ABSTRACT
Background: There is a lack of official national antimicrobial resistance (AMR) data in Lebanon. Individual hospitals generate their own antibiotic susceptibility data in the form of yearly pamphlets. Methods: In this study, antibiotic susceptibility data from 13 hospitals distributed across different governorates of Lebanon were collected to conduct a compilation-based surveillance of AMR in Lebanon for the years 2015-2016. The findings were compared with those of a previous nationwide study in this country conducted between 2011 and 2013 as well as with similar data obtained from the 2015 and 2016 European surveillance reports of AMR. To provide a clear presentation of the AMR situation, mean percent susceptibility of different antibiotic-microbe combinations was calculated. Results: During 2015-2016, the percent susceptibility of Enterobacteriaceae to third-generation cephalosporins and to carbapenems was 59 and 97%, respectively. Among Pseudomonas aeruginosa and Acinetobacter spp., carbapenem susceptibility reached 70 and 12%, respectively. Among Gram positive organisms, the percent susceptibility to methicillin in Staphylococcus aureus was 72%, that to vancomycin in Enterococcus spp. was 98% and that to penicillin in Streptococcus pneumoniae was 75%. Compared with results of 2011-2013, there was an overall trend of decreased susceptibility of bacteria to the tested antibiotics, with a variation of 5 to 10%. The antibiotic susceptibility data from Lebanon were found to be comparable with those from Eastern and South-eastern European countries. Conclusion: This study highlights the need to establish a robust national AMR surveillance system that enables data from Lebanon to be included in global AMR maps.
Subject(s)
Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Cephalosporins/pharmacology , Drug Resistance, Bacterial , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Enterobacteriaceae/classification , Enterobacteriaceae/drug effects , Europe, Eastern , Gram-Negative Bacteria/classification , Gram-Positive Bacteria/classification , Hospitals , Humans , Lebanon/epidemiology , Microbial Sensitivity Tests , Population Surveillance , Retrospective StudiesABSTRACT
We describe a case of a young male with disseminated tuberculosis and severe secondary hemophagocytic syndrome. He presented with symptoms of tuberculosis and Mycobacterium tuberculosis was diagnosed. Later, while on anti-tuberculous treatment, he developed pancytopenia and bone marrow aspirate showed large macrophages with increased phagocytosis of mature and immature blood elements typical of hemophagocytic syndrome.
Subject(s)
Lymphohistiocytosis, Hemophagocytic/etiology , Mycobacterium tuberculosis , Tuberculosis/complications , Adult , Antitubercular Agents/adverse effects , Antitubercular Agents/therapeutic use , Humans , Lymphohistiocytosis, Hemophagocytic/chemically induced , Lymphohistiocytosis, Hemophagocytic/microbiology , Male , Treatment Outcome , Tuberculosis/drug therapyABSTRACT
We report a fatal case of disseminated Mycobacteriumsimiae infection in an immunocompetent elderly man with fever of unknown origin. The diagnosis was based on culture isolation of non-tuberculous mycobacteria from cerebrospinal fluid and bronchoalveolar lavage. Both culture isolates were identified as M. simiae by 16S rRNA gene sequencing.
Subject(s)
Fever of Unknown Origin/microbiology , Mycobacterium Infections/microbiology , Mycobacterium/classification , Aged, 80 and over , Bacterial Typing Techniques , Bronchoalveolar Lavage Fluid/microbiology , Cerebrospinal Fluid/microbiology , Fatal Outcome , Humans , Immunocompetence , Male , Mycobacterium/genetics , Mycobacterium/isolation & purification , RNA, Ribosomal, 16S/genetics , Sequence Analysis, DNAABSTRACT
We report a patient presenting with severe epigastric pain and diffuse abdominal tenderness, with negative imaging and endoscopic evaluation. During hospitalization, the patient developed confusion, seizures, pneumonia, anemia and thrombocytopenia. A hemorrhagic rash appeared on day nine of admission, with serology and skin biopsy confirming a diagnosis of hemorrhagic varicella.
Subject(s)
Abdominal Pain/etiology , Chickenpox/diagnosis , Exanthema/etiology , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Chickenpox/complications , Chickenpox/drug therapy , Confusion/virology , Female , Hemorrhage/etiology , Humans , Leukemia, Myeloid, Acute/complications , Middle AgedABSTRACT
The increased use of antifungal agents in recent years has resulted in the development of resistance to these drugs. The significant clinical implication of resistance has led to heightened interest in the study of antifungal resistance from different angles. In this article we discuss antifungal susceptibility testing, the mode of action of antifungals and mechanisms of resistance. Antifungals are grouped into five groups on the basis of their site of action: azoles, which inhibit the synthesis of ergosterol (the main fungal sterol); polyenes, which bind to fungal membrane sterol, resulting in the formation of aqueous pores through which essential cytoplasmic materials leak out; allylamines, which block ergosterol biosynthesis, leading to accumulation of squalene (which is toxic to the cells); candins (inhibitors of the fungal cell wall), which function by inhibiting the synthesis of beta 1,3-glucan (the major structural polymer of the cell wall); and flucytosine, which inhibits macromolecular synthesis. Different mechanisms contribute to the resistance of antifungal agents. These mechanisms include modification of ERG11 gene at the molecular level (gene mutation, conversion and overexpression), over expression of specific drug efflux pumps, alteration in sterol biosynthesis, and reduction in the intracellular concentration of target enzymes. Approaches to prevent and control the emergence of antifungal resistance include prudent use of antifungals, treatment with the appropriate antifungal and conducting surveillance studies to determine the frequency of resistance.
