Aeromonas in Arab countries: 1995-2014.

The aim of this review is to provide information on the prevalence, clinical syndromes, and antimicrobial resistance and therapy of Aeromonas spp. infections in Arab countries. The data were obtained by an English language literature search from 1995 to 2014 of Medline and PubMed for papers using the search terms "Aeromonas+name of Arab country (i.e. Algeria, Egypt, etc.)". Additional data were obtained from a Google search using the aforementioned terms. The organisms have been reported from diarrheal children, patients with cholera-like diarrhea, an outbreak of acute gastroenteritis and from different types of animals, foods and water source in several Arab countries in the Middle East and North Africa with predominance of A. hydrophila, A. caviae and A. sobria. Using molecular techniques few studies reported genes encoding several toxins from aeromonads isolated from different sources. Among the antimicrobials examined in the present review third generation cephalosporins, fluoroquinolones and aminoglycosides showed excellent activity and can be employed in the treatment of Aeromonas-associated human infections in Arabic countries. Whenever possible, treatment should be guided by the susceptibility testing results of the isolated organism. In the future, studies employing molecular testing methods are required to provide data on circulating genospecies and their modes of transmission in the community, and on their mechanisms of resistance to antimicrobials. Microbiology laboratories and research centers are encouraged to look for these organisms in clinical, food and water sources to attain a better understanding of the public health risks from these organisms in Arab countries.

Antimicrobial resistance in Libya: 1970-2011.

Resistance to antimicrobial agents is a major health problem that affects the whole world. Providing information on the past state of antimicrobial resistance in Libya may assist the health authorities in addressing the problem more effectively in the future. Information was obtained mainly from Highwire Press (including PubMed) search for the period 1970-2011 using the terms 'antibiotic resistance in Libya', 'antimicrobial resistance in Libya', 'tuberculosis in Libya', and 'primary and acquired resistance in Libya' in title and abstract. From 1970 to 2011 little data was available on antimicrobial resistance in Libya due to lack of surveillance and few published studies. Available data shows high resistance rates for Salmonella species in the late 1970s and has remained high to the present day. High prevalence rates (54-68%) of methicillin-resistant Staphylococcus aureus (MRSA) were reported in the last decade among S. aureus from patients with burns and surgical wound infections. No reports were found of vancomycin-resistant S. aureus (VRSA) or vancomycin-intermediate-resistant S. aureus (VISA) using standard methods from Libya up to the end of 2011. Reported rates of primary (i.e. new cases) and acquired (i.e. retreatment cases) multidrug-resistant tuberculosis (MDR-TB) from the eastern region of Libya in 1971 were 16.6 and 33.3% and in 1976 were 8.6 and 14.7%, in western regions in 1984-1986 were 11 and 21.5% and in the whole country in 2011 were estimated at 3.4 and 29%, respectively. The problem of antibiotic resistance is very serious in Libya. The health authorities in particular and society in general should address this problem urgently. Establishing monitoring systems based on the routine testing of antimicrobial sensitivity and education of healthcare workers, pharmacists, and the community on the health risks associated with the problem and benefits of prudent use of antimicrobials are some steps that can be taken to tackle the problem in the future.

Enteric pathogens associated with childhood diarrhea in Tripoli-Libya.

Stool samples from children < 5 years of age with diarrhea (N = 239) were examined for enteric pathogens using a combination of culture, enzyme-immunoassay, and polymerase chain reaction methods. Pathogens were detected in 122 (51%) stool samples; single pathogens were detected in 37.2% and co-pathogens in 13.8% of samples. Norovirus, rotavirus, and diarrheagenic Escherichia coli (DEC) were the most frequently detected pathogens (15.5%, 13.4%, and 11.2%, respectively); Salmonella, adenovirus, and Aeromonas were detected less frequently (7.9%, 7.1%, and 4.2%). The most commonly detected DEC was enteroaggregative E. coli (5.4%). Resistance to ≥ 3 antimicrobials was observed in 60% (18/30) of the bacterial pathogens. Salmonella resistance to ciprofloxacin (63.1%) has become a concern. Enteric viral pathogens were the most significant causative agents of childhood diarrhea in Tripoli. Bacterial pathogens were also important contributors to pediatric diarrhea. The emergence of ciprofloxacin-resistant Salmonella represents a serious health problem that must be addressed by Libyan health authorities.

Isolation of antibiotic-resistant pathogenic and potentially pathogenic bacteria from carpets of mosques in Tripoli, Libya.

OBJECTIVE: Isolation of potentially pathogenic bacteria from carpets in hospitals has been reported earlier, but not from carpets in mosques. The aim of the present study is to determine the pathogenic and potentially pathogenic bacteria that may exist on the carpets of mosques in Tripoli, Libya. METHODS: Dust samples from carpets were collected from 57 mosques in Tripoli. Samples were examined for pathogenic bacteria using standard bacteriological procedures. Susceptibility of isolated bacteria to antimicrobial agents was determined by the disc-diffusion method. RESULTS: Of dust samples examined, Salmonella spp. was detected in two samples (3.5%, 1 in group B and 1 in group C1), Escherichia coli in 16 samples (28.1%), Aeromonas spp. in one sample (1.8%), and Staphylococcus aureus in 12 samples (21.1%). Multiple drug resistance was observed in >16.7% of E. coli and in 25% of S. aureus. CONCLUSION: Contamination of carpets in mosques of Tripoli with antibiotic-resistant pathogenic and potentially pathogenic bacteria may pose a health risk to worshipers, particularly, the very young, the old and the immunecompromised. Worshipers are encouraged to use personal praying mats when praying in mosques.

Uropathogens from diabetic patients in Libya: virulence factors and phylogenetic groups of Escherichia coli isolates.

Urinary tract infections (UTIs) in patients with diabetes mellitus (DM) are reported mainly from developed countries. In addition to this underreporting from developing countries, there is a lack of information pertaining to the virulence factors (VFs) and phylogenetic grouping of uropathogenic Escherichia coli (UPEC) from DM and non-DM patients in developing countries. Between July 2005 and June 2006, urine specimens were collected from 135 DM and 164 non-DM patients, all with clinically diagnosed UTIs, attending Elkhadra Hospital and the Diabetic Center in Tripoli, Libya. Specimens were examined for different uropathogens using standard microbiological procedures. Isolated uropathogens were tested for their susceptibility to antimicrobial agents by a disc diffusion method. In addition, UPEC was grouped phylogenetically by PCR and subsequently tested for 19 VFs. Uropathogens were isolated from 77 (57 %) of the DM group and from 110 (67 %) of the non-DM group (P >0.05). E. coli was isolated from 18 (13 %) and 29 (18 %), Klebsiella species from 18 (13 %) and 23 (14 %), and Staphylococcus aureus from 12 (9 %) and 12 (7 %) of the DM and non-DM groups, respectively (P >0.05). Age, gender, education level and marital status had no significant influence on the isolation rates of different organisms from the DM group compared with the non-DM group. With very few exceptions, no differences were observed in the antimicrobial resistance profiles of uropathogens from the DM and non-DM patients. In addition, UPEC from the DM patients was significantly less virulent and was associated with phylogenetic group A, whilst UPEC from the non-DM patients was significantly more virulent and was associated with group D. The results of our surveillance of UTI infections in DM patients agree, in general, with observations reported previously from several developed countries.