR) techniques. RESULTS: The blaCTX-M1 (20%), blaSHV (11%), blaTEM1 (33%), and AmpC encoding CIT (2%) ESBL genes, carbapenemase-encoding genes blaIM (4%) and blaOXA-48 (2%), and colistin-resistant mcr-1 gene (2.5%) were detected. The virulence-encoding genes including fimA (80%), pilQ (100%), matB (100%), mrkA (80%), and npsB (100%) were amplified. Therefore, PDR K. oxytoca containing adhesins and toxin-encoding genes with ability of biofilm formation causing AAHC and CRC were isolated. There was a significant difference between healthy and patients with CRC regarding the presence of K. oxytoca (p = 00.221). CONCLUSION: Bacterial enteric pathogens possibly play a role in CRC. Biofilm formation by K. oxytoca strains prevents the efficient infection elimination; therefore, rapid identification and control measure are chief requirements. Additionally, more investigations are necessary with this regard.

Preliminary survey of extended-spectrum ß-lactamases (ESBLs) in nosocomial uropathogen Klebsiella pneumoniae in north-central Iran.

Infections caused by extended-spectrum ß-lactamases (ESBLs) producing bacteria, including Klebsiella pneumoniae have increasingly subjected to therapeutic limitations and patients with these infections are at high risk for treatment failure, long hospital stays, high health care costs, and high mortality. The aim of this study was to screen the prevalence of the bla TEM,bla CTX-M and bla SHV ESBL genes in K. pneumoniae strains isolated from nosocomial urinary tract infections (UTIs). During the March 2016 to December 2017, one hundred isolates of K. pneumoniae were collected from urine specimens of patients suffering from nosocomial UTI referred to Khatam Al-Anbia hospital in Shahrud, north-central Iran. All isolates were identified by standard bacteriological tests. The pattern of antibiotic susceptibility was determined according to the CLSI guidelines. The presence of the ESBLs was investigated using the double-disc synergy test (DDST). Polymerase chain reaction technique was used to detect the bla TEM, bla CTX-M and bla SHV genes in DDST positive isolates. Most isolates showed remarkable resistance to tested antibiotics with highest rate against nitrofurantoin (75%) and trimethoprim/sulfamethoxazole (65%). The imipenem was the most effective antibiotic against K. pneumoniae isolates. ESBL phenotype was detected in 50 (50%) of isolates. The prevalence of bla TEM, bla CTX-M and bla SHV genes among 50 ESBLs-positive isolates was 25 (50%), 15 (30%) and 35 (70%) respectively. The bla TEM and bla SHV genes were seen in 25 isolates (50%) simultaneously. The findings of this study indicated the 50% frequency rate of ESBL-producing K. pneumoniae in our geographic region. Since the treatment of infections caused by this bacterium is associated with many limitations, this high prevalence is a warning sign to adopt new control policies to prevent further spread of this microorganism.

Comparison of adhesin genes expression among Klebsiella oxytoca ESBL-non-producers in planktonic and biofilm mode of growth, and imipenem sublethal exposure.

BACKGROUND: Bacterial adhesins play an important role in the bacterial attachment and colonization. The aim of this study was comparison of adhesin genes expression in the planktonic and biofilm mode of growth among ESBL-non-producers isolates of K. oxytoca and effect of imipenem. MATERIALS AND METHODS: A total of eight extended-spectrum beta-lactamase (ESBL) non-producer K. oxytoca isolates were included from patients with hemorrhagic colitis. The adhesin genes including fimA (type 1 fimbria), mrkA (type 3 fimbria), pilQ and the capsular matB genes were adopted. Phenotypic biofilm production was assessed by microtiter tissue plate assay. Expression of adhesin genes in the planktonic and biofilm growth conditions was calculated using quantitative Real-time PCR (RT-qPCR) technique and sub-MIC (0.25 µg/ml) levels of imipenem were also added to broth culture of isolates to evaluate the gene expression. RESULTS: The isolates produced biofilm in moderate level. The expression of pilQ, mrkA and matB but not fimA genes was significantly higher in biofilm conditions compared to the planktonic mode of growth (p = 0.002, p = 0.011 and p = 001, respectively). In addition, imipenem sub-MIC treatment led to a significant overexpression of matB (p = 0.002) and mrkA (p = 0.003) genes compared to the control group. CONCLUSION: Although none of isolates produced strong biofilm, biofilm conditions led to the increase in the expression of adhesin encoding genes in non-ESBL-producing K. oxytoca. Furthermore, ß-lactams; and especially carbapenems possibly increase the colonization of K. oxytoca and increase the biofilm formation. Hence, accurate consumption of antibiotics must be considered.